New Guidelines Advocates Colonoscopy 5 years earlier to screen for Colorectal Cancer
Node Smith, ND
Primary care doctors may be reminding their patients to schedule appointments for routine colorectal cancer screening by colonoscopy before age 50, soon. Fifty has been the age that the American Cancer Society (ACS) and other preventative guideline organizations have recommended beginning screening for colorectal cancer. However, new data is showing that the increased prevalence of colorectal cancer in younger individuals may warrant moving the initiation of screening forward, to 45 years of age.1
Study recommends screening for colorectal cancer 5 years earlier
The study, published in the journal Cancer, recommends screening for colorectal cancer 5 years earlier – age 45 – for both men and women regardless of race or ethnicity. This is a considerable change; however, estimates have been made that if everyone followed screening recommendations colorectal cancer could be cut in half.
Annually, 140,000 new cases of colorectal cancer are are diagnosed, and over 50,000 Americans will die from the disease yearly. Worldwide, about 850,000 will die.
SimCRC and MISCAN
It’s extremely difficult to assume that multiple cohorts of people will start screening for conditions at different ages, and then follow the outcomes from these cohorts. Instead, mathematical models are used to stratify the burden-benefit ratio for beginning general screening at various ages. Two models that are commonly used are SimCRC (a collaboration between the University of Minnesota and Massachusetts General Hospital) and MISCAN (by Memorial Sloan-Kettering in New York City and Erasmus, MC in the Netherlands).
Current study used MISCAN model
The current study used the MISCAN model, strategizing ages from 40 to 50 as possible initiation ages for screening, and 75 to 85 as ages to stop screening. The intention was to figure out how many years of life were gained per colonoscopy. The age which was found to have the greatest benefit-to-burden ratio was screening colonoscopy every 10 years beginning at 45 and ending at 75 years.
The question remains: why the increase in colorectal cancer in younger populations?
The bigger question, which the authors point out in the study, is why the increase in colorectal cancer at younger ages. Obesity, tobacco and alcohol, do not seem to account for the increase in prevalence, and researchers are beginning to look at sugar, tap water, microbiome and other lifestyle factors. From a holistic perspective it is likely that the widespread impact of “all of the above” factors are at work, and finding a single culprit is doubtful.
- Peterse, E. F., Meester, R. G., Siegel, R. L., et al. (2018), The impact of the rising colorectal cancer incidence in young adults on the optimal age to start screening: Microsimulation analysis I to inform the American Cancer Society colorectal cancer screening guideline. Cancer. . doi:10.1002/cncr.31543
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Node Smith, ND, is a naturopathic physician in Portland, OR and associate editor for NDNR. He has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp-out where naturopathic medicine and medical philosophy are experienced in nature. Four years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.