Age 45 or older? It’s time for colorectal cancer screening

March 17, 2023
Erika Romero, RN, charting on a computer in the clinic.

If you are age 45 or older and haven’t had a colorectal cancer screening yet, then it’s time to make your colon health a priority. During the COVID-19 pandemic, many suspended their regular cancer screenings either because some procedures were suspended to prioritize urgent medical needs, or they were concerned about visiting medical facilities unless it was absolutely necessary to do so.

While the rates of cancer screenings have since improved, continuing to delay routine screenings may result in a diagnosis that is more advanced and harder to treat. Recent research has shown a significant increase in colon cancer rates among adults younger than age 55. In response to this increase, the American Cancer Society (ACS) issued updated guidelines for colorectal cancer screening. Colon cancer and cancer of the rectum is the second deadliest cancer among U.S. adults.

The updated colorectal cancer guidelines are:

  • For people at average risk for colorectal cancer: Screening should start at age 45. In previous guidelines, the starting age was 50.
  • For people at high risk for colorectal cancer: Screening may need to start sooner, as recommended by your health care provider.

Factors that increase your risk include:

  • A personal history of colorectal cancer
  • A personal history of colon polyps (noncancerous growths that may turn into cancer over time)
  • A personal history of inflammatory bowel disease (Crohn’s disease or ulcerative colitis)
  • A family history of colorectal cancer

Earlier screening can save lives

After reviewing research on colorectal cancer screening, ACS experts found that lowering the starting age to 45 will save additional lives. There are several tests that may be used to screen for colorectal cancer screening. They include:

  • Stool-based tests
    • Highly sensitive fecal immunochemical test (FIT) every year
    • Highly sensitive guaiac-based fecal occult blood test (gFOBT) every year
    • Multi-targeted stool DNA test (MT-sDNA) every three years
    • Visual Exams
  • Colonoscopy every 10 years, or as recommended by your doctor
  • CT colonography (virtual colonoscopy) every five years

If you’re age 45 or older, or if you’re younger but in a high-risk group, talk with your health care provider about getting screened for colorectal cancer and which test is the best recommendation for you.

When it comes to finding and preventing colorectal cancer, sooner is much better than later.

To learn more about how to promote colorectal health and prevent colon cancer, we sat down with Dr. Syed K Mahmood, MD MPH, Director of Advanced Endoscopy at St. Elizabeth’s Medical Center in Brighton, MA.

Why is it important to pay attention to colorectal health, specifically the colon?

Colon cancer is preventable by age-appropriate screening. Gastroenterologists can remove pre-cancerous growths (polyps) from the colon via colonoscopy, drastically reducing the risk for future colonic malignancy. In addition to colon cancer, other preventable/treatable colon conditions (such as various forms of colitis) are often detected early due to attention to colon health.

What steps can people take to promote colorectal health and prevent colon cancer?

A balanced diet that is low in red and processed meat is recommended. Additionally, cigarette smoking, and heavy alcohol intake are associated with a higher incidence of colon cancer. Exercise is important, and there is a moderately increased risk of colon cancer with obesity.

What are some warning signs/symptoms of colon cancer? How does family history play a part?

Common presenting complaints of colon cancer include blood in the stool and persistent changes in bowel habits. Such symptoms should be brought to the attention of your physician immediately. Benign conditions such as hemorrhoids and diverticulosis may also cause bleeding. A colonoscopy can help differentiate between these diagnoses.

When should people get a colonoscopy? Why was the recommended age recently lowered to 45 and how important is that?

Age-appropriate screening is essential. In 2018, the American Cancer Society lowered the screening age to 45 (for the general population). The United States Preventative Task Force agreed with this recommendation in 2021, and gastroenterology societies have also confirmed this recommendation. If a patient has additional risk factors for colon cancer (such as a family history of colon cancer), the age for screening may be even lower. Please discuss your risk profile with your physician.

Can you speak to the importance of early detection in terms of treatment?

Colon cancer may be curable with early detection. Often colonic polyps contain a focus of cancer, and the patient may be considered cured if such a polyp is removed carefully.

Are there any common misconceptions about colon cancer that you see among patients?

A common misconception is that colon cancer occurs only in those with risk factors such as a family history of cancer. Unfortunately, this is not the case; colon cancer is seen in the general population.

Are there any notable disparities in age / race / gender when it comes to colon cancer cases?

Although cancer may affect all races/ages, its incidence is higher in males than females. Additionally, the incidence is also higher among African Americans, Native Americans, and Jewish people of Eastern Europe descent (Ashkenazi Jews). Finally, incidence is higher among the older population, although the incidence of colon cancer in the young is on the rise.