Do I now need colorectal cancer screening before age 50?

Is colorectal cancer screening now starting before age 50?

Colorectal cancer is the second leading cause of cancer death in the United States. Several organizations have long recommended regular colorectal cancer screening for US adults ages 50 to 75, based on the proven life-saving value and reduced mortality (death) with screening colonoscopy, and other screening modalities.

The recent change is that the American Cancer Society (ACS) became the first major organization to recommend colorectal cancer screening starting at 45, back in 2018.

“The American Cancer Society (ACS) became the first major organization to recommend colorectal cancer screening starting at 45.”

Why did the ACS recommend lowering starting colorectal cancer screening to age 45, from age 50?

The incidence of colorectal cancer and mortality (death) from it has declined over the last several decades among adults over 50. This is likely because of effective screening, namely a screening colonoscopy.

This supports that "colonoscopy saves lives" as seen in The New York Times, for example going back to 2012.

A screening colonoscopy has been proven to saves lives

However, since the early 1990s, there has been an increase in colorectal cancer and mortality from it among individuals younger than 50.

Since the early 1990s, there has been an increase in colorectal cancer and mortality from it among individuals younger than 50

When do I start screening?

The risk of individuals younger than 50 developing colorectal cancer is still lower than older adults. But diagnosis is usually delayed and the disease presents at later stages, making it harder to treat, needing more aggressive care (such as chemotherapy in addition to surgery), and with lower 5-year survival.

Why the increase in early-onset colorectal cancer?

It is still unclear and why this is. It has been suggested that there is an association with environmental triggers, obesity, and clearly there is a role of diet.

The majority of early-onset colorectal cancer occurs in individuals with no family history. There are family history, hereditary, and genetic risk factors that increase one's risk of colorectal cancer.

The majority of early-onset colorectal cancer occur among individuals with no family history

When do I start screening?

Individuals between 45 and 50 should discuss with their doctors whether to now begin screening at 45 or wait until 50.

What can I do to prevent colorectal cancer?

• Screening (with a colonoscopy for example) when appropriate

• Quit smoking

• Increase physical activity

• Avoiding being overweight and obese

• Drink alcohol in moderation

• Limit consumption of processed meats and red meat

• Aspirin*

*The US Preventive Services Task Force has recommended regular aspirin use for the prevention of colorectal cancer, but discuss this with your doctor first.

Never Too Young

Cancer doesn’t care how old you are and colorectal cancer awareness is no longer just for people over 50.

Here is a great campaign to educate you.

#nevertooyoung

Be aware. Be seen. Be screened if warranted.