A prominent cancer organization recommends for the first time that Americans age 45 start colorectal cancer screening instead of waiting until they reach the age of 50, a threshold that has long been advocated by many other medical groups. The new guidelines of the American Cancer Society would extend the routine screening of colon cancer 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 increasing in young adults, no longer exists a disease of older people
Dr. Thomas Weber, who co-chaired a colorectal cancer task group for the National Colon Cancer Roundtable but was not involved in creating the new recommendation, called lowering the age for the first screening "a game changer" saves Thousands of lives.
"That's a very, very big thing," Dr. Weber, the director of surgical oncology for the Northwest Region of Northwell Health. "Solid epidemiological data from our national cancer registries document a dramatic increase in the incidence of colorectal cancer, and in particular colon cancer, in people under the age of 50, and the vast majority of these cases are in the 40- to 49-year-olds."
On Wednesday Published guidelines have been published in CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the American Cancer Society. They do not demand that everyone has a colonoscopy, the gold standard of colon cancer screening. To increase the chances of people screening, the Cancer Society wants to offer patients a choice of six different screening options, from the most invasive procedure, the colonoscopy, which can be done every 1
The group estimates that this year, Americans under the age of 50 will be diagnosed with approximately 16,450 new cases of colorectal or rectal cancer. 19659002] In 2014, 43 percent of cases of colorectal cancer in children under the age of 50 were in adults between the ages of 45 and 49, according to Rebecca L. Siegel, an epidemiologist at the American Cancer Society and lead author of several reports of an increase in colorectal cancer in adults as young as her 20s and 30s.
The group does not recommend routine screening for patients under the age of 45, as the absolute rates of cancer in these age groups are still very low and risks are associated with procedures such as colonoscopy, including a perforated bowel.
Over 140,000 Americans are expected to be diagnosed with colorectal cancer this year. The disease causes more than 50,000 deaths each year, making it the second leading cause of cancer death among American adults.
The vast majority of colorectal cancers are still found in the elderly, with nearly 90 percent of all cases being diagnosed in people over 50. But while incidence and deaths among those over 55 have declined in recent decades, at least in part From preventive examinations that lead to the removal of precancerous lesions and early detection of cancer, recent analyzes have documented an increase in colon cancer rates by 50 percent in adults under 50 between 1994 and 2014.
While the mortality rate for people born between 1890 and 1950 were steadily declining, they rose for every generation since 1950. A recent study by the American Cancer Society Siegel found that adults born in 1990 had twice the risk of colon cancer and four times the risk of rectal cancer compared to the risk that adults born in 1950 were facing a comparable age  For younger adults such as Gale Fritsche, now 55, from Allentown, Pa., The existing recommendations have been neglected. Mr. Fritsche went to his first colonoscopy at age 50, but found that he already had advanced colorectal cancer.
"I went in and did not think there would be a problem, and I wake up with two doctors and said," We have a problem, "said Mr. Fritsche, a competitive athlete who said he was following a healthy diet "If the screening had started five years ago, my cancer might be trapped at the very early stages and not as advanced as it was."
The new directive brings the American Cancer Society into conflict Other national organizations that recommend starting screening at 50, and raises questions about whether health insurance companies will pay for the previous tests.
The influential Preventive Services Task Force decided against lowering the screening age to 45 when they did updated its recommendations in 2016 and recommends routine screening at 50.
The Multi-Society Colorectal Task Force Carcinoma, which includes representatives of several gastroenterology groups, urges African Americans to begin routine screening at the age of 45 because they have a higher burden of colon cancer, but others advise average risk for screening at 50.
The American Cancer Society acknowledges that the evidence for screening in individuals under the age of 50 is not as robust as it is for the 50s and older, but it's still compelling. The group also says screenings should continue until the age of 75, but decisions for those over 75 should be individualized based on patient preference, life expectancy and health status.
The message to the general public and doctors is, "Colon cancer. It can occur at any age," including among teenagers, said Dr. Richard C. Wender, chief cancer control officer for the American Cancer Society. If you lose weight or have bowel changes or have symptoms like blood in your stool, you need an answer as to why. "He noted that while hemorrhoids are a cause of rectal bleeding, they are less common in younger people and" There are no normal rectal ones bleeding. "
" What's really important is that the doctors are aware of this, "said Dr. Robin Mendelsohn, a gastroenterologist who is co-director of the Center for Young Colon Cancer at Memorial Sloan Kettering's Cancer Center, which is exclusive dedicated to treating patients under the age of 50. "Many of our young patients say," Now I've seen five doctors say they are hemorrhoids and I thought I was too young to have cancer. "One of our primary goals is to inform everyone Doctors who see these people first. "