Physicians with the Mays Cancer Center, home to UT Health San Antonio MD Anderson, praised the May 18 move by the U.S. Preventive Services Task Force to lower from 50 to 45 the recommended age to begin screening asymptomatic persons to prevent colorectal cancer. The goal is to identify and remove precancerous benign polyps. Physicians nationwide adhere to the panel’s guidelines.
“This is a long-awaited change,” said Haisar Dao Campi, MD, FACS, FASCRS, associate professor of surgery at The University of Texas Health Science Center at San Antonio, which includes the Mays Cancer Center. “Surgeons, gastroenterologists, and medical and radiation oncologists have seen with increased worry how younger and younger patients are presenting with advanced colorectal cancer. Nowadays it is not out of the ordinary to have patients significantly younger than 50 years of age with metastatic disease, with no risk factors to account for such an aggressive condition.”
“From 1990 to 2030, overall cancer incidence in patients under 50 is projected to increase by more than 133%,” said Alicia Logue, MD, associate professor of surgery, also with the Mays Cancer Center. “Additionally, people born after 1990 are thought to have a higher risk of colorectal cancer.”
Colon cancer, in particular, is thought to be a disease of older people. “Unfortunately, that’s not always the case,” Dr. Logue said.
All adults should begin colon cancer screening at age 45, which by definition is done in asymptomatic persons. Physicians emphasize to patients that the absence of symptoms does not mean screening is not needed. Certainly, anyone having persistent stomach pain or other sorts of gastrointestinal (GI) issues should report these symptoms to their health care provider promptly. “The incidence of this in young people, even those under 45, is definitely increasing,” Dr. Logue said.
Coverage at 45
The Preventive Services Task Force revision “will open the doors for screening patients at an earlier age, changing the disease course through diagnosis, and treating benign polyps before they undergo transformation into invasive disease,” Dr. Dao Campi said.
The task force action also results in most insurers extending coverage of colorectal cancer screening to those 45 to 49 with no copay. “Increasing the number of patients eligible to be screened will benefit our overall health as a society,” Dr. Dao Campi said.
One thing the revision does not do is change human behavior about the leading colon cancer screening tool, colonoscopy. Younger people tend to avoid it.
“It’s invasive and nobody likes the idea of the procedure that is involved, and additionally, the person being screened has to take bowel prep the day before, which requires taking a couple of days off from work,” Dr. Logue said.
Although colonoscopy is the best way to evaluate the colon for disease and treat small polyps if found, other screening modalities can be used, including a fecal occult blood test and fecal immune histochemistry, Dr. Logue said.
“These tests can be tremendously helpful, they’re not invasive, and are an alternative screening option that patients reluctant to consider colonoscopy may discuss with their doctor,” she said. “Positive results on an alternative screening test typically result in a recommendation for colonoscopy.”
Chadwick Boseman, the actor who portrayed baseball legend Jackie Robinson in 42 and King T’Challa in the Black Panther, was just 43 when he died on Aug. 28, 2020. He had been diagnosed four years earlier with stage III colon cancer.
Dr. Logue noted that Black people generally are diagnosed with this cancer at a younger age and have an overall poorer prognosis with the disease. They will benefit from being able to be screened earlier.
Ruben Mesa, MD, FACP, executive director of the Mays Cancer Center, praised the revision and committed to spreading the word. “As the National Cancer Institute-Designated Cancer Center for San Antonio and South Texas, the Mays Cancer Center will work with community partners and UT Health San Antonio’s clinical practices to tell as many people as we can about this change and expand colon cancer screening in the region,” he said.