New research suggests that patients at average risk for colon cancer may only need to undergo a colonoscopy every 15 years, instead of the recommended 10.
Swedish researchers found that waiting an additional five years after a first negative colonoscopy carried about the same risk of having a colorectal diagnosis or dying from the disease later as having tests every 10 years. Extending screening times could reduce “unnecessary invasive tests,” according to the study published Thursday in JAMA Oncology.
Colorectal cancer It is the fourth most common cancer diagnosed in the US and the second deadliest, behind only lung cancer. O The American Cancer Society recommends what screening begins at age 45 for people who do not have a family history of colorectal cancer or other risk factors such as inflammatory bowel disease.
In an editorial accompanying the new study, the gastroenterologists suggested that future screening guidelines could be safely extended for some people, noting that “15 has the potential to be the new 10.”
Although rates are declining among people over age 50, colorectal cancer diagnoses are increasing among young people, opening up a potentially large new group of people who may need colonoscopies.
Doctors are struggling to figure out the best way to allocate appointments.
“We don’t have enough gastroenterologists to do a colonoscopy every 10 years on everyone over age 50,” said Dr. Otis Brawley, Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University, who was not associated with the new search.
For the new study, researchers analyzed national registry data from more than 110,000 people whose first colonoscopy was negative for colorectal cancer. They compared these people with more than 1 million in a control group.
The average age in both groups was 59 years and approximately 60% of patients were female. Taking family history into account, they found that after having a negative first colonoscopy, the risk of later being diagnosed with colorectal cancer or dying from the disease was about the same among people who had a colonoscopy every 10 years and those that extended the time to 15 years. .
They estimated that waiting an additional five years between colonoscopies would cause two cases of colorectal cancer to be missed and cause one colorectal cancer-related death for every 1,000 people, potentially saving 1,000 colonoscopies for other patients.
“We need to think about how we can save resources and impact more people with the resources we have,” said Dr. Andrew Chan, a gastroenterologist and director of epidemiology at the Massachusetts General Cancer Center in Boston and co-author of JAMA. editorial.
More diverse population
The research was carried out in Sweden, which has a majority white population and a healthcare system very different from that in the USA. The national health system also collects information about the family health history of its citizens, which means researchers can be sure those who reported not having colorectal cancer in the family were correct.
“It would be very difficult to apply these findings to the U.S.,” said Dr. Cassandra Fritz, a gastroenterologist at Washington University in St. “When we ask patients about colorectal cancer in first-degree relatives, most people don’t know.” Fritz was not involved in the new study.
The U.S. is also much more racially and ethnically diverse, but the research provides important context that will help doctors understand how they can better delegate their limited resources, Fritz added.
The proportion of colorectal cancer that occurred in people under age 55 doubled from 1995 to 2019, from 11% to 20%. But the total number of cases in this population is still relatively low.
“When you are under 50, incidents of colorectal cancer will likely not require screening for everyone. The risk-benefit does not outweigh the cost,” Dr. Robert Bresalier, professor of medicine in the department of gastroenterology, hepatology and nutrition at the University of Texas MD Anderson Cancer Center in Houston. Bresalier was not involved in the new research.
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This only applies to people with no family history, he added. People who have a parent or sibling who has had colorectal cancer should begin screening 10 years before the parent or sibling is diagnosed, Brawley said.
Other means of screening, particularly stool tests, have been improved to be more accurate in recent years. Fecal occult blood tests detect blood in the stool, a warning sign of polyps or colon cancer. FIT-DNA tests, like Cologuard, detect altered DNA in stool, which may indicate cancer, and are about 90% effective in detecting cancer, but are less effective in detecting precancerous polyps.
These tests are non-invasive and relatively inexpensive compared to colonoscopy screening. The problem is that they need to be done more frequently – every one to three years – than colonoscopy. If the test is positive, the person should have a colonoscopy, which may trigger one every 10 years.
Still, the tests could be a good option to reduce the number of colonoscopies performed after a first negative screening, Chan said.
“It’s important to screen, but there are a finite number of resources to screen people,” he said. “To screen as many people as possible, we need to make choices about what kind of screening we are doing and how often.”
Better screening in the U.S. will likely be more tailored to risk factors other than age, which experts don’t yet know much about, Bresalier said.
“One size may not fit all. We know a lot about the genetics of colorectal cancer, but most of this research has been done on white people. There are potential differences between men and women and between different ethnicities,” he said. “We may get to a point where we get to risk-based ranges, even in people with normal risk, based on these other factors.”
Warning signs of colon cancer
Symptoms of colorectal cancer usually only appear in later stages and can be difficult to differentiate from other less serious diseases.
“You can’t rely on symptoms,” Chan said. “Many people have no symptoms and this highlights the importance of testing.”
Having blood in your bowel movements, which may appear red or black, a change in how often you go, abdominal pain and weight loss can be warning signs of colorectal cancer – and can also be signs of irritable bowel syndrome, an inflammatory disease. intestinal and a series of other less serious problems.
However, people with new symptoms should make a doctor’s appointment, Fritz said.
Anyone over 45 should start getting tested. What this looks like can be determined by where you live.
“In some areas it is more feasible to have a colonoscopy than in others. In some areas, it may be more realistic to do a stool test,” Chan said.
This includes people who live in rural areas or without access to a gastroenterologist. For those who are underinsured or uninsured, Fritz said it is possible to pay cash for a stool test, although a positive stool test will require a colonoscopy later.
Something everyone should do is understand the risk they are taking, Fritz said.
“Many people avoid talking about evacuations, but it is very important to talk to your family to find out if you are at high risk,” she said.
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