• Colon cancer rates for people under age 50 have increased significantly over the past 10 years.
• In response, the U.S. Preventive Services Task Force has issued revised guidelines that change the recommended starting age for colon cancer screening from age 50 to 45.
• Screening can include stool tests, endoscopic tests, or computed tomography colonographies and colonoscopies.

Colorectal cancer rates have been rising in seemingly healthy people under age 50 according to recent research, and health officials are taking action.

The U.S. Preventive Services Task Force (USPSTF) has issued new guidelines today that recommended colon cancer screening start at age 45 instead of age 50.

Although roughly 90 percent of colorectal cancer cases happen in people over age 50, cases of colorectal cancer have been rising in adults younger than 50, according to the National Institutes of Health (NIH).

A study published in April 2021 in the Journal of the American Medical Association (JAMA) found that for the age group 20 to 49, colorectal cancer is estimated to become the leading cause of cancer-related deaths by 2030.

“We are seeing a clear uptick in colorectal cancer in younger generations,” Haddon Pantel, MD, a Yale Medicine colorectal surgeon, said in a statement.

Study confirms benefit of lowering age to begin screening

The new guidelines come after the USPSTF issued an initial draft recommendation to lower the recommended age to begin colorectal cancer screening from 50 to 45 years old last October.

Now, a new comparative modeling study published in JAMA confirms not only that routine screening for colorectal cancer reduces lifetime risk of being diagnosed with and dying of the disease, but that the greatest benefit was for those who began screening at age 45.

“Far too many people in the U.S. are not receiving this lifesaving preventive service,” says Task Force vice chair Dr. Michael Barry, in a statement released today. “We hope that this new recommendation to screen people ages 45 to 49, coupled with our long-standing recommendation to screen people 50 to 75, will prevent more people from dying from colorectal cancer.”

Screening can include stool tests, endoscopic tests, or computed tomography colonography and colonoscopies.

This research builds on findings from a 2016 USPSTF study, which was the basis for the previous recommendation to begin screening starting at age 50.

Risk factors for colon cancer

Certain people are more at risk of developing colorectal cancer, according to David Bernstein, MD, digestive disease specialist at Northwell Health in New York, and there are some risk factors we can change, and some we can’t.

“I totally agree with it [the new guideline],” said Bernstein. “And I think it makes perfect sense to do this.”

He said other risks include:

• eating a diet heavy in red meat
• having obesity
• smoking
• consuming alcohol

Bernstein told Healthline that people with inflammatory bowel disease, especially ulcerative colitis, are at higher risk, as are those with a family history of colon cancer or conditions such as Lynch syndrome or familial adenomatous polyposis.

“If you think about what the risk factors are, there are those that you can’t control, like family history, and there are those you can control,” he said. “Probably, you can decrease the amount of red meat that you eat, you can exercise, lose weight.”

He also points out that if you’re smoking or drinking significant amounts of alcohol, you may be able to find help to stop.

African Americans are disproportionately affected

Colorectal cancer is the third most common cancer in the United States and the second most common cause of cancer-related death.

Studies show that African American people are disproportionately affected, with over 20 percent higher incidence of colon cancer than white people, and an even larger difference in mortality.

“In the United States, the incidence and mortality rates for colorectal cancer are higher in the African American population, especially in men, than in other racial or ethnic groups. In this group, colorectal cancer also occurs at a higher rate below the age of 50,” said Elena Ivanina, DO, a gastroenterologist at Lenox Hill Hospital in New York City.

The reasons behind these rates of colon cancer in African Americans need more balanced and representative research, but inequities and racism in treatment and access to healthcare may be a factor.

According to Ivanina, the most important action you can take to prevent this disease, besides making any necessary lifestyle changes, is routine colonoscopy.

“The most important way to prevent or reduce the risk of developing colon cancer is getting a colonoscopy and removing precancerous polyps,” she said. “The other lifestyle factors include getting regular physical activity and eating a [balanced], high fiber diet.”

Colonoscopy is not the only option

“I think it important to understand that individuals at average risk can be screened for colon cancer with a stool-based test or a visual exam,” said Dory Roedel Ferraro, DNP, ANP-BC, clinical associate professor of nursing at Adelphi’s College of Nursing and Public Health.

She explained that colonoscopy is a procedure performed by inserting a long, flexible tube with a camera at the end of it into the rectum.

“This allows the doctor to visualize the large intestine to detect any abnormalities such as polyps or tumors, and to take tissue samples if necessary,” explained Ferraro.

She added, “Not everyone needs to have a colonoscopy.”

According to Ferraro, other colorectal cancer screening tests include much less invasive, stool-based tests performed annually, such as:

• fecal immunochemical test
• guaiac-based fecal occult blood test
• multi-targeted stool DNA test (“This is the Cologuard test you see advertised on TV,” said Ferraro.)

Ferraro emphasized the role nurse practitioners play in colon cancer screening and prevention.

“They can assess patient risk; counsel patients regarding healthy lifestyles, maintaining weight, regular physical activity, and diets; and discuss screening with patients as per the updated USPSTF recommendations,” she said.

Warning signs of colon cancer

Bernstein said there are particular signs to look out for.

“A change in bowel habits, in particular new onset constipation,” he said. “All of sudden, if they started noticing their stools are narrow, what we call pencil-thin stools,” he added.

Another symptom to look out for is “seeing bright red blood collecting or unexplained abdominal pain,” said Bernstein.

However, he warned the problem is that most people don’t show symptoms, which is why colonoscopy can be so important. The test doesn’t just find cancer, it actually prevents it by finding abnormal growths (polyps) that are precursors to cancer.

“The colonoscopy not only finds cancer but prevents cancer,” said Bernstein. “Meaning you can find smaller polyps and take them out. Many of those would’ve been the type that would have changed and would have become cancer in the future.”

He explained that because colonoscopy both prevents colon cancer by removing precancerous lesions and by finding cancer itself, the earlier screening begins the better.

“It makes perfect sense to move the recommendations down from 50 to 45. I believe it will save lives,” he said.

Bernstein emphasized that if you catch colon cancer before it spreads outside the colon, regardless of its size, “the prognosis is excellent.”

The bottom line

Colon cancer rates for people under 50 have increased significantly over the past 10 years. In response, the USPSTF has issued revised guidelines that change the recommended starting age for colon cancer screening from 50 to 45.

Experts say that colonoscopies save lives by not only finding cancer but also preventing it by detecting precancerous polyps, which can then be removed before they become an issue.

Lifestyle measures that can help prevent colon cancer include eating less red meat, maintaining weight, and avoiding smoking and drinking excess alcohol.

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