VIDEO: Determining what age to start, stop colon cancer screening is a ‘big controversy’
SAN ANTONIO — In this exclusive video from the American College of Gastroenterology Annual Meeting, Aasma Shaukat, MD, MPH, FACG, professor of medicine at University of Minnesota and GI Section Chief at the Minneapolis VA Medical Center, discusses a major debate in colorectal cancer screening and surveillance.
“One of the biggest controversies that we are dealing with is what age should we start colon cancer screening, and at what age should we stop,” Shaukat told Healio Gastroenterology and Liver Disease.
Shaukat notes that current guidelines from the U.S. Preventive Services Task Force, the U.S. Multi-Society Task Force and the American College of Physicians all recommend starting colorectal cancer screening at age 50.
However, the American Cancer Society recently released guidelines noting that colorectal cancer screening should begin at age 45, which, according to Shaukat, caused a conundrum.
“Their rationale was, there seems to be a rising trend in the incidence of colon cancer in individuals younger than 50, particularly 45- to 49-year-olds,” she said in an interview. “While we see a decreasing trend in men and women 50 and older, we see an increasing trend in 45 to 49 and perhaps we should try to curtail that through screening earlier.”
But, Shaukat noted it’s not as straightforward.
“We don’t have any direct benefit that screening earlier actually reduces colon cancer incidence and mortality,” she said. “Screening for them will actually cause a dent in reducing the incidence and then if we start screening this group now, we will lose our opportunity to actually study the differences between this group and an older group and then 30 years later we might be scratching our heads and saying, ‘we lost our opportunity to study that.’”
She did acknowledge that there is a documented increase in CRC incidence in individuals younger than 50 and is “very tragic and it’s something as a society we’d like to prevent.”
There is a guideline forthcoming from the U.S. Preventive Services Task Force that will update their colon cancer screening recommendation, Shaukat noted.
“For now, the message is, get everybody through the door who is 50 and older by all means, African Americans starting at age 45 and anybody younger than 50 that has any symptoms of bleeding in their stool, blood on their toilet paper, that needs to be taken very seriously and those individuals need to come to a colonoscopy,” she said. – by Ryan McDonald
Shaukat A. “At What Age Should I Start Screening and When Should I Stop?” Presented at: American College of Gastroenterology Annual Scientific Meeting; Oct. 25-30, 2019; San Antonio.
Disclosure: Shaukat reports no relevant financial disclosures.