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Published on July 23, 2018

This deadly cancer is striking younger peopleThis deadly cancer is striking younger people

Think you’re off the hook for a colonoscopy until you’re 50? Not anymore.

With more and more Americans getting the disease at a younger age, the American Cancer Society now recommends you get your first colonoscopy at 45. The group announced the change in its recently released recommended guidelines.

According to a study published earlier this year in the Journal of the National Cancer Institute, people born in 1990 have double the risk of colon cancer and four times the risk of rectal cancer than people born in 1950. The organization says poor lifestyle choices are probably to blame, such as being overweight, being inactive, smoking, drinking heavily, and eating too much red meat and fried, grilled and heavily processed meat.

“Obviously, it’s scary, it’s alarming,” said Liam Haveran, DO, a Hyannis surgeon who specializes in colon and rectal surgery.

Rectal Cancer Rates Up

The study, which was done jointly by the Intramural Research Department of the American Cancer Society and the Intramural Research program of the National Institutes of Health/National Cancer Institute, examined the records of nearly 500,000 people 20 and older diagnosed with colon or rectal cancer between 1974 and 2013.

Researchers found that for patients 20-39 years old, the rate of colon cancer increased 1 to 2 percent per year. For patients 40-54 years old, the rate increased by 0.5 to 1 percent annually from the mid-1990s to 2013.

Rectal cancer rates rose more dramatically, by 3 percent annually for patients 20-29 years old between 1974 and 2013. They also rose 3 percent annually for patients aged 30-39 from 1980 to 2013. In comparison, rectal cancer rates increased by 2 percent annually for adults 40-54 years old between the 1990s and 2013.

Many Choices For Screening

Colorectal cancer screening can be done through a variety of fecal (stool) tests or visual procedures. The ACS stresses getting tested rather than endorsing one type of exam. It recommends the following testing schedules for these tests:

  • Highly sensitive fecal immunochemical test (FIT) – detects blood in stool, annually
  • Highly sensitive guaiac-based fecal occult blood test (gFOBT) – detects blood in stool, annually
  • Multi-targeted stool DNA test (MT-sDNA) – detects indicators of cancer, precancerous lesions and blood in stool, every three years
  • Colonoscopy – examines colon (large intestine) via inserted scope, every 10 years
  • CT colonography (virtual colonoscopy) – examines colon via low-level X-rays, every five years
  • Flexible sigmoidoscopy (FSIG) – examines rectum and lower colon via inserted scope, every five years

Still The Gold Standard

Dr. Haveran said he prefers colonoscopy, as it allows him to view the walls of the lower intestine and take tissue samples or remove polyps, if present. The procedure is low-risk and would likely be ordered if a fecal test indicated bleeding, he said.

“Colonoscopy is the gold standard,” he said.

The ACS recommendation has not been adopted by the American Society of Colon and Rectal Surgeons, of which Dr. Haveran is a member. He said the group, as well as the American College of Gastroenterology, is likely studying the recommendation before acting, but he said the data was compelling and he would keep it in mind when seeing younger patients.

“It makes sense to me, based on what I see,” he said.