Gastroenterology

The study find that the age of colorectal cancer screening to 45 years in adults at average risk; issued by the American Cancer Society (ACS) last year; could result in a waste of healthcare resources, specialists warn. Therefore “I suspect they will see a lot of healthy 45-year-olds  such as kale eating marathoners getting test;” said Robert Schoen, MD, from the University of Pittsburgh.

Adults at average risk

Even though the incidence of the cancer is increasing in people younger than 50 years; the addition of this new 5-year cohort of people  absorb so many resources it; could “crowd out” older people who need it more, he explained. Instead, Schoen  along with David Lieberman, MD; from Oregon Health Sciences University in Portland say screening should start at 50 years unless the person is at elevated risk for colorectal cancer. The two specialists presented their viewpoint here at Digestive Disease Week 2019.

The overall incidence of colorectal cancer is increasing around the world; and the number of related deaths is expected to jump from 861,000 in 2018 to 1.1 million by 2030; Schoen reported. But even with this increase, the incidence in people 45 to 49 years is still only about half that in people 50 to 54 years; said Schoen.

Oregon Health Sciences

The most effective time to begin screening has been a matter of debate. The US Preventive Services Task Force (USPSTF) estimated lifetime outcomes in a model cohort of 1000 40-year-old people. On the basis of the increase in colonoscopies required to save lives and the lack of data supporting for a younger starting point, the USPSTF endorsed colorectal screening.

In contrast; ACS models which estimated more lives saved than the USPSTF model but more lifetime colonoscopies required led to the recommendation that screening start at 45 years. Schoen presented a comparison of the costs and benefits of three scenarios of colonoscopies done at 10-year intervals: screening starting at age 45; screening starting at age 55 for anyone not currently being screened; and screening starting at age 65 for anyone not currently being screened.

More lifetime colonoscopies

Compared with the current practice  screening starting at age 50 with many people not being screened lowering the age of screening would increase healthcare costs and save only a few lives; results showed. In contrast, testing unscreened older people would not only save more lives, it would save money because so many fewer people would need cancer treatment.

It is not clear why colorectal cancer is increasing in people born in 1965 or later, he explained. Sedentary lifestyles; increased use of antibiotics, more industrial food processing, inflammation and atopy, ambient radiation, and other environmental exposures might all contribute.