Cancer Group Now Recommends Adults Start Colorectal Cancer Screening Earlier

Rates of colorectal cancer are rising among millennials in the U.S., and a growing number of people under the age of 55 are dying of the disease. Now, the American Cancer Society is taking action by recommending that adults start screening for the disease earlier on.

There will be approximately 97,220 new cases of colon cancer and 43,030 new cases of rectal cancer diagnosed in 2018, according to ACS estimates. The disease is also expected to cause about 50,630 deaths this year.

The ACS is now recommending that adults at average risk of colorectal cancer start regular screening for it at age 45.

Previously, the ACS recommended regular colorectal cancer screening in adults aged 50 and older who are at average risk. That's still considered a strong recommendation, they note, however the earlier screening is a qualified recommendation. For now, the U.S. Preventative Services Task Force still recommends starting colorectal cancer screening at age 50.

Early detection is crucial when it comes to colorectal cancer because it allows doctors to find and remove precancerous polyps before they turn into cancer, epidemiologist Robert Smith, M.D., vice president for cancer screening at the ACS, tells SELF. And, when colorectal cancer is detected early, it’s more likely to be treatable.

The decision to lower the screening age for all Americans was made based on data on colorectal cancer incidence rates and modeling that show it will help lower future rates, Dr. Smith says. “Based on these models, we were seeing that starting screening at the age of 45 was judged to be an efficient strategy and offered an improvement in life years gained,” he says. The potential risks and benefits were similar to starting screening at the age of 50, Dr. Smith added.

People who are at an increased risk of colorectal cancer, like those with a family or personal history of colon cancer, or a personal history of inflammatory bowel disease may need to be screened earlier, the ACS says, which doesn’t change from their previous recommendation. Specific recommendations vary depending on your risk, but you can find out more about colorectal screening recommendations here.

In general, doctors are pretty on board with the change.

"This is a great thing," Yi-Qian Nancy You, M.D., a surgical oncologist at The University of Texas MD Anderson Cancer Center, tells SELF. There are many doctors who have been worried about rising colorectal cancer rates among younger adults, she says, and the lowering of the screening age highlights that issue and attempts to do something about it.

The new recommendations show that the ACS is serious about recent findings that colorectal cancer rates are increasing in younger patients, Felice Schnoll-Sussman, M.D., director of The Jay Monahan Center for Gastrointestinal Health at Weill Cornell Medicine, tells SELF, noting that she'll now be offering colorectal screening procedures to a younger population.

The new recommendations are a "much needed change," Scott R. Steele, M.D., colorectal surgeon and Chairman of the Department of Colorectal Surgery at Cleveland Clinic, tells SELF. “Our goal is to prevent colorectal cancer, or at a minimum detect it at an early stage. This is a collaborative, proactive and well-thought out change in the recommendations and hopefully will lead to the intended result.”

Dr. You says she often sees patients who are diagnosed at 50 who already have colorectal cancer that is at stage three or four. "Hopefully with earlier screening we can diagnose people at an earlier stage, and hopefully we’ll see fewer patients at an advanced stage," she says.

However, this change doesn’t necessarily mean that you need to get a colonoscopy at 45.

A colonoscopy, a procedure where a doctor inserts a fiber-optic instrument through your anus to examine your colon, is considered the best test for colorectal cancer, Dr. Smith says. Under the new recommendations, adults at average risk should have one every 10 years starting at age 45.

But a colonoscopy isn’t your only screening option. The recommendations specifically state that patients can either screen with a stool-based test (where you test your poop) or a structural test (which includes colonoscopy, CT colonography, or flexible sigmoidoscopy) based on their personal preferences and the availability of the test.

When it comes to stool tests, you're choosing between a fecal immunochemical test (recommended every year), a high sensitivity guaiac-based fecal occult blood test (also recommended every year), and a multi-target stool DNA test (recommended every three years), the ACS explains. The first two use different methods of detecting blood in your stool, while the DNA test picks up abnormal sections of DNA from cancer or polyp cells in your poop. If you get a positive result on any of these tests, it's recommended that you follow it up with a colonoscopy.

If you'd prefer to go ahead with a structural test, your doctor may recommend a CT colonography, which uses a CT scanner to take many pictures of your colon as you’re rotated around on a table, the ACS explains. Then, the images are put together to make 2D and 3D views of the inside of your colon and rectum to allow doctors to look for polyps or cancer. If you go this route, the new ACS recommendations suggest doing it every five years, starting at age 45.

Or you can opt for a flexible sigmoidoscopy, which is performed using a flexible, lighted tube that goes in through your anus and moves into the lower part of your rectum, the ACS says, which is also recommended every five years. However, this test can only look at part of your colon, Dr. Smith points out.

Colonoscopies are still considered the gold standard of colorectal cancer screening. And, again, if you get a positive result from any of the other screening tests, you'll need to get a colonoscopy to confirm the result anyway, Dr. Smith says. It’s also just better at detecting cancer, Dr. Steele says. “We know with other tests, there is a risk for false positives,” he says. With a colonoscopy it’s “not as much, as you either find a lesion or you don’t,” he says.

All screening tests have their pros and cons, but the most important thing is that you get some screening done.

Colonoscopies come with real but rare risks, including complications related to anesthesia and the potential for bleeding or perforations. Plus, getting a colonoscopy takes a fair amount of preparation ahead of time, including a liquid diet and taking an intense laxative (known as "prep") that cleans you out before the procedure.

So, although colonoscopies are generally recommended, all of the screening options can be helpful, and some type of screening is definitely better than none, Dr. Smith says. “Most people clearly favor one test over another,” he says. “If we’re ever going to get colorectal screening results where they should be, then people should be encouraged to choose the test they prefer.”

It’s hard to know right now if health insurance will cover the cost of tests at these younger ages, Dr. Steele says, meaning you may have to pay for the test yourself if you want to take the new recommendation and start screening at age 45. The ACS notes that insurance providers are not currently required by law to provide coverage for colonoscopies before the age of 50.

And, of course, the decision to start testing earlier is one you'll need to make with the guidance of your doctor. So, if you're interested (or nervous) about what lays ahead for your colon, check in with them about your options.


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