With colorectal cancer rates rising among younger patients, Ohio State doctors at are joining colleagues across the country in recommending screening at age 45. For many years, doctors recommended that people at average risk for colorectal cancer begin undergoing regular screening at 50. For more than a decade, though, diagnoses have been rising among people 49 and under. While researchers are working to identify the reason for the increase, physicians are advising people to be screened earlier to increase the chances of prevention and life-saving early detection. Read on as OSUCCC – James gastroenterologist Peter Stanich, MD, explains the reason for the new guidelines and the ways that colorectal cancer screening can save lives. Why change the guidelines? “In 40-year-olds, and particularly 45-to-49-year-olds, the risk for colon cancer has been going up — currently the risk for them is very similar to where it used to be for 50-year-olds,” Stanich says. “We know colon cancer screening is effective. Now, we just need to shift it earlier to age 45 to start to see that benefit in more people. Even though there are unfortunately 20- and 30-year-olds who are diagnosed with colon cancer, thankfully that is still very rare.” Risk matters “When we think about colon cancer screening, the first thought is to break it down into average-risk people and high-risk people,” Stanich says. “Average risk is when you have no family history of colon cancer or high-risk colon polyps. High risk is considered to be having a first degree relative — a sibling, parent or child who's had colon cancer — or high-risk colon polyps. “If you're high risk, it's a little bit different. We recommend starting either at age 40 or 10 years before your relative was diagnosed. Let's say you had a parent who developed colon cancer at 55; we would recommend starting your screening at age 40. But if your parent developed it at age 45, I would recommend that you start at age 35.” So do symptoms “One important note is that if you have symptoms that could be consistent with colon cancer — including new abdominal pain, blood in the stool and/or dark black stool — all of that takes you out of those risk categories,” Stanich says. “That is something you need to discuss with your doctor, and you’ll likely need a colonoscopy sooner than the recommended ages.” Testing methods “The tried-and-true method is colonoscopy,” Stanich says. “That's where we take a long flexible camera, and we go through the large intestine to look for any polyps that can potentially turn into cancer. We know when we remove those polyps, we reduce your risk for colon cancer. We also know that we can find colon cancer early with colonoscopies, and then you can have surgery and potentially other treatments that save lives. “The stool-based testing method is approved and also very good (though I don’t recommend it for those at high risk), but it's a two-step process where you have a test, and then you need a colonoscopy to follow up on the results if the results are abnormal. And there’s a radiologic test called a CT colonography — or virtual colonoscopy — that's also approved. This also would need to be followed by a colonoscopy if polyps or cancer are noted.” Testing tech “We're very excited about some new techniques that are available at the OSUCCC – James, including computer-aided detection, which is basically a computer that helps doctors find polyps in real-time by scanning the screen during colonoscopies,” Stanich says. “We're currently trialing this, and we're having a lot of success. We’re excited to be able to provide this to our patients at Ohio State.” Why it matters “We know colon cancer screening is effective, and we know that the colon cancer rate in people over age 50 has been dropping because of this,” Stanich says. “We're excited to be able to bring that to a younger tier of patients.”