New Age Recommendations for Colonoscopies

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The new guidelines, from the American Cancer Society, would extend routine colorectal cancer screening to an additional 22 million American adults between the ages of 45 and 49 and send a clear message that colorectal cancer, which has been rising in young adults, is no longer just a disease of older people. A study published today the journal Cancer ads this new data to the model used as a basis for the ACS guidelines, showing what it calls a "favorable balance between screening benefits and burden" with screening starting at age 45, five years younger than now recommended for both men and women of all races and ethnicities.

"More information came out on cancer in younger people and the rates are going up so we decided it's time to revise the guidelines", said Church.

Cologuard is now approved for use in people with an average risk of colorectal cancer between the ages of 50 and 84.

"The American Cancer Society should be praised for taking a critical step toward helping more Americans get screened for colorectal cancer and potentially detecting the disease earlier", said Exact Sciences CEO Kevin Conroy.

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"But as we saw data pointing to a persistent trend of increasing colorectal cancer incidence in younger adults, including American Cancer Society research that indicated this effect would carry forward with increasing age, we made a decision to reevaluate the age to initiate screening in all United States adults". Using a statistic-based model, researchers have determined the new ideal time to begin screening, a time that could add the most overall life-years and use all available screening tests: colonoscopy, stool testing, and CT colonography. Based on microsimulation modeling that showed a favorable risk:benefit ratio for screening at age 45, the recommendation comes with the "expectation that screening will perform similarly in adults ages 45 to 49 as it does in adults for whom screening is now recommended". Colorectal cancer has not been linked to the human papillomavirus (HPV), which can cause anal cancer, as well as cervical, throat, penile and other types of cancer.

"Be aware screening is important, screening can save their lives, screening can actually prevent colorectal cancer", said Church. "It is well established that the risk of CRC has been increasing dramatically in young adults (under age 50) over the last 15 years but the new ACS-commissioned analyses were the first to take race, gender, and this increased risk into account".

"Think of it this way", Dwyer says, "if screening started at age 20, you'd have maximum benefit but also a huge burden".

"For the past, maybe as much as ten years, we're seeing younger and younger patients with advanced colon cancer", O'Neil said. And they typically do not show the traditional risk factors - obesity, smoking, physical inactivity or high-fat diets.

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She said rates are not only increasing among people in their 40s, but also among those in their 20s and 30s (though the incidence at those ages remains low). "That's the public health statement, which is, pay attention to your bowels, and seek medical care if things don't seem right, if there's blood in your stools or your bowel habits change suddenly".

The younger start data for colorectal cancer screening puts the ACS at odds with the U. S. Preventive Services Task Force (USPSTF), which stayed with its recommendation of initial screening at age 50 in an update published in 2016.

Dr. Nilofer Saba Azad, associate professor of oncology at Johns Hopkins Medicine in Baltimore, agrees with the newly updated guidelines.

"It's hard enough to get people to do it at all", Plescia noted.

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Colon and rectal cancers have increased 51% among adults under age 50 since 1994, the cancer society said.

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