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45 Is the New 50 for Colonoscopies

For many Charlotte residents putting off a colonoscopy, the COVID-19 pandemic has offered one more excuse to keep waiting. But new recommendations for the colorectal cancer screening age mean 45 is the new 50 for those at average risk.

With 10% of new colorectal cancer patients under the age of 50, this disease is on the rise in younger patients. While incidence rates of colon cancer are dropping in older adults due to successful screening practices, they are increasing at a rate of two percent per year for those younger than 50.

Though it is the second-most common form of cancer death, when colorectal cancer is caught early through screenings it can be much easier to treat. That’s why the screening age of 50 that people are so familiar with has now been decreased to age 45.

“If we can speed up screenings, we might be able to catch cases earlier and make an impact on overall cancer mortality,” says Dr. Eric Hilgenfeldt, a gastroenterologist at Tryon Medical Partners SouthPark. 

Knowing Family History Is Key

When a patient has no symptoms of colorectal cancer, making a plan for screening starts with understanding family history, says Dr. Hilgenfeldt. Being able to share a family history of polyps or colorectal cancer with your physician, allows them to classify your risk and provide recommendations of when to begin routine screening. 

For colorectal cancer, family history is heavily weighted and can necessitate a screening exam to be performed a decade or more before the general population,” Dr. Hilgenfeldt says. “It all starts with a discussion.” 

Often, those conversations with family may only happen during the holidays when everyone is around the dinner table, but cancer won’t wait. Dr. Hilgenfeldt notes that he’s had patients where multiple polyps are found in their first colonoscopy. After, the patient talks to a family member who confirms they’ve had them, too. If that conversation had happened sooner, the patient’s screening recommendation may have changed allowing polyps to be caught earlier, well before becoming cancerous.

Sharing a known family history begins with a primary care physician (PCP) who can then make recommendations for screenings for a variety of conditions. Relationships with a PCP are years long, in many cases even decades or generational, says Dr. Hilgenfeldt. They can not only recommend screening plans but also call on specialists when needed. 

Insurance Coverage Still Catching Up

Changing the colorectal cancer screening age to 45 for those at average risk was a recommendation initially made by the American Cancer Society three years ago, says Dr. Hilgenfeldt. Draft recommendations came out from the U.S. Preventive Services Task Force, which were adopted in May 2021. Currently, only a few insurers cover screenings between ages 45 and 50 for those at average risk, but the formalization of these recommendations by the Task Force means change will happen.

For those who are considered high-risk for colorectal cancer through factors like family history, recommendations and insurance coverage can still happen even earlier. 

Despite colorectal cancer being the third-most commonly diagnosed form of cancer in the United States, patients still find a myriad of reasons to put off their screening. Dr. Hilgenfeldt says in 2020 he heard patients use the excuse of COVID-19 to put off their screening. In 2021, it’s about waiting for a vaccine. 

“There’s always a reason to kick the can down the road,” Dr. Hilgenfeldt says. “But for those patients putting off screening because they don’t have symptoms, that’s exactly when we should be doing the screening.” 

While it’s true that the cancer growth cycle can take up to a decade as polyps develop and become cancerous, those who have never been screened have no idea where they are in that cycle. Dr. Hilgenfeldt encourages patients to take those first steps by having conversations with family to understand their medical history, then sharing that information with a primary care provider to develop a screening plan. It all starts with a discussion.