FORTY-FIVE IS THE NEW FIFTY
Written By: Chukwunonso Chime, MD Gastroenterologist
Colorectal Cancer is a disease of the colon or rectum, which are parts of the digestive system. Unlike most cancers, colorectal cancer is often preventable with screening and highly treatable when detected early. Most cases of colorectal cancer occur in people ages 45 and older, but the disease is increasingly affecting younger people.
In the United States, colorectal cancer is the third most commonly diagnosed cancer in men and women combined and the second leading cause of cancer death in men and women. According to recent data, it is estimated that in 2022, just over One Hundred and fifty thousand people will be diagnosed with colon cancer with 52,580 deaths this year alone. The median age of diagnosis for colorectal cancer among US population is about 66 years but the year of onset has gradually trend toward the younger age group. The rates of colorectal cancer appear to be dropping for older age group and this correlates with screening in this age group. This data has informed the decision and trend towards screening at earlier ages. The United States Preventive Services Task Force updated their guidelines in May 2021 to recommend colorectal screening from age 45 years instead of 50 years for average risk general population. This does not affect earlier age screening recommendations for patients that have a higher risk due to positive family history or genetic cancer syndromes.
Colorectal cancer is staged from 1 to 4 in order of decreasing chance of cure and increased morbidity and mortality. The earlier colorectal cancer is detected, the more the likelihood of cure. According to the SEER database, between 2011 and 2017, 5-year survival rates for stage 1 or localized colon cancer was 91% compared to 14% for stage 4 or distant spread. The rates were similar for rectal cancer too.
Fortunately, there are tools that have been developed over time to help with early colorectal cancer detection with the goal of finding these cancers at an early stage when the chance for cure is greatest. Colonoscopies offer a unique approach to cancer screening; in that they use a one-step approach. With a Colonoscopy, we detect and remove polyps with one procedure. These polyps could have grown over time to become cancer. Thus, colonoscopies are an efficient way of early cancer detection and prevention. For patients who are unable or unwilling to undergo colonoscopy or FIT, the ACG suggests consideration for flexible sigmoidoscopy every 5-10 years, multitarget stool DNA test (Cologuard) every 3 years, CT Colonography or Colon Capsule every 5 years.
Age and in some patients, genetics, appears to be the only proven non-modifiable risk factors for developing colorectal polyps but there are also other modifiable environmental factors at play that have not been proven conclusively but could be contributory including smoking and obesity. Increasing incidence in younger age group could be related to a western diet but no diets have been proven to reduce the risk of colorectal cancer. Aspirin has a promising role for chemoprevention of colorectal cancer but has to be individualized and taken for at least 10 years to be beneficial.
summary, screening should start at age 45 years for average risk patients and continue until the age of 75. For patients with family history of either colorectal cancer or high-risk polyps in their first degree relative, screening should start at age 40 years or 10 years younger that the age of affected relative. Between the ages of 75 to 85 years, screening recommendations would be based on prior screening history, overall health of patient and preferences.
Please contact Western Wisconsin Health at 715-684-1111 to set up your colorectal screening to determine if you will need a colonoscopy with Dr. Chime or Dr. Dahlberg.
Western Wisconsin Health~Building a healthier tomorrow, together.
- Colorectal cancer alliance
- Centers for Disease Control and Prevention
- SEER database
- American College of Gastroenterology Guidelines
- United States Preventive Services Task Force