Get the primary colonoscopy at 45, not 50

From Cara Murez
HealthDay reporter

TUESDAY, May 18, 2021 (HealthDay News) – Many people think 50 is the magic number for a first colonoscopy, but earlier is better, a renowned panel of US experts now says.

Based on evidence that younger people are diagnosed with colon cancer and would benefit from screening, the US Preventive Services Task Force (USPSTF) is moving the recommended age for colon cancer screening from 50 to 45 years.

The recommendation applies to all adults with no symptoms, personal health history of colon polyps, or family medical history of genetic disorders that increase risk, according to the task force.

“Colon cancer screening saves lives and people aged 45 to 75 should be screened … to reduce the risk of dying from this devastating disease,” said Dr. John Wong, USPSTF Scientific Director. “There is new science about colorectal cancer in people under the age of 50. This science has allowed us to extend our recommendation to people aged 45 to 49.”

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Although the USPSTF is an independent, voluntary group of health professionals in a number of specialties, its recommendations carry weight. For example, the Affordable Care Act has linked the USPSTF recommendations to insurance coverage requirements.

The task force doesn’t have enough evidence to show benefits for lowering the screening age even lower, Wong said, but called for additional research.

The American Cancer Society recommended screening this younger age group after changing its recommendations in 2018 to include those aged 45 to 49.

The changing USPSTF recommendations mean less confusion about which recommendation to follow and insurance coverage for screening at an earlier age, said Robert Smith, senior vice president of cancer screening for the American Cancer Society.

“We want doctors and the public to see the value of starting screening by age 45, rather than postponing it until age 50 or even later, which frankly a lot of people do,” said Smith. “It’s not like everyone starts screening right away by age 50. They usually postpone it until their mid-50s.”

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It is estimated that a quarter to a third of people in the already recommended age group of 50 to 75 do not get their screening on time, despite colorectal cancer being the third leading cause of cancer death in the United States.

“This recommendation of screening for colon cancer is an important preventative measure for all people ages 45 to 75 to help them live longer, healthier lives,” said Wong.

Given that black adults are particularly likely to have colon cancer and more likely to die from the disease, the task force encouraged doctors to reach out to their black patients to make sure they are regularly screened.

Also, people should speak to their doctors if their bowel habits, blood in their stools, or their stool darkening changes, which could be a sign of bleeding, Smith said.

Different types of tests can check for colon cancer, Wong said. Some can be done at home. Some can be done in a doctor’s office. Patients can speak to their doctor to find out which test is right for them.

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The task force recommended both direct visualization tests such as colonoscopy and stool-based tests. The correct test is the one that gets the screening done, the task force statement said. The cancer society also recommends a stool test or a direct visualization test. Visualization tests also include sigmoidoscopy or CT colonography.

“We can prevent this disease through screening and we can find it early,” said Smith.

There’s no answer as to why more younger people get colon cancer, Smith said. An editorial to the new recommendations published online May 18 in the Journal of the American Medical Association stated that diet and lifestyle changes can reduce risk.

Nearly 53,000 Americans will die from colon cancer this year, the task force estimates.

The USPSTF has not changed its recommendations for older adults aged 76 to 85 years.

“We recognize that the benefits and harms depend on a person’s general health, whether or not they have been previously examined, as well as their personal circumstances and preferences. We therefore recommend that people in this age group speak to their doctor about this talk about whether an investigation is being conducted properly for them, “Wong said.