Colon and colon cancer screenings should start at 45, according to new guidelines

    Abdulaziz Sobh

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    If you are around 40 and have not had your colon checked, it could be time.

    The new updated guidelines from the American Cancer Society for colon and rectal cancer screening recommend that adults at average risk be tested starting at age 45 instead of age 50, as indicated above.
    The updated guidelines come immediately after what appears to be an increase in colorectal cancer among younger adults.
    Those most at risk include African-Americans, Alaska Natives, and people with a family history or personal history of colon or rectal polyps; Risk factors such as these may require earlier detection.
    Published in CA: A Cancer Journal for Clinicians on Wednesday, updated guidelines also indicate that there are six screening options for adults, ranging from non-invasive stool testing to visual examinations such as colonoscopy, based on patient preference and availability. proof.
    Other health organizations in the United States, such as the US Preventive Services Task Force. UU., They still recommend screening for colon and rectal cancer from age 50.
    Colorectal cancer, which includes both colon and rectal cancer, is the third most common cause of cancer-related deaths in the world, according to the World Health Organization.
    In the United States, colorectal cancer is the second leading cause of cancer-related deaths among cancers that affect both men and women, according to the US Centers for Disease Control and Prevention. UU
    Some studies suggest that death rates from colorectal cancer are increasing among American adults under 55 years of age.
    After declining overall from 1970 to 2004, death rates from colorectal cancer among 20-54-year-olds increased by 1% annually from 2004 to 2014, according to a study published last year in the medical journal JAMA
    "Behind these numbers are real people and real faces, and all of us in the world of colorectal cancer and all gastroenterologists and all oncologists have been seeing more and more young people developing this disease," said Dr. Richard Wender, chief Cancer official control of the American Cancer Society, which oversaw the development of the new guidelines.
    "In people born more recently, they have four times more risk of rectal cancer than people born in the 50s (at the same age), for example, and double the risk of colon cancer," he said. "It's what we call a birth cohort effect, nobody knows why it's really clear, and that's a big area of interest, but nobody questions what's happening."
    Six detection test options
    To carry out the updated guidelines, the researchers conducted a systematic review of published studies on colorectal cancer screening strategies.
    The researchers also commissioned a microsimulation modeling study that involves a model called MISCAN, which simulates the incidence and mortality of colorectal cancer and estimates risk factors and the impact of screening and treatment practices.
    The researchers' new modeling study was an extension of the analyzes conducted for the recommendations of the US Preventive Services Task Force. UU And he evaluated the possible risk and benefit of various colorectal screening strategies among black men and women in the United States.
    Based on their review and the simulation model, the researchers identified effective strategies for screening from 45 years of age.
    Those strategies underwent a colonoscopy every 10 years; a colonography by computed tomography or "virtual colonoscopy" every five years; a flexible sigmoidoscopy every five years; a multitarget stool DNA test every three years; a fecal immunochemical test to take home a year; or a high-sensitivity guaiac fecal occult blood test to take home annually. The updated guidelines also indicate that there is a wide variation in the costs of those evaluation options, depending on the patient's insurance plans, ranging from around $ 30 for a fecal immunochemical test to take home up to thousands of dollars for a colonoscopy
    Out of the cost and frequency with which a test is recommended, "all of these tests are approximately equal in value and can be offered," Wender said.
    "We know from the trials that if we offer an option between colonoscopy and a less invasive test, that more people will choose to be evaluated, which is our goal at the end," he said. "The evidence is now absolutely clear, and I can not emphasize how carefully this was done." It took us two years of work to provide a compelling argument and evidence that the age of detection for all should begin at age 45, not at age 50. . "
    What explains the increase in colorectal cancer?
    Time will tell if other lea.g health organizations follow in the footsteps of the American Cancer Society in screening for adults under 50.
    In addition, more research could shed light on why there has been an increase in colorectal cancer among these younger adults, said Dr. George Chang, chief of colorectal surgery at the MD Anderson Cancer Center in Houston, who was not involved in the guidelines. updated.
    "Detection rates at this time under 50 are negligible, so what we have observed with the increasing incidence is not simply a result of detection bias," Chang said. "This seems to be a real phenomenon."
    He added that he has some ideas on what factors could be driving this increase, since "there are several things that have changed in recent decades and have to do with exhibitions and lifestyle."
    "We know that obesity is associated with a higher incidence of many cancers, including colorectal cancer, and the obesity epidemic is still a major and growing problem in the US So that may be an associated factor," Chang said.
    Other possible factors could include sedentary lifestyles, environmental exposures and high diets in processed foods, he said.
    "While we have not identified the causal factor, it is likely that all of these factors contribute to this growing incidence," he said.
    A separate report published last week by the World Cancer Research Fund and the American Institute for Cancer Research showed that being physically active and eating whole grains and high-fiber foods, along with other healthy habits, can decrease the risk of colorectal cancer.
    The consumption of red meat, processed meat, and alcoholic beverages, among other factors, could increase the risk of colorectal cancer.
    For any adult, regardless of age, Chang said that paying attention to your body and your bowel habits is important to track your overall health and that alerting your doctor to any change is key.
    "Even if you are younger, if you realize that there is a change in your bowel habits or stool and that something is not right, then go to your doctor," he said. "That's the public health statement, that is, pay attention to your bowels and seek medical attention if things do not seem right if there is blood in your stools or if your bowel habits change suddenly."
    'This gives us a real chance'
    Dr. Nilofer Saba Azad, associate professor of oncology at Johns Hopkins Medicine in Baltimore, agrees with the recently updated guidelines.
    "If you take into account the fact that people develop colon or rectal cancer for many years, and that there is a progressive progression from not having anomalies to having polyps and then developing cancer, this gives us a real opportunity to prevent the people develop cancer by moving the screening at younger ages, "said Azad, who did not participate with the guidelines.
    "It's not just catching the youngest people with cancer, but actually catching the younger people with only a polyp that can be removed at the time of the colonoscopy, and they never have cancer, so it's preventative, not just early, diagnosis, "she said, adding that she thinks the risks of early detection outweigh the benefits.
    Such risks include false-negative or false-positive results, as well as rare complications or feelings of anxiety with more invasive testing approaches, such as colonoscopy.
    However, "there are many ways to detect colon cancer beyond colonoscopy, and we can find a way to do it, no matter how apprehensive people are," said Azad.

     

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