Get First Colonoscopy at 45, not 50

By Cara Murez
HealthDay reporter

TUESDAY, May 18, 2021 (HealthDay News) – A lot of people think that age 50 is the magic number to get a first colonoscopy, but sooner is better, now says a prestigious group of American experts.

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

The recommendation is for all adults without symptoms, without a personal medical history of colon polyps, or without a family history of genetic disorders that increase risk, the task force noted.

“Screening for colorectal cancer saves lives and people between the ages of 45 and 75 should be screened … to reduce their risk of dying from this devastating disease,” said Dr. John Wong, Scientific Director of the USPSTF. “There is new science on 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 experts in a range of specialties, its recommendations carry weight. For example, the Affordable Care Act tied the USPSTF’s recommendations to its insurance coverage requirements.

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

The American Cancer Society was already recommending screening for this younger age group, after changing its recommendations in 2018 to include people aged 45 to 49.

The changing USPSTF recommendations will mean less confusion over which recommendation to follow as well as 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 recognize the value of starting screening at age 45, instead of postponing it at age 50 or even later, which a lot of people frankly do,” Smith said. “It’s not like everyone starts screening immediately at age 50. They usually postponed it until about fifty.

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By some estimates, between a quarter and a third of people in the already recommended age group of 50 to 75 do not get tested on time, even though colon cancer is the third leading cause of cancer death in the United States. .

“This recommendation for colorectal cancer screening is an essential preventive measure for all people aged 45 to 75 to help them live longer and healthier lives,” said Wong.

Noting that black adults have particularly high rates of colon cancer and are more likely to die from the disease, the task force encouraged doctors to contact their black patients to make sure they are screened regularly.

Also, people should talk to their doctor if they have a change in their bowel habits, blood in their stools, or darkening stools, which can be a sign of bleeding, Smith said.

Several types of tests can screen for colon cancer, Wong said. Some can be done at home. Some can be done in a doctor’s office. Patients can talk to their doctor to determine which test is right for them.

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The task force recommended both direct visualization tests such as colonoscopy and stool tests. The right test is the one that allows screening, according to the task force statement. 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,” Smith said.

There isn’t a single answer as to why more young people are getting colon cancer, Smith said. An editorial accompanying the new recommendations – published May 18 online in the Journal of the American Medical Association – said the risk can be reduced by changes in diet and lifestyle.

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

The USPSTF has not changed its recommendations for people aged 76 to 85.

“We recognize that the pros and cons depend on a person’s general health, whether or not they have been screened before, as well as their personal circumstances and preferences. We therefore recommend that people in this age group speak to their clinician to find out if screening is right for them, ”said Wong.

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The evidence used to formulate the new recommendations included randomized controlled trials and USPSTF modeling studies.

More information

The American Cancer Society has more on colon cancer screening.

SOURCES: John Wong, MD, scientific director and vice president, clinical affairs, US Preventive Services Task Force, Rockville, Maryland; Robert Smith, PhD, senior vice president, cancer screening, American Cancer Society, Atlanta; Journal of the American Medical Association, May 18, 2021

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