A medical professional holds a sign that reads, “Colonoscopy”
Colonoscopy continues to be the gold standard for detection of colon cancer. (For Spectrum Health Beat)

Get ready, 40-somethings.

As the rate of colorectal cancer continues to rise among younger people, experts are recommending stepped-up screening guidelines as one of the best ways to fight back.

The new guidelines urge people to start screening at age 45, rather than 50. For those with family history or other risks, screening should begin much earlier.

“This is a big change for an average-risk person without any symptoms,” said Randall Meisner, MD, a Spectrum Health gastroenterology specialist.

It’s also an important change.

Experts hope the updated guidelines will save lives, detecting cancer earlier.

“If caught early, colon cancer has a 90% to 95% five-year survival rate,” Dr. Meisner said.

Colon cancer rates are declining in older people, but for reasons yet unknown the rates are rising in younger people.

“We’re catching cancers earlier,” Dr. Meisner said. “But over the last several decades, incidents among younger people are increasing.”

Some theorize the rise may be linked to antibiotic use, certain food additives, diabetes or obesity.

Regardless, the new reality has changed how gastroenterologists view cancer threats. They’ve stepped up their vigilance of symptoms—including minor bleeding—to catch cancer sooner.

Earlier screening

The good news? The change in recommendations comes as Americans are increasingly more likely to get screened.

In 2018, the latest year statistics are available, about 69% of U.S. adults age 50 to 75 had gotten some type of screening, according to a Centers for Disease Control and Prevention report. That’s up slightly from about 67% in 2016.

While the pandemic caused a drastic falloff in screening, they rebounded quickly as health care centers adopted protocols to keep patients safe.

That’s all encouraging, Dr. Meisner said.

“But there’s still plenty of room for improvement,” he said.

The rates include all types of screening, he said, pointing out the significant differences.

Colonoscopy continues to be the gold standard for cancer detection. It’s most effective when done by an experienced practitioner skilled at spotting and removing all types of polyps, including the harder-to-detect flat growths.

Patients undergo a thorough bowel preparation, a regimen of fasting, laxatives and fluids the day before the procedure.

Yes, it’s no picnic. But bowel preparation, done right, allows cameras a crystal-clear view of the colon’s walls.

While some consider the procedure itself uncomfortable, the discomfort is well controlled by sedation now, Dr. Meisner said.

“And any risk, from both the procedure and the sedation, are very, very low,” he said.

Some patients opt for another visual procedure, CT colonography. Sedation isn’t necessary and these tests are effective in detecting polyps over 6 millimeters in size. (Gastroenterologists consider polyps under 5 millimeters small, those over 10 millimeters large.)

Bowel prep is required for this test, too.

The downside is that if the CT scan detects polyps, they can’t be removed for biopsy during the procedure, Dr. Meisner said. So if the test finds anything, you’d have to come back for a colonoscopy.

Even less invasive are stool tests, including stool cards used for fecal immunochemical tests, or FIT.

There are also stool-based molecular DNA tests, such as the heavily advertised Cologuard.

“In our opinion, that’s not a good front-line test because it doesn’t detect all cancer,” Dr. Meisner said. “And it doesn’t detect large polyps, which is what you want. You want to get the polyps out before they become cancerous.”

Another downside is false positives.

“Those cause a lot of anxiety, only to find out through that colonoscopy everything is normal,” Dr. Meisner said.

Despite the higher level of accuracy with colonoscopy, the most important thing is to get screened.

“No matter which test you choose, any test is better than no test at all,” the doctor said.

Know your risks

Healthier lifestyle choices also reduce cancer rates. That means you should strive for a diet high in fruits and vegetables, low in fats and limited alcohol use. Smoking increases risk.

Knowing your family history is essential. This is especially true for the Black community. Because of their increased level of risk, 45 has been the suggested age of screening for some time.

This means asking some questions. A parent or relative who had a large polyp might not have talked about it.

If any family member has a history of colon cancer or large polyps, screening should begin at age 40 or 10 years before the age the relative was diagnosed. For example, if a parent had a large polyp removed at 43, children in that family should begin screening at 33.

Other risk factors that might call for earlier screenings include a personal history of inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease, or a personal history of radiation to the abdomen or pelvic area because of a prior cancer. Those who have previously had a large polyp are also at higher risk.

People in good health should continue screenings through age 75. For age 76 through 85, the American Cancer Society says screening should happen based on preferences, life expectancy, overall health and prior screening history.

Once people hit 85, screening is no longer recommended.