Colorectal cancer screening plays an important role by identifying precancerous growths or early-stage cancers in the colon or rectum. A colonoscopy allows for the direct visualization of the large intestine. This examination is a preventive measure, as it can detect and remove polyps before they become malignant, thereby reducing the incidence and mortality of colorectal cancer.
The Updated Screening Guideline
The recommendation to begin colorectal cancer screening at age 45, rather than 50, was introduced. The American Cancer Society (ACS) updated its guidelines in 2018, recommending screening for average-risk individuals beginning at 45. The U.S. Preventive Services Task Force (USPSTF) issued a similar recommendation in May 2021. These changes reflect a consensus among major health organizations.
Why the Age Recommendation Shifted
The primary reason for lowering the screening age is the rise in colorectal cancer cases among younger adults. While overall colorectal cancer rates have declined, diagnoses in individuals under 50 have increased, with some research indicating that approximately 10% of cases in the U.S. are diagnosed in this age group. Deaths among people under 55 increased by 1% per year from 2008 to 2019, contrasting with the overall decline in rates. This concerning epidemiological trend highlighted the need for earlier detection strategies to improve outcomes for younger patients.
The shift aims to identify polyps and cancers when they are asymptomatic. Early detection is important because colorectal cancer is most treatable when found in its initial stages. By screening at 45, healthcare providers hope to intervene sooner, potentially preventing advanced polyps from becoming cancerous or detecting cancer at a more manageable stage.
Who the New Guidelines Apply To
The updated guidelines primarily apply to individuals considered to be at “average risk” for colorectal cancer. Average risk means a person does not have a personal history of colorectal cancer or certain types of polyps. It also means they do not have a family history of colorectal cancer, which can significantly increase risk. Individuals with inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, or known genetic syndromes like Lynch syndrome or familial adenomatous polyposis, are not considered average risk. These specific conditions place individuals at a higher risk, necessitating different screening approaches.
For average-risk individuals, the goal is to identify abnormalities before they progress. This ensures earlier screening benefits the majority, catching potential issues at a more treatable stage.
Important Considerations for Screening
While age 45 is the recommendation for average-risk individuals, screening may be advised earlier for those with specific risk factors. A strong family history of colorectal cancer, particularly in a first-degree relative diagnosed before age 60, often warrants earlier screening, sometimes as early as age 40 or 10 years before the youngest family member’s diagnosis. Individuals with a personal history of certain types of polyps or inflammatory bowel disease also require more frequent or earlier surveillance.
Experiencing symptoms such as rectal bleeding, persistent changes in bowel habits, unexplained weight loss, or abdominal pain should prompt an immediate discussion with a healthcare provider, regardless of age. These symptoms can indicate underlying issues that require prompt evaluation. While colonoscopy is a screening method, other options exist, including stool-based tests like fecal immunochemical tests (FIT) or stool DNA tests (Cologuard). The choice of screening method should be a personalized decision made in consultation with a healthcare professional, considering individual risk factors and preferences.