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Benefits, downfalls of colorectal cancer screening in younger patients

PHILADELPHIA — Initiating colorectal cancer screening in patients younger than 50 years has recently sparked debate and a need for primary care physicians to consider the benefits and downfalls of testing in this age group, according to a presentation at the ACP Internal Medicine Meeting.

“The new American Cancer Society (ACS) guidelines, released in May 2018, caused quite a bit of stir,” Aasma Shaukat, MD, MPH, GI section chief at Minneapolis VA Health Care System and professor of medicine at the University of Minnesota, said during her presentation.

In its recommendations, which are based on modeling studies, the ACS lowered the screening age from 50 years to 45 years in at-risk men and women of all races due to the rising incidence of rectal cancer in younger individuals, she said.

By screening at an earlier age, CRC incidence and mortality can be reduced in this group with a growing incidence, according to Shaukat. If physicians started telling patients to initiate screening at age 45 years, it would boost the screening rate for those aged between 50 and 55 years, she said.

However, there is no evidence to show that screening younger individuals actually benefits them or will be effective at mitigating the trend, she said.

“It seems simplistic to assume that the mechanism of cancer development and progression is the same as older individuals,” Shaukat said.

While the new guidelines are encouraging screening in this younger age group, there are not enough resources to screen the higher risk group, she noted.

Additionally, many healthy younger adults may start getting tested, she said. This group of patients is known as the “worried well” and probably have a lower risk than the patients physicians really want to screen, she said.

“There are more than 21 million people in the United States aged between 45 and 49 years, so there is a concern that if they all started coming in for screening that it would really crowd out the capacity for getting those who need it screened and tested,” Shaukat said.

Earlier screening for CRC may also worsen disparities in cancer screening, she said.

“If we change our recommendations now, it doesn’t allow us the opportunity to actually study this group to see if there is a benefit or not,” Shaukat said.

Additional data evaluating whether the increase in CRC incidence in younger adults is also lethal is needed, she said.

“It continues to be an ongoing debate for the time being,” she said. – by Alaina Tedesco

Reference:

Shaukat A. Colon cancer screening: What’s new? Presented at: ACP Internal Medicine Annual Meeting. April 11-13, 2019; Philadelphia.

Disclosure: Shaukat reports no relevant financial disclosures.