American Cancer Society Updates Colorectal Cancer Screening Guideline

June 11, 2018
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Michele Battista, bottom right, was part of Monmouth Medical Center’s Cancer Survivor Luncheon June 3. Battista, who was diagnosed with colon cancer at age 50, has been cancer-free for six years. Courtesy MMC

By Judy O’Gorman Alvarez |

When the news came last week that the American Cancer Society (ACS), the premier health organization dedicated to eliminating cancer, updated its colorectal cancer screening guidelines, many medical and health professionals were pleased.

The new ACS guidelines stated: “colorectal cancer screening should begin at age 45 – rather than the current recommendation for age 50 – for people at average risk. This change is based in part on data showing rates of colorectal cancer are increasing in young and middle-aged populations.”

“I think it’s phenomenal,” said Michele Battista of Colts Neck about the new screening guidelines.

Battista speaks from experience. At age 50 her first-time colonoscopy revealed stage 3 colon cancer; Battista had no family history of the disease.

“I woke up from the colonoscopy and was told I had colon cancer and needed to see a surgeon ASAP.”

The American Cancer Society now recommends adults age 45 and older with an average risk of colorectal cancer undergo regular screening with either a high-sensitivity stool-based test or a structural (visual) exam, such as colonoscopy, depending on patient preference and test availability.

As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.

“When we began this guideline update, we were initially focused on whether screening should begin earlier in racial subgroups with higher colorectal cancer incidence, which some organizations already recommend,” said Richard C. Wender, M.D., chief cancer control of ficer for the American Cancer Society, in a press release announcing the change. “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 decided to reevaluate the age to initiate screening in all U.S. adults.”

The ACS states colorectal cancer incidence has declined steadily over the past two decades in people 55 and over due to screening that results in removal of polyps, as well as changes in exposure to risk factors.

But there has been a 51 percent increase in colorectal cancer among those under age 50 since 1994.

For Howard Hampel, M.D., Ph.D., Riverview Medical Center’s section chief of gastroenterology, all the new data that indicates that incidences of colorectal and rectal cancers in patients younger than 50 have increased since 1990 makes the revised guidelines understandable and appreciated.

“Brand-new guidelines by the American Gastroenterological Association are also on board,” he said. “Not all societies are recommending it yet but it looks like that’s the way it’s going.”

It’s important to note that the ACS recommends options, including invasive procedures such as colonoscopy – every 10 years – to lab tests on stool samples collected at home. Those tests would be repeated more often and require colonoscopies if results are positive.

Recognizing adults vary in test preferences, patients are encouraged to speak with their clinicians to decide which test is best for them.

“They’re not saying everybody needs a colonoscopy,” at age 45, said Hampel.

Cost may be a factor for some patients and Hampel points out that even though a stool test is less expensive a patient will need one every two years and of course follow up with a colonoscopy if there are positive results.

Another area that may be of concern is insurers’ decisions whether to cover the cost of colonoscopies at an earlier age.

The reasons for the increase in colorectal cancer are still not yet known. “We do know obesity is a risk factor,” but there are other causes as well. Research continues in that area.

Emmanouil P. Pappou, M.D., Ph.D., a surgeon who sees patients at Memorial-Sloan Kettering Monmouth, thinks the new guidelines are a good preventive step, but what’s more important is awareness and reaction to symptoms.

Pappou too is alarmed at the higher rates of colon cancer at younger ages “even under age 30.”

“The change is a step in right direction, but it does not address the issue of higher incidences of cancer.”

“It’s occurring in people younger than 45, even as young as 18,” he points out. “That’s what we should be discussing.”

Pappou tells of a 42-year old patient who had rectal bleeding for six months and his physician attributed it to his use of steroids. Finally, a colonoscopy revealed cancer. “So even lowering the age to 45 would not have helped that patient,” he said.

He says the emphasis should be that if someone regardless of age has symptoms – blood in the stool, change in bowel habits, excessive bloating – it requires a diagnostic workup.

Although a non-invasive test may be more comfortable, it may not be completely accurate and there is the risk of false positives. “But you can easily see (any problems) with the colonoscopy.”

But the question remains about how to get the public to be screened. “People are just not easy to convince,” Pappou said. “For many it’s taboo, an invasive test.”

Although they are working on developing a better non-invasive test, “until that time, we’re relying on general guidelines,” he said.

But the important message, according to Pappou, is: “If people have symptoms, they should discuss it with a gastroenterologist.”

Battista, who is celebrating six years cancer-free, believes earlier testing can save lives.

“I did not have blood in my stool, no anemia and the blood marker test for cancer was normal,” said Battista who recently participated in the Monmouth Medical Center’s Cancer Survivor Luncheon representing the #ColorectalCancerAlliance for National Cancer Survivor Day.

“There was no clue.”

She believes testing earlier could have helped her case. “Colon cancer is a slow growing cancer and the doctor said I probably had it for five to 10 years,” she said. “If I had gone at 45 I might’ve caught it as polyp.”

“It could’ve saved me from a colon resection and six months of chemo.”

This article was first published in the June 7-June 14, 2018 print edition of The Two River Times.

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