Cancer Society says screening for colon cancer should start at 45, not 50; Ky. leads the nation in colon cancer and deaths from it

By Melissa Patrick
Kentucky Health News

In response to rising rates of colorectal cancer among younger people, the American Cancer Society now recommends that adults with a normal risk for colon cancer get their first screening at age 45, instead of 50.

The change was prompted by an ACS study published last year in the Journal of the National Cancer Institute, which found that since the mid-1990s colon-cancer rates among Americans between the ages of 20 and 54 have been steadily increasing, between 0.5 percent and 2 percent per year. Rectal cancer has risen more rapidly, 2 to 3 percent a year.

“Millennials have double the risk of developing colon cancer and quadruple the risk of rectal cancer for reasons that are not yet 100 percent clear,” Amanda Smart, executive director of the Colon Cancer Prevention Project, said in a news release about the new recommendations.

Nationally, colon cancer is the second leading cause of death from cancers that affect both men and women with 43 percent of “young onset patients” diagnosed between the ages of 45 and 49, according to the release.

Kentucky leads the nation in colon cancer, but is nationally recognized for getting its citizens screened for it, moving from 49th to 19th in the past 15 years. However, only 65 percent of Kentuckians 50 and older have been screened. So, there’s more work to do — especially in a state that ranks fourth for colon cancer deaths.

Smart added, “No matter your age, if you are experiencing symptoms such as rectal bleeding, unexplained anemia, changes in bowel habits, unexplained weight loss or gain, or unexplained abdominal pain, please don’t wait to be screened!”

Dr. Whitney Jones, a Louisville gastroenterologist and founder of CCPP, emphasized that, while this policy change is a huge step forward, it only applies to individuals with average risk who do not have symptoms.

“Those with a family history of colon or rectal cancer, or advanced adenomatous colon polyps, should check with the doctor about on-time screening, which begins at 40 but could be necessary even earlier,” he said in the release.

Options for screening include a colonoscopy, which is recommended every 10 years for people at average risk of the disease, a yearly stool test that looks for hidden blood, a DNA-based stool test done every three years, virtual colonoscopy and a flexible sigmoidoscopy, according to the National Cancer Institute. 

Colon cancer usually starts from precancerous polyps in the colon or rectum, which can be removed before they turn into cancer. Screening also allows for early detection of the cancer, which is 90 percent curable when detected early.

In Kentucky, those with commercial insurance will be immediately eligible to receive “on-time” screening at 45, says the release.

Kentucky Medicaid has no age restrictions on colonoscopies for its fee-for-service members. The co-payment requirement is cancelled if it is billed as a preventive service for people 50 and older, but the state Department for Medicaid Services says it is working to have this changed to 45. The department said managed-care organizations will develop their own policies for their members.

Smart added that the new guideline may cause some confusion for doctors and patients, and stressed that it will be important for providers to enter the appropriate insurance code to make sure younger patients don’t get charged for the exam.

The Patient Protection and Affordable Care Act requires colon cancer screenings be entirely covered by insurance. Kentucky has also passed a law to clarify that a fecal test to screen for colon cancer, and any follow-up colonoscopy, are also covered by insurance.

Smart said her Colon Cancer Prevention Project can help patients who have been wrongly charged.

The U.S. Preventive Services Task Force guidelines still recommend initial screening for colon cancer at age 50 for those with average risk.

Laurie McGinley of The Washington Post reports that the task force decided several years ago to not lower its recommended age because it concluded that the data was mixed and that a younger starting age would only proved a “modest” benefit. She adds that the cancer society, by extending the analysis used by the task force and incorporating recent data on the rising incidence of the disease among younger people, came to a different conclusion that shows the life-saving potential of earlier screening.

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