Screenings for Colon Cancer Should Now Begin at 45, New ACS Report Says

Doctor holding colonoscope

It may be time to make some changes to your medical check-up calendar.

According to new guidelines from the American Cancer Society (ACS), the recommended age for your first colon cancer screening has decreased from age 50 to age 45.

This change was inspired by a recent ACS study, which determined colon and rectal cancer rates are on the rise among young adults. Researchers, having checked the records of nearly 500,000 patients diagnosed with colorectal cancer between 1974 and 2013, found that occurrences of the disease have increased by one percent to two percent per year for adults age 20 to 39.

Stressing these findings, Dr. Otis Brawley, chief medical officer for ACS, , said the risk of contracting colon cancer has increased for every generation born since the 1950s – someone born during the 1990s is at twice the risk of contracting colon cancer as someone born during the mid-century.

With this new and sobering information at hand, the ACS updated its guidelines for colorectal cancer screenings in May, lowering the recommended age of first screenings to 45. People should continue receiving regular screenings until age 75.

To be clear, these recommendations are for men and women with an average risk of colorectal cancer. People with higher risk, for example, those with a family or personal history of colorectal cancer and/or inflammatory bowel diseases—should begin screenings before age 45 or as recommended by their gastroenterologist .

The new guidelines also detail the various forms of colon cancer screenings available to patients, which fall under two main categories: “visual exams” and “stool-based tests.”

Recommended visual exams include:

  • A colonoscopy every decade - The most reliable of colon cancer screenings, this procedure entails pushing a tube (outfitted with a camera and light source) through your large intestine, in order to project images of your colon’s interior. 
  • A CT colonography every five years - Also known as a “virtual colonoscopy,” this procedure is less invasive than a standard colonoscopy. It uses computer software and X-ray imaging to produce a three-dimensional picture of your large intestine. 
  • Flexible sigmoidoscopy every five years - Similar to a colonoscopy, this procedure only examines the lower third of your GI tract, thesigmoid colon and rectum.

Recommended stool-based tests include:

  • Highly sensitive fecal immunochemical test every year - This screening, which you would use at home, tests for hidden blood in your stool.
  • Highly sensitive guaiac-based fecal occult blood test every year - Similar to the FIT, this screening also tests for hidden (or occult) blood in stool.
  • Multi-targeted stool DNA test every three years - This test screens for roughly 10 biomarkers related to colorectal cancer.

Signs and symptoms of colon cancer include abnormal bowel movements (diarrhea or constipation) that lasts for weeks, cramps or other abdominal discomfort, bloody or dark stool, and unexplained weight loss.

"Despite the increasing incidence in younger persons, colorectal cancer can still be easily detected and treated when found early, so please contact your primary care physician or gastroenterologist today to schedule your cancer screening," said Penn Medicine colon and rectal surgeon, Skandan Shanmugan, MD.

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The Focus on Cancer blog discusses a variety of cancer-related topics, including treatment advances, research efforts and clinical trials, nutrition, support groups, survivorship and patient stories.

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