45 is the New 50! Colorectal cancer screening at a younger age

Wait…… WHAT???? This doesn’t mean that we are aging faster than previously, it was merely the headline that the CDC used in June 2021 to draw attention to the new recommendation from the United States Preventative Services Task Force (USPSTF). They recommend that colorectal cancer screening should start at age 45 (previous recommendations were to start screening at age 50 in the general population).

Now…no one really wants to talk about cancer, especially not colorectal cancer with its specter of bowel preps and medical cameras in places where no one wants a camera! But, when an assembly such as the USPSTF takes the bold step of recommending EARLIER screening for any cancer, we should all sit up and take notice. 

According to the CDC, colorectal cancer is a leading cause of cancer death for men and women, with almost 53,000 people dying of this treatable condition every year. Risk factors for colorectal cancer include gender (men have a slightly higher risk), family history, obesity, low physical activity, diet (including high amounts of red meat or processed meats), and smoking. Colorectal cancer also causes higher rates of death in Black and Indigenous populations (American Indians and Native Alaskans), which is potentially correlated with decreased access to care. The explanation for the movement to a younger age population to begin screening is based on the mounting evidence that colorectal cancers are developing at earlier stages in our overall population, as well as the knowledge that colorectal cancers are treatable/curable when discovered at earlier stages. Checking earlier leads to finding cancers when they are small/just starting out, and they can then be removed/cured.

So, does this mean way more medical cameras in use over a lifetime? Not necessarily. There are a number of ways to screen for colorectal cancers, several of which are yearly or every 1-3 years and do not involve cameras at all if they are negative. Two of these tests, the traditional fecal occult blood test, and the newer fecal immunochemical test (FIT), are yearly tests of a stool sample. These tests are either in a doctor’s office or at home, to determine if there are trace amounts of blood in the stool that may indicate a cancer. Stool DNA tests detect specific markers in stool that are shed by cancer cells. The USPSTF has suggested that data would also support use of a combination DNA-FIT test every 1-3 years.

So, what if one of these screening tests is positive? That’s when the cameras come into play – for the most effective way to screen for colorectal cancer is through direct visualization. For most of us that means the dreaded bowel prep and colonoscopy. Although I say “dreaded”, in reality most people (myself included!) tolerate the bowel prep just fine, and sedation is offered for the colonoscopy, so you get interesting pictures to look at but generally don’t feel/remember a thing. It does take some scheduling to allow for the prep (usually the day before the colonoscopy) and the procedure itself (including recovery from sedation), but best-case scenario that only has to occur every 10 years.

The bottom line is that these stool tests done annually, or the visualization with colonoscopy or CT colonography every 10 years, are truly easy tradeoffs to death from colorectal cancer. But you actually have to do the tests! While in a perfect world everyone would have regular visits with their PCP, well controlled body weight through balanced diet and exercise, and no one would smoke cigarettes; in our world we need to be self-advocates and make the effort to reach out to our doctor or health care provider and ASK for the screening test to be arranged. AND be sure to quit smoking, avoid obesity and inactivity, and eat a diet rich in fruits and vegetables, with less red meat, and less processed meats such as bacon and ham. No one said staying health was easy… but it definitely feels better than the alternative if you can manage it!