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ACS: Colorectal cancer screening 'should start at age 45'

The average American should start regular colorectal cancer screenings at the age of 45, according to new guidelines issued by the American Cancer Society (ACS). Previous recommendations from the organization suggested people at average risk of the condition should begin a screening schedule at the age of 50. 

People considered “average risk” are those with no personal history of colorectal cancer, certain types of polyps, or inflammatory bowel diseases (such as ulcerative colitis); no family history of colorectal cancer; no confirmed or suspected hereditary colorectal cancer syndrome; and no personal history of radiation therapy targeting the abdomen or pelvic area as treatment for a prior case of cancer. 

The new ACS guidelines recommend regular screening for colon cancer from the age of 45 and that for those between 76 and 85, the decision should be based on prior screening history, general health, life expectancy, and personal preference. Seniors over the age of 85 no longer require regular colorectal cancer screenings, according to the ACS. 

Colorectal cancer is the third most common form of cancer in men and women in the United States. In 2014 alone, nearly 140,000 Americans were diagnosed with the condition, yet around one-quarter of adults between the ages of 50-75 (the previous recommended age range for regular testing) have never been screened, according to the latest Behavioral Risk Factor Surveillance System figures from the Centers for Disease Control and Prevention (CDC). Despite this, the CDC data also showed that the percentage of adults in this age range who were up-to-date with screening increased by 1.1 percentage point between 2014 and 2016, which represents an additional 3.3 million adults screened.

How do you test for colorectal cancer?

There are two main forms of screening available for colorectal cancer, stool-based tests, and visual exams of the colon and rectum. The former is done through annual fecal immunochemical (FIT) and guaiac-based fecal occult blood tests (gFOBT), and a multi-targeted stool DNA test (MT-sDNA) every three years. These tests can be conducted by the patient at home and then mailed to the laboratory for analysis.

Visual exams do not need conducting on such a regular basis. They include a colonoscopy every ten years, and a CT colonoscopy and flexible sigmoidoscopy every five years. The ACS recommends any non-colonoscopy testing option with abnormal results should be followed up with a colonoscopy. 

How do you reduce the risk of developing colorectal cancer?

While there are several risk factors that can increase the likelihood that you will develop colorectal cancer, such as age and medical history, there are steps that may reduce the risk. The US Food and Drug Administration recommends exercising regularly, maintaining a healthy diet and weight, limiting alcohol consumption and avoiding smoking.

How is colorectal cancer treated? 

As with most cancers, colorectal cancer is usually treated with some combination of surgery, chemotherapy radiation therapy, or targeted drug therapy. Among the drugs used to treat advanced colon cancer are Avastin (bevacizumab), Vectibix (panitumumab) and Stivarga (regorafenib). In some cases, physicians may also recommend immunotherapy using medication such as Keytruda (pembrolizumab) or Opdivo (nivolumab).