Experts: New screening guidelines for colorectal cancer could save lives
Posted May 31, 2018 2:26 p.m. EDT
ATLANTA -- Natasha Haddad's maternal great-grandmother and grandmother died of colon cancer.
So, she's worried that she's at a higher risk of getting the disease.
She would be screened in a minute. The problem is the Atlanta human resources and payroll assistant is 46.
She said her insurance won't pay for a colonoscopy because of her age and because she is not currently experiencing any symptoms.
"It really scares me," said Haddad.
Her situation could change.
The American Cancer Society, in a dramatic move, has proposed that Americans start routine colorectal cancer screenings at age 45 for people of average risk instead of the long-held recommendation of age 50.
"I think this is great," said Haddad, who lived with her grandmother as she battled the disease. "Colon cancer can be very sneaky. I'm certain I'm going to end up going to a doctor and being told I have polyps. The moment my insurance says they're paying for it, I'm getting one. It's not a very pleasant experience, but I'd rather do that than die."
The move, say experts and colorectal cancer survivors, could change thousands of lives.
"It's a big deal and a very important change," said Dr. Richard Wender, chief cancer control officer for the Atlanta-based American Cancer Society. "We've been recommending screenings for colorectal cancer for people 50 and older, but we know we can have a greater impact (with earlier screenings). We just need to work hard to implement a new mindset for clinicians and the public."
In the United States, colorectal cancer is the fourth-most-common cancer diagnosed among adults and the second-leading cause of death from cancer, according to the ACS. It's expected to cause more than 50,600 deaths this year.
Each year, more people die of lung cancer than of colon, breast and prostate cancers combined.
The five-year survival rate for colorectal cancer when it's diagnosed at an early stage is 90 percent, but diagnosis in younger people is often delayed. After all, most younger people don't think about colorectal cancer.
It's something that their grandparents or parents might face, not someone starting a family or someone in midcareer.
Atlanta attorney Tawny Mack was diagnosed with stage 3 colon cancer in June 2016.
She was 30 years old.
For years, Mack had complained to doctors about the presence of blood in her stool. Each time, she was told it probably wasn't anything to be worried about.
"They just dismissed my concerns because of my age," said Mack, who said doctors also cited her overall good health, her level of activity and the fact her bloodwork came back perfect. "Looking back, I should have pushed back against the doctors. I should have advocated more for myself. I trusted my doctor. I relied on him as an expert."
It wasn't until she went to a gastrointestinal specialist that Mack finally got her colonoscopy.
Mack had surgery to remove the cancerous growth, which was about the size of a golf ball, and underwent six months of chemotherapy. Currently there are no signs of the disease in her body.
While the new guidelines may not have helped her, she thinks it could have sent a strong message to the medical community and insurers.
"This is going to save lives, even if they just lower it by five years," said Mack of the new recommendation. "This increases awareness that colorectal cancer is changing. It's no longer just an older person's disease. "
The revised recommendations were published in CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the ACS.
A more comprehensive colonoscopy is not the only screening one may have. The ACS "wants physicians to offer patients a choice of six different screening options, from the most invasive procedure, colonoscopy, which can be done every 10 years, to lab tests done on stool samples that can be collected at home, which must be repeated more often and followed by colonoscopy if results are positive," according to The New York Times.
According to a report in JAMA, by 2030, 10.9 percent of all colon cancers and 22.9 percent of all rectal cancers will be diagnosed in patients younger than 50.
The Colorectal Cancer Alliance plans to invest $10 million in research, which, among other things, will examine why there appears to be an increase in young-onset colorectal cancer.
Michael Sapienza, CEO of the Colorectal Cancer Alliance, said his mother died of colon cancer at age 59, so whether he would one day get the disease sometimes creeps into the back of his mind.
Because of his job, Sapienza, 39, got an early screening, but he worries about other Americans who haven't had the same opportunity.
"It's compelling," he said. "If this is implemented and doctors buy in and insurance companies buy in, it will save lives. It's a huge step in the right direction, but there's still a lot of work to do."
Sapienza said the moment the revised recommendation was released, his office began getting calls from people who are younger than 45.
"We've gotten calls and emails and tons of messages, asking, 'What about us? I was 37 when I was diagnosed. I was 29 or 43 when I was diagnosed.'"
Dr. Charles A. Staley, chief of the Division of Surgical Oncology at Winship Cancer Institute of Emory University, has been concerned for years.
"In my practice, in the last 10 years or so, I've seen younger people come down with colon cancer who are ages 51, 52 and 53," he said. "Boom. All of a sudden, they have colon cancer."
The increase could be attributed to several factors, including obesity, diet, environmental issues, lack of exercise, smoking, alcohol and less fiber in the diet. And certainly that includes people who are medically predisposed for the disease.
"The key here is reinvigorating the discussion that this is a preventable cancer," he said. "What we need is for people to get screened."
Deondre Williams, an entrepreneur from Covington, Georgia, was diagnosed with colon cancer last July at age 36, but is now in remission.
His father was diagnosed with colon cancer at age 25. Despite that family history, Williams thought the blood in his stool was from hemorrhoids.
"I'm one of those people who don't like to think the worst," he said. Soon, though, the problem returned and there was more blood this time.
His wife urged the father of five to get it checked out.
His colonoscopy came back positive for cancer.
He thinks the revised guidelines are good, but wonders if age limits should be removed anyway.
"You don't have a limit to get checked for AIDS/HIV," he said. "So why do I have to wait until I'm 45 or 50 to get screened for colon cancer? If you have insurance, you should be able to get checked out for whatever you need. My father had cancer at 25. It's better to check sooner rather than later."
-- The American Cancer Society is now recommending that adults undergo screening for colorectal cancer beginning at age 45 rather than 50.
-- People with a family history of colorectal cancer are already advised to start getting screening tests before age 50.
-- Colorectal cancer is the fourth-most-common cancer diagnosed among adults in the United States. More than 50,000 people are expected to die of colorectal cancer this year.
Shelia M. Poole writes for The Atlanta Journal-Constitution. Email: spoole(at)ajc.com.
Story Filed By Cox Newspapers
For Use By Clients of the New York Times News Service