Cancer Study Recommends Lowering CRC Screening Age

January 25, 2016

The authors of the study recommend lowering the screening age for colorectal cancer (CRC), especially for first-degree relatives of CRC patients and those with a genetic predisposition to the disease.

A retrospective analysis of colorectal cancer (CRC) patients in the United States found that nearly 15% of diagnosed patients were less than 50 years old, which is the recommended screening age in the United States. This is concerning and raises questions about policy changes to address questions around monitoring younger adults earlier for their risk of developing CRC.

Conducted at the University of Michigan, the population-based retrospective study of the Surveillance, Epidemiology, and End Results registry, published in the journal Cancer, analyzed information on patients diagnosed with CRC in the United States from 1998 to 2011. Of 258,024 patients, 37,847 (nearly 15%) were younger than 50 years old, the recommended screening age.

Young colorectal patients were more likely to be diagnosed with the more advanced regional or distant disease, which are both more dangerous than localized disease, the study found. Among CRC patients with distant metastasis, younger patients were more likely to receive surgical therapy for their primary tumor (72% versus 63% of older patients), as well as radiation therapy (53% versus 48%). Overall, CRC patients who were younger than 50 years old lived slightly longer without a cancer recurrence, even though they tended to have more advanced disease when they were diagnosed, the study found. This result, the authors suggest, could be a result of the more aggressive treatment that the younger patients received.

The 5-year cancer-specific survival for younger patients was 95.1% versus 91.9% for patients 50 and older for localized disease, 76% versus 70.3% for regional disease, and 21.3% versus 14.1% for distant disease, respectively.

“This study is really a wake-up call to the medical community that a relatively large number of colorectal cancers are occurring in people under 50. In a practical sense, this means that we should look out for warning signs of colorectal cancer such as anemia, a dramatic change in the size or frequency of bowel movements, and dark blood or blood mixed with the stool in bowel movements,” said study author Samantha Hendren, MD, MPH, associate professor of surgery at the University of Michigan Medical School, in a press release. She also suggests optimizing the process of early screening (earlier than 50 years) in individuals with a positive family history for CRC, such as in those with a first-degree relative with CRC and some others who are at higher risk should begin screening earlier than 50. “This is already recommended,” said Hendren, “but we don’t think this is happening consistently, and this is something we need to optimize.”