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Should Regular Colorectal Cancer Screening Begin Earlier Than Age 50?

ANN ARBOR, MI – Are patients screened early enough for colorectal cancer?

In a recent analysis of U.S. data, one in seven colorectal patients was found to be younger than 50 years old, the recommended age to begin screening.

Furthermore, according to the study published early online in the journal Cancer, younger patients were more likely to be diagnosed with advanced stage disease. However, they also received more aggressive therapy and lived longer without a cancer recurrence.

While colorectal cancer usually is considered a disease of the elderly, the proportion of cases in younger individuals is on the rise. That’s why a study team, led by Samantha Hendren, MD, MPH, of the University of Michigan, conducted a population-based retrospective review of the nationally representative Surveillance, Epidemiology, and End Results registry, specifically looking at information on patients diagnosed with colorectal cancer in the United States from 1998 to 2011.

Of 258,024 colorectal patients, 37,847 -- nearly 15% -- were younger than 50 years old, the age at which routine screening begins in the United States. Earlier screening wouldn’t be out of line with other cancers: Study authors pointed out that breast cancer screening often begins at age 40 even though fewer than 5% of invasive breast cancers occur in women younger than that age.

“These findings suggest the need for improved risk assessment and screening decisions for younger adults,” study authors wrote.

Results indicated that young colorectal patients were more likely to be diagnosed with regional or distant disease, more serious forms of cancer leading to more aggressive treatment. In fact, 72% of younger patients compared to 62% of older patients received surgical therapy for their primary tumor, and 53% of younger patients had radiation therapy compared to 48% of older patients.

In fact, colorectal cancer patients who were younger than 50 years of age lived slightly longer without a cancer recurrence, even though they tended to have more advanced disease when they were diagnosed. The five-year cancer-specific survival for younger patients was 95.1% vs. 91.9% for patients 50 and older for localized disease, 76% vs. 70.3% for regional disease, and 21.3% vs. 14.1% for distant disease, respectively.

"This study is really a wake-up call to the medical community that a relatively large number of colorectal cancers are occurring in people under 50. In a practical sense, this means that we should look out for warning signs of colorectal cancer such as anemia, a dramatic change in the size or frequency of bowel movements, and dark blood or blood mixed with the stool in bowel movements," Hendren said in a Wiley press release. "Also, people with a positive family history for colorectal cancer (in first-degree relatives, such as parents or siblings) and some others who are at higher risk should begin screening earlier than 50. This is already recommended, but we don't think this is happening consistently, and this is something we need to optimize."

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