New colorectal screening guidelines: What they mean for you

August 20, 2018 | by Molly Peck

Recently, the American Cancer Society changed their policy regarding colorectal cancer screenings. For many years, the group had recommended being checked every 10 years, beginning at age 50.
Now, the recommended age to start screening has been changed to 45, following a sustained increase in colorectal cancer in adults under 50.
Cary Presant, M.D., a hematologist and oncologist with City of Hope, answered a few questions to give us a better perspective on this change.

Patients Getting Younger

Researchers are unsure of the reason for the increase in colorectal cancer in younger adults, but it’s being seen across the country.
The best preventive measure one can take is to catch colorectal cancer early, which vastly improves survival rates. One reason for this is that when caught early, polyps that may later become malignant can be removed.
The American Cancer Society hopes that 16,000 more cases of colorectal cancer will be detected this year with the change in guidelines. They also hope to debunk the myth that people under 50 years old are too young to have colorectal cancer. Many doctors are not currently trained to look for colon or rectal cancer in patients under 50, which can result in misdiagnosis and delay treatment, said Presant.
Don’t let the doctor say they don’t have time to discuss your risk of colorectal cancer!”

Plan on Prevention

According to Presant, many diagnosed colorectal cancer patients under 50 do not exhibit traditional risk factors (including obesity, smoking, drinking alcohol and inactivity). Still, Presant said that the best way to prevent colorectal cancer is to improve your health.
“Eat a diet that has more fruits and vegetables, that has less red meat and more fish and chicken,” he said. “Be sure your diet has fiber. Avoid excessive alcohol, avoid smoking altogether, and exercise.”

Colonoscopy and Other Options

There are less invasive procedures than colonoscopy available to test for colorectal cancer. Home stool tests can be easily perfomed, wherein you send a sample to a lab for analysis. A second type of home stool test is called the multitarget stool DNA test, or MT-sDNA. This tests for blood in the stool as well as abnormal DNA that could indicate polyps or cancer.
Another test called a flexible sigmoidoscopy is alternatively known as a virtual colonoscopy. The procedure consists of a small, flexible camera being inserted in to the lower colon, and is used for the detection of polyps and other risk factors. Sigmoidoscopies examine the lower part of the colon, where polyps are most common. Flexible sigmoidoscopies are recommended every five years according to the new American Cancer Society guidelines. According to recent research, no colorectal cancer test is more effective than another, and the American Cancer Society cites no preference on the types of tests.  
Presant said that he prefers the colonoscopy “because it will find and remove polyps, as well as see other issues in the colon, like diverticulitis.” None of the other tests, he said, can remove polyps at the same time as detecting them, meaning the patient would have to have a colonoscopy in addition to the first test, if it were positive.

Hereditary Risk

Besides testing, the other important fact to remember is that colorectal cancer can run in families.
“First thing, know what your family history is,” said Presant. “Knowing if your relatives have had colorectal cancer or related cancers — endometrial, ovary, stomach, small intestine, hepatobiliary tract, urinary tract, brain and skin cancers — can affect how your doctor tests you for colorectal cancer. If your family has a history of colorectal cancer, you may want to start testing at age 30 to 40, instead of 45.”
Along with the release of new screening guidelines, the American Cancer Society has released new handouts about colorectal cancer, meant to facilitate engagement between patients and doctors. 
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