Colorectal screening may need to start at age 45, U.S. panel advises

colorscreen-300x168An important federal advisory group has joined with medical specialists in recommending a change in the age at which patients should start screening for colorectal cancer, to age 45 and not the current 50 years old.

Earlier detection of bowel issues could save lives, the U.S. Protective Services Task Force (USPSTF) has decided, with the influential medical group issuing a draft screening guidance and posting it online for public and expert comment.

Clinicians have reported for a while now that they are seeing more cases of colorectal cancers in younger patients, and their treatment might have better outcomes if it could be started earlier, too. As the New York Times reported:

“Though the vast majority of colorectal cancers are still found in those 50 and older, 12% of the 147,950 colorectal cancers that will be diagnosed this year — some 18,000 cases — will be found in adults under 50, according to an American Cancer Society study. The incidence of colorectal cancer, which dropped steadily for people born from 1890 to 1950, has been increasing for every generation born since the mid-20th century. Many early-onset cancers are diagnosed in people as young as their 20s and 30s who will not be covered by the draft recommendation. For example, Chadwick Boseman, the actor who starred in ‘Black Panther’ and other films, died in August at 43 from colon cancer that was diagnosed several years earlier. Still, advocates for people with cancer hailed the proposal by the task force as a major step forward, saying it has the potential to save tens of thousands of lives.”

The newspaper also noted that:

“The American Cancer Society in 2018 recommended starting routine screening at 45, after its own researchers reported a sharp rise in the disease among adults as young as their 20s and 30s, including a particularly sharp rise in rectal cancers.”

The shift by the USPSTF is important because, as the New York Times reported, its “guidance on screenings and preventive care services is followed by doctors, insurance companies and policy makers.”

African Americans may wish to take greater notice of the screening advisory. As CNN reported, quoting Dr. Kimmie Ng, a medical oncologist and director of the Young-Onset Colorectal Cancer Center at Dana-Farber/Brigham and Women’s Cancer Center in Boston about the disease:

[T]here are … racial disparities in the incidence and mortality of colorectal cancer — where black adults are more likely to get the disease at a younger age and more likely to die from the disease — and screening early might help close that racial gap. So hopefully by starting screening earlier for all average risk Americans, we may be able to make some in roads into mitigating those disparities.”

Experts quoted in news articles emphasized that all patients should be aware of rectal bleeding and changes in bowel movements and contact their doctors if these symptoms occur. They also should be persistent, particularly with younger patients, and not let their concerns be wrongly dismissed, as the New York Times reported:

“According to a report by the Colorectal Cancer Alliance, 81% of young adults with colorectal cancer surveyed said they experienced at least three symptoms of cancer before they got a diagnosis, while more than half were misdiagnosed, and told they had hemorrhoids, anemia, irritable bowel syndrome or even mental health problems.”

By the way, the screenings under consideration include options besides the invasive, costly, and often-dreaded colonoscopy. As the newspaper reported:

“Though people often think of a colonoscopy when they think of colon cancer screening, the task force has recommended the choice of direct visualization tests such as colonoscopies as well as tests that can identify signs of cancer based on stool samples. The stool-based tests are non-invasive and can be done at home but must be done more frequently. Colonoscopies are invasive tests that carry some risks but can be done every 10 years.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the challenges they have to deal with due to over screening, over diagnosis, misdiagnosis, and over treatment. These are significant challenges in the U.S. health care system, contributing not only to billions of dollars in unnecessary costs but also subjecting patients to a cascade of expensive, invasive, and unhelpful further tests and procedures.

Early detection and treatment of cancers may be helpful. It also may be counter-intuitive but it bears repeating: As the National Cancer Institute has noted, “more screening does not necessarily translate into fewer cancer deaths and … some screening may actually do more harm than good.”

The USPSTF provides an important, independent check on screenings and has evaluated evidence to advise about the need for lesser testing with care for breast and prostate cancer. If the research supports a different path for colorectal screening, the good counsel should be considered, along with issues like family history of conditions, by patients and their doctors. Experts also may need to revisit the outcomes of increased screening, and whether healthy, younger people — who may be more inclined to afford and access recommended care — surge into colorectal tests while older patients (who statistically are more likely to suffer problems) do not. We’ve got work to do to battle cancers of all kinds.

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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