Colorectal cancer screenings now recommended to start at age 45

March is National Colorectal Cancer Awareness Month, highlighting the fourth leading cause of cancer death in the United States. 

In 2018, the most recent year complete information is available, over 141,000 Americans were diagnosed with colorectal cancer and over 52,000 died. While the average age of diagnosis is 67, the number of young people diagnosed with colorectal cancer has been dramatically increasing.

Since 2009, the rate of new colorectal cancer diagnoses in patients under age 50 has increased by 2% every year. Colorectal cancer disproportionately affects Black Americans with 40 new cancers diagnosed per 100,000 Black Americans compared to 36 new cancers per 100,000 White Americans. 

Starting in 2021, the US Preventative Services Task Force lowered the recommended age to start colorectal cancer screening from 50 to 45. Lowering the age to begin screening is a significant change and recognizes the concerning rise in colorectal cancers diagnosed at a young age.  

Jordan Kharofa, MD, associate professor in the University of Cincinnati Department of Radiation Oncology, a University of Cincinnati Cancer Center member and a UC Health physician, told 55KRC's Simply Medicine program he has personally observed the increase of younger patients being diagnosed with colorectal cancer.

"It used to be when I started practice and residency around 2010, I’d uncommonly see patients who were less than 50 years old," he said. "But more and more we’re seeing these patients in our clinics now to the point where it doesn’t strike us as an exception to the rule. The annual increase in young patients has steadily grown over the course of the last 10 years."

Because the majority of patients with colorectal cancer do not have symptoms, the new recommendation means that everyone should start colorectal cancer screening at age 45, even if it seems like nothing is wrong. 

In spite of all this, there is good news. Kharofa said the overall rate of new colorectal cancers and deaths has been steadily decreasing in the US for the past 20 years. Nearly 90% of patients diagnosed with colorectal cancer in the earliest stage are cured. 

While some of this positive change is due to more effective treatments, screening for colorectal cancer is critical for earlier diagnosis and treatment. Safe and effective screening methods have been proven for decades to decrease the risk of dying from colorectal cancer and newer, stool-based testing offers many of the same benefits without invasive procedures. 

There are a variety of screening methods that clinicians and patients can choose from. Colonoscopy is considered the most reliable screening method. It has the advantage of direct visual inspection of the colon and can be performed as infrequently as every 10 years, but it requires a bowel prep and an invasive procedure. 

Testing stool samples for blood does not require an invasive procedure but must be performed more frequently. Newer stool tests for abnormal DNA also allow at-home collection without a bowel prep and can be performed less often than stool blood testing.

Listen to the Simply Medicine interview. (Note: Segment begins around 21:39 mark.)

Featured photo at top of Dr. Kharofa. Photo/Colleen Kelley/UC Creative Services.