Colorectal Cancer Prevention 

Updated guidelines reinforce the effectiveness of screenings

In response to a higher incidence of colorectal cancer in people under the age of 50, the American Cancer Society (ACS) updated its screening guidelines in 2018. Previously, ACS recommended that people with no colorectal cancer symptoms and no family history of the disease start getting screened at age 50; it now has lowered the initial screening age to 45.

“There has been a noticeably higher incidence of colorectal cancer in younger people,” says Don Colvin, MD, FACS, FASCRS, colorectal surgeon and Section Chief of Colorectal Surgery at Inova Fairfax Medical Campus. “The curve has shifted a bit, and that’s just for people who are asymptomatic without family history.”

Dr. Colvin explains that for people with a family history of the disease, screenings are recommended even earlier. “If someone has a family history — for example a close relative like a brother or sister who had the disease at age ‘X,’ then the other members of their family should be screened 10 years earlier than the age that person had their cancer detected,” Dr. Colvin notes.

It’s important to note that, at this time, only ACS and a few other health and medical organizations have lowered their recommended screening age for colorectal cancer to 45. Age 50 remains the recommended age among most organizations. Still, it’s important to talk to your doctor about your risk and when is the right time to get screened.

“Risk factors are different for every person, and for some people earlier testing is recommended,” points out gastroenterologist Nitin Sardana, MD. “When it comes to your health, it is smart to be proactive. If you are under age 50, include this question about screening at your next appointment.”

ACS suggests that any one of six types of colorectal cancer screening procedures may be used, including fecal tests, CT colonography and colonoscopy. However, if any of the non-colonoscopy tests come back positive, that person should have a colonoscopy soon after. People of average risk should continue undergoing colonoscopies every 10 years, according to ACS.

“Colonoscopy is the gold standard,” says Dr. Colvin. “The procedure itself is very low risk for bleeding or injury and the detection rate is very good. And if we see a polyp during the screening it can be removed, potentially preventing cancer down the line if that polyp wasn’t detected with another procedure.”

Dr. Colvin explains that lowering the recommended age for colorectal cancer screening was an important step because colonoscopy has been shown to definitively decrease the incidence of colon cancer in patients. Cancerous polyps grow slowly, so screening is an extremely effective way to catch them and remove them at an early stage, eliminating the cancer before it affects a patient’s health.

“The earlier we can detect colorectal cancer, the more likely you are to be cured,” says Dr. Sardana.

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