Did you know that the recommended screening age for colorectal cancer (cancer of the colon or rectum) has been lowered to age 45? Many people mistakenly believe that it’s still age 50. But in May 2021, the U.S. Preventive Services Task Force (USPSTF) announced the new, younger recommended screening age — bringing it down from 50 to 45.
The reason? Because despite overall decreases in colorectal cancer rates, more and more young people are being diagnosed with the disease. In fact, the rate of the colorectal cancer in adults aged 40 to 49 years has increased by almost 15% in the period from 2000 to 2016, according to statistics from the USPSTF.
More recently, Colorectal Cancer Statistics 2023, a report on cancer facts and trends by the American Cancer Society, showed that diagnoses of people under 55 years of age doubled from 11% (one in 10) in 1995 to 20% (one in five) in 2019. Overall, in 2023, an estimated 153,020 people will be diagnosed with colorectal cancer in the U.S., and 52,550 people will die from the disease.
Younger Diagnoses
“No one really knows exactly why younger people are being diagnosed at higher rates,” says Dr. Robert Akbari, colorectal surgeon with Doylestown Health Colorectal Specialists. “… Many young people who are diagnosed with colorectal cancer have no obvious risk factors. A lot of times, they’re young, healthy, fit people with no concerning family history.”
Another interesting difference, he explains, is that young people have a tendency to develop colorectal cancer on the left side of the colon including the rectum.
“Rectal cancer rates are rising in people under age 50 and unfortunately, it can be more challenging to treat,” says Dr. Akbari.
On the other hand, older people tend to develop colorectal cancer on the right side, which can be less challenging to treat.
Risk Factors for Colorectal Cancer
Despite a person’s age, there are common risk factors for developing colorectal cancer. According to information from the Centers for Disease Control and Prevention (CDC), they include:
- A personal or family history of colorectal cancer or colorectal polyps
- Having inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis
- Having a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome)
Lifestyle Factors
In addition to risk factors, lifestyle factors may contribute to an increased risk of colorectal cancer and include the following:
- Lacking regular physical activity
- Eating a low-fiber and high-fat diet or a diet high in processed meats
- Consuming a diet low in fruit and vegetables
- Being overweight or obese
- Using alcohol and/or tobacco
How it Starts
Colorectal cancer develops from polyps (abnormal growths in the colon or rectum), which are not cancer but if they’re left alone and not removed, they can develop into cancer over time. Colorectal cancer is usually slow growing and doesn’t always cause symptoms, especially at first. So you may not know you have it.
Symptoms
By the time people have symptoms, it may be a more advanced cancer. It’s important not to ignore the symptoms, which may include the following:
- A change in bowel habits
- Blood in or on your stool (bowel movement)
- Diarrhea, constipation, or feeling that the bowel does not empty all the way
- Abdominal pain, aches, or cramps that don’t go away
- Weight loss and you don’t know why
Importance of Screening
Sadly, colorectal cancer is the third most commonly diagnosed cancer and second leading cause of cancer death in the United States, according to the American Cancer Society report. But the disease can be largely prevented through routine screening when polyps are found early, which is also when treatment works best. Screening tests can find precancerous polyps, so that they can be removed before they develop into cancer. Here are some of the most common screening tests.
Colonoscopy
Known as the gold standard, colonoscopy is not just a screening test, it’s also a preventive measure. “Colonoscopy, unlike most screening tools, has the ability to both prevent and diagnose cancer. It finds precursors to cancer (polyps) and prevents cancer by removing the polyps,” explains Dr. Akbari.
Colonoscopy is recommended for everyone 45 and older. If you’re younger than 45 and have a family history of colorectal cancer or polyps, colonoscopy should be done even sooner — check with your doctor.
How it works: Your physician inserts a thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon. During the test, your physician can find and remove most polyps and some cancers. Colonoscopy is also used as a follow-up test (known as a diagnostic colonoscopy) if anything unusual is found during one of the other screening tests or if you have symptoms, for example, like bleeding. Most people need to have a screening colonoscopy every five to 10 years, depending on the findings.
Multi-Target Stool DNA Test (Cologuard®)
For people 45 years and older with average risk (no personal or family history of colorectal cancer or polyps), this screening test is noninvasive and requires a stool sample that is sent to a lab. Marketed under the brand name Cologuard, it screens for blood and DNA markers that may indicate colon cancer. If you qualify, you should be screened every three years.
“If patients meet those requirements, it’s perfectly appropriate and acceptable to offer the Cologuard test as an alternative to colonoscopy,” says Dr. Akbari. “The challenge is if the test comes back positive for colon cancer, then that person has to get a diagnostic colonoscopy, which can be more expensive for the patient than an upfront screening colonoscopy.”
Other Stool Tests
- The guaiac-based Fecal Occult Blood Test (gFOBT) uses the chemical guaiac to detect blood in the stool, notes information from the CDC. For this test, you receive a kit from your health care provider. At home, you use a stick or brush to obtain a small amount of stool. You return the test kit to the doctor or a lab, where the stool samples are checked for the presence of blood. This test done once a year.
- The Fecal Immunochemical Test (FIT) uses antibodies to detect blood in the stool. It is also done once a year in the same way as a gFOBT.
With the variety of screening tests available, everyone 45 and older has an option for screening they might be comfortable with. “The bottom line is to follow your doctor’s advice for screening and pay attention to your body — don’t ignore bleeding, abdominal pain, or a change bowel habits,” recommends Dr. Akbari.
- For more information on colorectal screening or to schedule a test, contact Doylestown Health Gastroenterology at 215.345.6050.
Related Event
To mark Colorectal Cancer Awareness Month, we are hosting an informative Colon Cancer Panel on March 15, 2023, featuring Dr. Akbari and other healthcare providers. The talk will address what colorectal cancer is, what to expect from surgery if you have colorectal cancer, and how to eat to sustain your health during this time. For more information and to register, visit our Community Education events blog.
Further Reading
- To learn more about the screening recommendation, visit U.S. Preventive Services Task Force and see the official recommendation published in JAMA in May 2021.
- To read the Colorectal Cancer Statistics 2023 report, see it published in the March 1, 2023 issue of CA: A Cancer Journal for Clinicians and learn more about it from the American Cancer Society.
About Gastroenterology
Our caring, compassionate gastroenterologists are experts in the diagnosis and treatment of disorders and diseases of the digestive system. Using advanced screening tools, state-of-the-art treatments and innovative technology, our gastroenterology team delivers comprehensive care for conditions of the esophagus, stomach, small intestine, colon and rectum, pancreas, gallbladder, bile ducts and liver. The Open Access Colonoscopy Program allows healthy patients the convenience of scheduling a screening colonoscopy without an initial office visit.
About Doylestown Health Colorectal
Doylestown Health Colorectal Specialists provide expert assessment, diagnosis, and treatment for a wide range of disorders of the colon, rectum, anus and small intestine. Our board-certified physicians offer compassionate, personalized care, continuing patient education and state-of-the-art technology, using advanced colon and rectal surgery and minimally invasive robotic surgery techniques.
