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Colon cancer screening should start earlier, at age 45, US committee says

Adults should start routine colorectal cancer screening at age 45, instead of waiting until age 50, a US task force recommended on Tuesday, reflecting the sharp rise in colon cancer numbers and rectum in young adults.

The US Preventive Services Task Force’s proposal has yet to be finalized. His advice on screening and preventive care services is followed by doctors, insurance companies and policy makers.

Although the vast majority of colorectal cancers are still found in people aged 50 and over, 12% of the 147,950 colorectal cancers that will be diagnosed this year – or 18,000 cases – will be found in adults under 50, according to a study. from the American Cancer Society. The incidence of colorectal cancer, which declined steadily for people born from 1890 to 1950, has increased for every generation born since the middle of the 21st century.

Many early-onset cancers are diagnosed in people as young as their 20s and 30s who will not be covered by the draft recommendation. For example, Chadwick Boseman, the actor who has appeared in “Black Panther” and other films, died in August at age 43 of colon cancer diagnosed several years earlier. Still, cancer advocates hailed the task force’s proposal as a major breakthrough, saying it has the potential to save tens of thousands of lives.

The panel stressed that healthcare providers should especially encourage black men and women to get tested at age 45, due to the high rates of the disease and higher death rates in African American communities.

“This is probably the best news for colorectal cancer patients and survivors that I can remember over the past 10 or 20 years,” said Michael Sapienza, CEO of the Colorectal Cancer Alliance, an advocacy group. “We have been fighting for this for so long. This is a huge victory for our community and a milestone for the colorectal cancer community and for cancer care.

Doctors who treat cancer patients also praised the recommendation, saying it would draw attention to concerns about early-onset colon and rectal cancer and encourage primary care physicians and clinicians. young adults to consider warning signs such as rectal bleeding and changes in stool. The committee refused to lower the screening age when it last updated its recommendation in 2016.

“Lives will be saved,” said Dr. Kimmie Ng, director of the Young-Onset Colorectal Cancer Center at the Dana-Farber Institute in Boston. “We will prevent cancers in young people, catch them at an earlier stage when they are more likely to be cured, and hopefully improve survival rates.

Dr Scott Kopetz, a gastrointestinal medical oncologist at the MD Anderson Cancer Center in Houston, agreed. “One in three patients we see now is under 50,” he said. “It’s a major problem.”

Some critics, however, said the draft recommendation was long overdue and fell far behind data showing an increase in colorectal cancer in young adults. The American Cancer Society recommended in 2018 starting routine screening at age 45, after its own researchers reported a sharp increase in the disease in adults as young as 20 and 30, including a particularly sharp increase in rectal cancers.

Jim Nauen, 54, of Newton, Mass., Learned he had stage 3 rectal cancer at age 49 after his doctor urged him to have a colonoscopy before he was 50. but the procedure detected a tumor the size of a baseball.

“If I had been screened at 45, nobody can say specifically, but it could be just a polyp that would have been zapped and we would all have gone our way, or maybe stage 1 cancer. Mr. Nauen said. Instead, he underwent three surgeries, chemotherapy and radiation therapy.

Younger patients say their complaints are often dismissed by doctors. According to a report from the Alliance Against Colorectal Cancer, 81% of young adults with colorectal cancer surveyed said they had at least three symptoms of cancer before being diagnosed, while more than half were in pain. diagnosed and said they had hemorrhoids, anemia, irritable bowel syndrome or even mental health issues.

Kim Newcomer, 47, who runs the Never Too Young program for the alliance, said she learned she had advanced rectal cancer at 35 but had to fight to have a colonoscopy and that a doctor had told her at one point that she had a “woman hysteria.” She said the recommendation was “a step in the right direction, but there is always more to be done”.

The task force bases its recommendation on scientific evidence, and Dr Alex Krist, a family physician at Virginia Commonwealth University who chairs the task force, said a review of the evidence indicated that the greatest benefits would come from the screening adults aged 45 to 75 years. , not younger adults.

“The risk of developing colon cancer for a 45-year-old today is the same as for a 50-year-old in the past,” Dr. Krist said.

The recommendation of the task force, a group of independent experts appointed by the Department of Health and Social Services, is a draft proposal. The next step is for the committee to release the draft for review, solicit public comment for a period of four weeks, and then develop the final recommendation. Although the committee, which gives ratings to its guidelines, gave the new recommendation a “B”, meaning that there is high or moderate certainty of the benefits, most private insurance plans must fully cover. services that receive an “A” or Grade “B”, without patient co-payment, once the recommendation is approved. (For those aged 76 to 85, the committee did not change its recommendation for patients to discuss the risks and benefits of screening with their healthcare provider.)

Although people often think of a colonoscopy when they think of screening for colon cancer, the task force recommended choosing direct visualization tests such as colonoscopies as well as tests to identify signs of cancer at from stool samples. Stool-based tests are not invasive and can be done at home, but should be done more frequently. Colonoscopies are invasive tests that carry some risk, but can be done every 10 years.

The recommendation to step up screening is an anomaly for the task force, which canceled screening for certain reproductive cancers in women more than ten years ago. In 2009, the panel said women should delay their first Pap smear until the age of 21 and be tested less frequently than they had in the past. That same year, the committee recommended that women start routine mammograms at age 50, rather than 40, and get them every two years, rather than once a year.

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