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American Cancer Society urges earlier testing for colon cancer

02 June 2018

A study published today the journal Cancer ads this new data to the model used as a basis for the ACS guidelines, showing what it calls a "favorable balance between screening benefits and burden" with screening starting at age 45, five years younger than now recommended for both men and women of all races and ethnicities.

The researchers also commissioned a microsimulation modeling study involving a model called MISCAN, which simulates colorectal cancer incidence and mortality and estimates risk factors and the impact of screening and treatment practices.

The guideline suggests screening either through a high sensitivity stool-based test or visual examination such as colonoscopy. Personal preferences, life expectancy and prior screening should all be considered.

"The most common finding when you're screening is actually not cancer".

"If we catch the cancer in its early stages", he explained, "the cure rate is practically 90 percent, but if we wait until the cancer has spread, the cure rate drops to 30-40 percent, or even less, depending on how far the cancer has spread".

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Cologuard is indicated to screen adults of either sex, 50 years or older, who are at typical average-risk for CRC.

Others argue that instead of lowering the age for routine screening, more effort should be put into getting more people tested.

"When we began this guideline update, we were initially focused on whether screening should begin earlier in racial subgroups with higher colorectal cancer incidence, which some organizations already recommend", said Richard Wender, chief cancer control officer for the American Cancer Society.

"Think of it this way", Dwyer says, "if screening started at age 20, you'd have maximum benefit but also a huge burden".

The current study worked with the MISCAN model, adjusting the lifetime incidence of colorectal cancer to reflect the most current data, which includes higher incidence younger in the lifespan.

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The guidelines, released Wednesday, were published in CA: A Cancer Journal for Clinicians, a peer-reviewed journal of the American Cancer Society. Patients who test positive for signs of cancer on a non-colonoscopy screening method should follow up with a colonoscopy quickly, the group said.

Colorectal cancer is the third-leading cause of cancer-related deaths in men and women in the United States and is expected to cause about 50,630 deaths during 2018, according to ACS. It is the first organization that has recommended that average risk colorectal cancer (CRC) screening in the U.S. should begin at age 45 rather than 50 for both men and women and for all races and ethnicities. ACS represents one of several clinical guidelines for colorectal cancer screening. "That's the public health statement, which is, pay attention to your bowels, and seek medical care if things don't seem right, if there's blood in your stools or your bowel habits change suddenly".

If this new guideline is adopted, lives will be saved.

Screening is generally done routinely every ten years. And some will cover stool testing, but refuse to cover follow-up colonoscopies for those with abnormal results, he said.

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American Cancer Society urges earlier testing for colon cancer