Monday, June 11, 2018

New Colorectal Cancer Screening Guidelines

By Sidney C. Roberts, MD
Lufkin Radiation Oncologist

This article was originally published June 10 at the Lufkin Daily News and on the Angelina Radiation Oncology Associates blog. 

In what has been described as a game-changing recommendation, on May 30, 2018, the American Cancer Society released a new colorectal cancer screening guideline that recommends most adults start regular screening at age 45, as opposed to where it has been at age 50. Why is this so important?

Colorectal cancer is the third most common cancer in both men and women, as well as the third leading cause of cancer death overall. Colorectal cancer strikes more than 140,000 people in the United States every year. More than 50,000 will die from it each year. (Prostate and breast cancer are the most common cancers in men and women, respectively, and lung cancer is the second most common cancer in both sexes. Lung cancer, however, is the deadliest cancer for both sexes, while prostate and breast cancers are the second deadliest for men and women, respectively.)

The overall incidence of colorectal cancer is actually decreasing, attributable in large part to success in getting people screened. You might wonder, then, with all the success, why the change in the screening recommendation? After all, it wasn’t that long ago that the American Cancer Society got some grief for loosening screening recommendations for breast cancer.

It turns out, recent data from the American Cancer Society research team shows a 51 percent increase in colorectal cancer since 1994 among those under age 50. Adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with adults born around 1950. That means my kids — all in their 20s — have a much higher risk of colorectal cancer over their lifetime than I do.

The reasons for this increase have not been well-identified. But according to Otis Brawley, MD, the chief medical officer of the American Cancer Society, that increasing risk of colorectal cancer (which, by the way, is increasing for every generation born since the 1950s) is likely due to what he describes as a complex relationship between colorectal cancer and obesity, an unhealthy diet, and lack of physical activity.

Because of this increasing risk among younger individuals, the American Cancer Society believes that by lowering the age of screening to 45, many more lives can be saved. And they have modeling data that strongly supports that recommendation.

Making a recommendation is a far cry from making it happen, though. Someone has to pay for the extra screening for those who are age 45 to 49. Currently, the Affordable Care Act requires insurance coverage based on recommendations issued by the United States Preventive Services Task Force (USPSTF). Their current recommendation is that colorectal cancer screening start at age 50. This will be an area where the American Cancer Society and their political arm, the American Cancer Society Cancer Action Network (ACS CAN), will be working to change the law to expand insurance coverage to those in the 45 to 49 age range (which, according to The New York Times, could be an additional 22 million U.S. residents).

As alarming as the increased incidence of colorectal cancer in people under age 50 sounds, the good news is that colorectal cancer remains highly preventable with screening, because polyps can be found and removed before they develop into cancer. If colorectal cancer develops, cure rates are also high if it is caught early. For example, those with localized colorectal cancer are cured 90 percent of the time, whereas the overall cure rate is only about two out of three (because not everyone is getting screened).

There are many tests that can be used for screening. The screening most linked with the decreasing incidence of colorectal cancer is colonoscopy (again, because polyps, if present, can be removed before they turn into cancer). When negative, colonoscopy only needs to be done every ten years. Other tests like the fecal immunochemical test (FIT) may need to be done every year.

The most important thing is to get screened, no matter which test you choose. Talk with your doctor about it and also check with your insurance about what they cover. Check out the American Cancer Society’s website for more information as well. People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.

It’s not just about screening, though. What else can you do? The American Cancer Society believes you can lower your risk of colorectal cancer by eating lots of vegetables, fruits, and whole grains and less red meat (beef, pork, or lamb) and processed meats (hot dogs and some luncheon meats), getting regular exercise, watching your weight, avoiding tobacco, and limiting alcohol to no more than two drinks a day for men and one drink a day for women.

Guess what? These lifestyle and dietary changes help us is so many other ways, too, from lowering our risk of heart and lung disease or diabetes, lessening the risk of getting many types of cancer, and basically improving our overall quality and quantity of life. Now that’s a game changer!

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