Colonoscopy guidelines change: 45 is the new 50

Shifting colonoscopy guidelines show that earlier screenings can save lives.

image of a polyp in a colonoscopy

Because the disease grows slowly over a long period of time, a colon cancer screening is an effective tool against its development. But when to start those screenings is a question that draws varied answers.

The American Cancer Society (ACS) recently adjusted its age recommendation for when most people should start screening tests for colorectal cancers. The group now recommends that initial testing for adults at an average risk for colon and rectal cancers start at age 45, rather than 50.

Mark Claussen, M.D., a surgeon at Sanford Health in Bemidji, Minnesota, believes that more groups will soon align their recommendations with this younger age.

“The data supports this as a good move for people’s health,” he says. “I think age 45 will become more standard.”

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This shift by the ACS comes as colon cancers are being seen in more young adults. According to the ACS, since 1994 colon and rectal cancers have increased 51 percent among adults under age 50.

“Previous to this it hasn’t been clear that starting screenings earlier would decrease a person’s chances of getting a colon cancer,” Dr. Claussen says. “But now the data is supporting that moving the age will capture more people early on, when we need to know if something is happening.”

Preventing colon cancer

A colon cancer screening is essential in the fight against colon cancer because there are no early signs of it –- only late signs, such as bleeding or obstruction.

“That’s why colon screening makes so much sense,” Dr. Claussen says. “Because if you wait for symptoms you’re only going to catch late stage cancers.”

Colon cancer is the second most common cause of cancer related death in the U.S., second only to lung cancer. About 50,000 people a year die from colon cancer and more than 90 percent of those could have been prevented with proper screening.

Because it develops slowly and the typical progression is so well documented, colon cancer is one of the most detectable and preventable cancers. Typically, it takes about 10 years for a normal colon lining to develop a polyp (abnormal tissue growth) and for that polyp to turn into cancer that invades into the colon wall. While not all polyps turn cancerous, almost all colon cancers start as a polyp.

“The nice thing about that is if you come in for a colonoscopy and your colon is normal, it’s a nice long interval between scopes,” Dr. Claussen says.

Why colonoscopies matter

A colonoscopy is a colon cancer screening that often requires a day off from work while a patient prepares for the screening with a bowel cleansing. With normal results, patients can wait 10 years before their next colonoscopy check.

While the ACS says the initial colon cancer screening does not have to be a colonoscopy, Dr. Claussen is passionate about highlighting the key differences between the types of colon cancer screenings.

“With a colonoscopy we’re trying to find polyps and remove them before they have the chance to form into a cancer, whereas with the other tests we can only find a cancer after its already developed,” Dr. Claussen explains. “People should be highly encouraged to do a colonoscopy. Everything else is second best.”

Other screening tests include at home stool testing options, which are available by prescription. But because these other tests are very poor screenings for polyps, they aren’t good substitutes for a colonoscopy.

“People get a false sense of security by doing these other tests instead of doing their colonoscopy and even though it’s a nuisance to have the procedure, it’s really not as hard as people make it out to be,” Dr. Claussen says.

Getting a colonoscopy does have some risks, like bowel perforation, and the risks increase with age. But the peace of mind they offer could be priceless.

“It gives you great peace of mind for the next 10 years,” says Dr. Claussen. “That’s worth the effort.”

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Posted In Cancer, Digestive Health, General Surgery

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