Blog | Friday, June 8, 2018

American Cancer Society wants colon cancer screening at age 45


Until last week, colon cancer screening for most folks started at age 50. Why 50? Why hadn't the colonoscopy coming of age been set younger to prevent the tragedy of a 45-year-old, or an even younger person, developing colon cancer? In the past 2 weeks, I had to give a young patient and his wife the sad and serious news that he had colon cancer. Because of his young age, he never received a screening colon exam, as we routinely do with 50-year-old individuals. Is it time to make an adjustment?

Our colon cancer screening system is not perfect. It is not designed to prevent every case. There have been people in their 20s who have been diagnosed with this disease, and there is simply no way to capture them in the system. Experts in disease prevention must carefully analyze disease trends and behavior to find the sweet spot of when to begin screening. And, money is part of this decision. Let's face it. We don't have unlimited resources to pay for every worthy medical benefit.

Determining when to recommend mammography, and how often this test should be done, is a very similar issue.

Colon cancer prevention experts had believed that age 50 was the proper starting point for screening. Delaying until age 55 would leave too many people at risk, and starting earlier would save too few folks and wouldn't be worth the cost or effort. That is, until now. The American Cancer Society (ACS) issued new guidelines last week recommending that colon cancer screening start at age 45, a radical change from established dogma. The reason is that colon cancer in younger people has become more common. Keep in mind, this recommendation did not emanate from a gastroenterology (GI) organization who might be expected to endorse any system that would benefit GI practitioners like me. The ACS revised its colon cancer screening guidelines on the merits. We await responses from other respected medical organizations on this issue. And ultimately, insurance companies and the government will have to buy in to this proposal.

This bold recommendation, if universally adopted, will save lives. Maybe yours will be one of them.

This post by Michael Kirsch, MD, FACP, appeared at MD Whistleblower. Dr. Kirsch is a full time practicing physician and writer who addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.