Colonoscopy … Is It That Time Already?

Congrats!  You have made it to age 45, just in time to start colorectal screening!

Having a “Wait, What!” reaction to that statement is not unusual. However, official guidelines on this issue were published in 2021 and the American Cancer Society, the American College of Gastroenterology, and the US Preventative Services Task Force are among the medical organizations recommending that the screening age for average risk individuals to be dropped from age 50 to age 45.  This may involve a trip to the doctor sooner than anticipated, but there is good reason to be checked for colon cancer at this age.

Colon cancer is diagnosed in 150,000 Americans each year and 50,000 of these individuals do not survive their disease.  It is the second leading cause of cancer death in the US. The US Preventative Task Force documented that rates had been slowly decreasing from 1970 to the beginning of 2000.  Since 2004 however the rate of colon cancer death in the age group of patients from age 20-54 has gone up 1% a year resulting in a 15% increase from previous numbers.  There is no clear medical explanation for this yet, and when cancer is diagnosed because of symptoms in a young individual it is often found to be at a late stage which is difficult to treat.  Until we know more about prevention, early detection is our best defense against a poor outcome, since 90% of colon cancers are curable when discovered early.

Average risk individuals are those without a history of abdominal symptoms, previous colon polyps, family history of close relatives with colon cancer, inflammatory bowel disease like ulcerative colitis or Crohn’s disease, and hereditary colon cancer syndromes.  Those patients at higher risk should certainly screen by age 45 but should also consult their doctor concerning special precautions they should take for detection.

Screening options, listed in order of increasing sensitivity, include: FIT/FOBT which detect blood, Cologuard looking for abnormal DNA, and colonoscopy which seeks and removes abnormal growths of the lining of the colon, namely polyps which cause almost all colon cancers.  Colonoscopy is the only test which is therapeutic as well as diagnostic since the precursors of colon cancer are located and removed.  You should discuss with your provider the right choice for you.

Questions remain about the best way to detect colon cancer patients between the ages of 20 and 45. However, with increased screening in a younger population, more patients should be found at an earlier stage which may shed light on causation and prevention.

For now, the best advice from experts on how to lower your chances for colon cancer includes eating a diet high in fruits and vegetables and low in red meat and processed meat, minimizing alcohol, maintaining a good body weight, and engaging in regular activity and exercise.  And, of course, being proactive and getting screened for colorectal cancer!