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Colorectal cancer testing should now start at age 45 for healthy adults


There are six different test options outlined in the ACS guidelines that it recommends at various intervals, depending on the given method selected. (Pamela A Moore)

The American Cancer Society updated its guidelines for colon and rectal cancer screenings, lowering the age at which healthy adults should get their first test from 50 to 45.

The updated recommendation, published in CA: A Cancer Journal for Clinicians on Wednesday, comes on the heels of upward trends over the past 24 years in colorectal cancer rates among younger Americans.

While some groups are already considered at a higher risk of developing these cancers — such as people with a family history or African-Americans — the new guideline widens the need for earlier screenings for the general popuation.

"Colorectal cancer (CRC) is the fourth most commonly diagnosed cancer among adults in the United States," the ACS said in its report. "Among adults younger than 55 years, there was a 51% increase in the incidence of CRC from 1994 to 2014 and an 11% increase in mortality from 2005 to 2015."

Experts are at a loss as to why colorectal cancers are developing in younger people, although some speculate poor diet is a potential factor.

"There's little evidence for any underlying cause," director of the Division of Gastroenterology at NYU Langone Health, Dr. Mark Pochapin, told the Daily News. "It could be a change in the bacteria living in the gut or changes towards diets rich in fat, red meat and processed foods."

There are six different test options outlined in the ACS guidelines that it recommends at various intervals, depending on the given method selected. An otherwise healthy adult should: undergo a colonoscopy every 10 years or a "virtual colonoscopy" every five years, a flexible sigmoidoscopy every five years, a stool DNA test every three years, a fecal immunochemical test every year or a fecal occult blood test each year.

"Only a colonoscopy can prevent cancer by removing polyps," Pochapin told The News. "Any other tests that come back positive will then need a colonoscopy."

Pochapin said that the most important risk factor is family history. Anyone who has a parent, for example, who had colon cancer, needs to be screened 10 years younger than when that parent first found a polyp. Anyone with a family history of associated cancers, like rectal, uterine or cervical, are also considered at a higher risk.

"Smoking is also a risk," Pochapin said. "Excessive red meat consumption or alcohol use and obesity are all risk factors. If you're at a high risk or are experiencing colorectal cancer symptoms, like a marked change in bowel habits, narrowing of the stool, rectal bleeding or unexplained anemia, you have to be evaluated."

Colon cancer is one of the most treatable cancers — especially when discovered early. Pochapin said that the ACS came to its new guidelines by seeing a great improvement in what's known as "live years saved," or, the number of years added to a person's life because of early intervention thanks to screenings like colonoscopies at and after 50 years of age. Colon cancer prevention is one of the "most successful public health campaigns we've ever had," he said.

"The ACS felt that earlier screenings would help everybody in preventing colon cancer," Pochapin told The News. "By looking for early signs of cancer — in the form of precancerous polyps at age 45 — the test might find it earlier when it's still benign, keeping you healthy and not allowing you to develop cancer."