Too Young For Colon Cancer? To Screen, or Not To Screen?
Colorectal cancer rates are on the rise among young adults. According to the American Cancer Society, compared to a decade ago, nearly twice as many adults under age 55 are being diagnosed with colon cancer annually, and more are dying from the disease each year. Where colonoscopies were previously recommended to begin at age 50, the new recommended age to begin screening is 45. What can be done to reverse this increasing trend? Understanding cause and effect as well as risk factors and available options is crucial for all adults, not just those over 50.
Colorectal cancer is when cells in the rectum or colon grow out of control. Diagnosis of this disease can be life-changing. It's important to note that colonoscopy is the most expensive and highest risk cancer-screening test ever recommended. The procedure searches for pre-cancerous polyps, known as adenomas, by inserting a camera up the rectum. In 2016, the Canadian task force advised against colonoscopy as a primary screening test due to lack of evidence on mortality outcomes.
With insufficient evidence, many people have opted out of colonoscopy screening. Other options such as a Cologuard test may only detect 42 - 69% of large, precancerous polyps but are much less invasive. Cancer screening does not always reduce all-cause mortality. Sometimes healthy people find themselves becoming patients receiving unnecessary procedures and costly treatments. Despite a lack of mortality benefit data, the United States Preventive Services Task Force (USPSTF) has increased recommended screening options and expanded the screening age range to start at 45-49 years old.
A randomized trial led by Michael Bretthauer, a gastroenterologist and researcher in Norway, included over 84,000 people ages 55-64. The results found colonoscopy does not significantly reduce risks of colorectal cancer or mortality. To prevent just 1 colorectal cancer case, 455 people needed to be screened. The mortality risk was only slightly reduced in the colonoscopy group compared to the control group.
There are also risks to colonoscopy, including colon perforation. The preparation is unpleasant, requiring drinking fluids to clean out the colon. The procedure is time consuming with extended recovery time needed afterwards. Given the lack of mortality benefit and the risks and burdens of colonoscopy, the average person may reasonably decline screening. Researchers are currently working on a large randomized trial to compare colonoscopy and fecal matter screens.
The Center for Disease Control and Prevention lists diets low in fruits and vegetables, alcohol consumption, tobacco use, being overweight and obese, meat consumption, and lack of physical activity as being the leading causes. While colonoscopies may still be useful in some cases, what if we put more focus on prevention? What if more research was done on the benefits of making fresh produce available to more people? Why? Those are the most nutrient-dense, water-rich, high-fiber foods on the planet. What if we focused resources on cancer prevention efforts rather than extensive screening that has been shown to provide little advantage? Some food for thought on how lifestyle choices impact one of the leading causes of mortality.
