US Task Force Recommends Colorectal Cancer Screening Begin at 45

The sad news of the death of “Black Panther” actor Chadwick Boseman at the age of 43 from colon cancer drew attention to the need for earlier screening, particularly for Africans and African Americans who carry a higher risk for colon cancer. On October 27, 2020, the U.S. Preventive Services Task Force, an independent group of experts appointed by the Department of Health and Human Services, issued its draft recommendations that individuals should be screened for colorectal cancer beginning at the age of 45 based on increasing case rates and deaths in patients under age 50. This recommendation is now in the four-week public comment phase before they can develop a final recommendation. This recommendation by the Task Force is consistent with a 2018 recommendation from the American Cancer Society.

When people think of colorectal cancer screening, the first thought that comes to mind is a colonoscopy; however, the Task Force recommends a choice of screening methods for people based on personal preferences and availability. Screening can be conducted either via a high-sensitivity stool-based test (which must be followed up by a colonoscopy if the result is positive) or a structured visual test like a colonoscopy. This recommendation from this task force is commended for its potential to save lives, and there are several methods that can be used to screen for colorectal cancer, including:

• Flexible Sigmoidoscopy: only examines half the colon
• Colonoscopy: examines the whole colon, if found, polyps can be removed during a single exam
• Computed Tomo-graphic Colonography (Virtual Colonoscopy): not covered by many insurance plans
• Guaiac-based fecal occult blood test: used to detect upper gastrointestinal bleeding but due to affects from proximal gastrointestinal bleeding, this test can lead to false-positives
• Fecal Immunochemical Test (FIT): uses antibodies to detect human blood in the stool, detects some polyps
• Multitarget stool DNA Test (MT-sDNA; Cologuard, Exact Sciences): used to detect both altered DNA and blood in the stool, detects many polyps

People may question the efficacy and accuracy of each test and wonder which is best. Effective screening is based on sensitivity, compliance, and access. The main barriers are compliance with recommended screening recommendations and access. It is best for people to discuss these various options with their physicians. All of these options are thought to reduce colon cancer deaths and improve high quality years of life, with good safety.

Advantages of FIT and MT-sDNA:

• Noninvasive and simple enough for patients to perform at home without lost work time and fully covered by most insurance and Medicare
• Sensitivity for early-stage colorectal cancer is virtually the same between a colonoscopy and the MT-sDNA test.
• No preparation, diet, or medication restrictions

Disadvantages include:

• Must be followed by a colonoscopy if there is a positive result
• Must be performed more frequently
  • Every year for FIT
  • Every 3 years for MT-sDNA

Advantages of Colonoscopy:

• The entire colon is examined by and expert, and if lesions are found they can be biopsied or removed during the same procedure

Disadvantages include:

• Preparation, missed work time, variability of endoscopists’ skill, and temporary discomfort and embarrassment

Chadwick Boseman was diagnosed with Stage III colon cancer in 2016 and fought this disease through surgery and chemotherapy while continuing to live and act in movies. He would have been 39 at the time of his diagnosis, well under the age of even these younger screening recommendations. However, these recommendations are a step in the right direction, and the Task Force’s recommendation of offering a choice of how people can be screened just may increase the compliance rate for screening and increase access. Early detection is key for colorectal cancer as this disease is preventable, treatable, and beatable.

Resources:

• Colon Cancer Screening Should Start Earlier, at Age 45, U.S. Panel Says—New York Times, Roni Caryn Rabin, October 27, 2020.
• Colon Cancer Screening Should Start at 45, panel recommends—NBC News
• Stool-Based Tests Vs Screening Colonoscopy for the Detection of Colorectal Cancer—Gastroenterology & Hepagology, David A. Ahlquist, M.D., August 15, 2019
• Colon Cancer Screening: Weighing the Options—Mayo Clinic Staff
• Chadwick Boseman Biography—Biography.com

Connect with others talking about the colorectal cancer screening, diagnosis and treatment, and supporting one another in the Colorectal Cancer support group.