The U.S colorectal cancer screening age is set to lower following new research carried out by the American Cancer Society.
Colorectal cancer is cancer of the large intestine and rectum. Clumps of cells called adenomatous polyps may develop within the walls of the intestine and rectum. These polyps can be small and produce few symptoms but have the capacity to develop into cancerous tumours. This week, LetsGetChecked analyzes the development of colorectal cancer screening in the U.S.
The World Health Organization reports that colorectal cancer (CRC) is the third most common cancer in the world among the male demographic after lung and prostate cancer and the second most common cancer diagnosed among females after breast cancer.
The high incidence of colorectal cancer globally has sparked a call to action in screening programmes worldwide, in particular the higher incidence of colorectal cancer among younger demographics has provoked talks of lowering the screening age for colorectal cancer.
Global Screening Ages
The globally recommended screening age for colorectal cancer screening falls between 50 and 75 years of age using a colonoscopy every 10 years or flexible sigmoidoscopy every 5 years.
Globally, there is a 5% chance of developing colorectal cancer and a 45% of dying from the disease. Colorectal cancer has the highest prevalence in Australia and New Zealand and the lowest prevalence in Western Africa.
The rate of development in each country largely impacts on the level of awareness, subsequent screening and survival rates.
The American Cancer Society (ACS) recommends that the average age of screening is reduced to 45 years of age due to the prevalence of the disease amongst those in their early 40s in recent years.
This follows a report that predicts that 140,000 Americans will be diagnosed with colorectal cancer in 2018, with an expected 50,000 people predicted to die from the disease in the same year. Between 1994 and 2014, there was a 51% increase in the number of colorectal cancer diagnoses in those aged under 55.
Following this report, LetsGetChecked has collated the recommended screening ages worldwide. The below graph shows that Japan has the lowest recommended screening age of 40 years old while Iceland, Sweden and Finland have the highest recommended screening age of 60 years old.
The analysis of global data shows that there is a proportion of countries who exhibit a poor or non-existent quality of medical data, while other countries do not provide screening programmes to begin with. Unsurprisingly, all data shows that the higher the awareness and quality of the screening program, the lower the mortality rate by colorectal cancer.
U.S Screening Age to Decline
The American Cancer Society states that the there is a growing incidence of colorectal cancer among demographics known as Gen X and millennials. Their study reports a steady increase of 10 new cases of rectal cancer being diagnosed in patients under the age of 55, doubling the proportion of cases in 1990.
Colorectal cancer is the second leading cause of death by cancer in the U.S. Colorectal cancer has the highest incidence and mortality rates among African Americans, American Indians and Alaska Natives. Among these racial groups, the ACS previously recommended earlier screening but the group are now extending this recommendation to all races due to the higher prevalence of colorectal cancers among younger demographics.
Colorectal cancer is widely known as a “lifestyle cancer” as drinking alcohol, smoking and a poor diet heavy in processed foods are known elements in developing the disease.
The incidence of colorectal in those aged over 50 years has steadily declined over twenty years, due largely to increased awareness and the implementation of screening for that demographic. However, there has been a 51% increase in colorectal cancer among those who are under the age of 50 since 1994. In particular, rectal cancer doubled between 1991 and 2015 in individuals aged 20-49 years.
Today, the American Cancer Society reports that there 40% of U.S adults are not up to date with their colorectal screening.
Women were more likely to participate in the screening process, however men exhibits a greater number of positive results for colorectal cancer.
Globally, the Netherlands has the highest level of participation in screening programmes at 68.2%, while Canada shows the lowest level of participation at 16%. Participation is highest in screening programmes that provide a FIT test due to the single sample and non complicated nature of the test. The FIT test is the most widely used means of screening for colorectal cancer worldwide. The advent of this testing method has lead to an overall increase in participation numbers worldwide.
55% of colorectal cancer cases occur in developed regions but the highest mortality rates for the disease occur in less developed regions. The American Cancer Society suggests that lowering the number of the recommended screening age will lead to a higher level of awareness and thus a lower death rate by colorectal cancer.
The symptoms of colorectal cancer are varied and can be easily hidden. The assumption that an individual suffering from colorectal cancer would be overweight can create a false sense of security. The only way to know for sure is to take a FIT test, however symptoms that one should watch out for include:
A persistent change in bowel habits
- Has your normal bowel habit changed in recent times?
- Are you going to the toilet more often or experiencing diarrhoea?
- Do you have constipation, bloating or incomplete emptying of your back passage after going to the toilet?
Bleeding from the bottom or blood in your stool
- Have you been bleeding from your bottom with no clear reason such as local soreness, piles (haemorrhoids) or tears (anal fissures)?
- Have you tried over the counter remedies without the condition improving?
Pain in your stomach
- Do you have constant or intermittent pain, discomfort or bloating always provoked by eating? It may be linked to going to the toilet or it might come and go like cramps or colic.
A lump in your abdomen
- Can you feel a new, unexplained lump in your abdomen that won’t go away?
- Dizziness, tiredness or breathlessness for no reason
- Do you feel constantly tired, dizzy or breathless? Are you looking paler than usual?
Unexplained weight loss
- Have you lost weight without dieting, maybe due to reduced appetite?
Mistaking these symptoms for other less serious illnesses is not uncommon, and one of the reasons why half of all cancer screenings happen too late. Cancer is one of the leading causes of death worldwide, with several million new diagnoses every year. In 2012 the World Health Organization registered 8.2 million cancer-related deaths worldwide and 14.1 million new diagnoses.
Dr. Dominic Rowley explains everything you need to know about bowel cancer in this video:
Written by Hannah Kingston | Approved by Medical Director Dominic Rowley