(Press-News.org) BOSTON - Prompted by a recent alarming rise in cases of colorectal cancer in people younger than 50, an independent expert panel has recommended that individuals of average risk for the disease begin screening exams at 45 years of age instead of the traditional 50.
The guideline changes by the U.S. Preventive Services Task Force (USPSTF), published in the current issue of JAMA, updates its 2016 recommendations and aligns them with those of the American Cancer Society, which lowered the age for initiation of screening to 45 years in 2018.
Colorectal cancer (CRC) is one of the most preventable malignancies, owing to its long natural history of progression and the availability of screening tests that can intercept and detect the disease early. Overall incidence of CRC in individuals 50 years of age and older has declined steadily since the mid-1980s, largely because of increased screening and changing patterns of modifiable risk factors.
"A concerning increase in colorectal cancer incidence among younger individuals (ie, younger than 50 years; defined as young-onset colorectal cancer) has been documented since the mid-1990s, with 11% of colon cancers and 15% of rectal cancers in 2020 occurring among patients younger than 50 years, compared with 5% and 9%, respectively, in 2010," said Kimmie Ng, MD, MPH, first author of an editorial in JAMA accompanying the article about the guideline change of the USPSTF. Ng is the director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute.
The causes of the increase in young-onset CRC aren't currently known.
Lowering the recommended age to initiate screening "will make colorectal cancer screening, which is so important, available to millions more people in the United States, and hopefully many more lives will be saved by catching colorectal cancer earlier, as well as by preventing colorectal cancer," said Ng.
The USPSTF is an independent panel of experts funded by the U.S. Department of Health and Human Services. It systematically reviews the evidence of effectiveness of preventive services and develops recommendations. American health insurance groups are required to cover, at no charge to the patient, any service that the USPSTF recommends with a grade A or B level of evidence, regardless of how much it costs.
The task force recommendation means that insurers will be required to cover preventive procedures such as colonoscopies and stool tests designed to detect colon cancer in early stages.
The task force selected age 45 based on research showing that initiating screening at that age averted more early deaths than starting at age 50, with a relatively small increase in the number of colonoscopy complications. There is no change to the USPSTF 2016 recommendation to only selectively screen individuals aged 76 to 85, as research shows only small increases in life-years gained.
The accompanying JAMA editorial asked rhetorically whether the age of screening should be lowered even younger than age 45. While the majority of young-onset CRC diagnoses and deaths occurs in persons 45 to 49, the rate of increase in young-onset CRC is actually steepest in the very youngest patients. Colon cancer incidence is increasing by 2% per year in 20 to 29-year-olds, compared with 1.3% in 40 to 49-year-olds. Rectal cancer incidence is increasing by 3.2% per year in 20 to 29-year-olds and 30 to 39-year-olds, versus 2.3% in 40 to 49-year-olds.
"We are now seeing patients even younger than 45 - in their 20s and 30s - who are being diagnosed with this cancer and often at very late stages," said Ng. "Clearly the USPSTF recommendation to start screening at age 45 will not be enough to catch those young people who are being diagnosed."
Ultimately, optimal prevention and early detection of CRC in people younger than 45 will require further research into the underlying causes and risk factors of young-onset
CRC, which have thus far remained elusive, said the editorial authors.
The authors also called for "bold steps" to translate the lowered age of beginning screening into meaningful decreases in CRC incidence and mortality, noting that despite the preventive benefits of colorectal cancer screening, only 68.8 percent of eligible individuals in the United States undergo screening. The rate is lower among the uninsured and underinsured, those with low incomes, and racial and ethnic minorities. Barriers include lack of knowledge of the importance of screening, concerns about the invasive nature of colonoscopy, and lack of access to and provider recommendations for screening.
The editorial lists examples including public awareness campaigns, including those aimed at gaps in CRC incidence and mortality between Black and white Americans, and specific actions. Employers could provide 45-year-old employees with a paid "wellness day" to undergo CRC screening, or offer day care or transportation vouchers to overcome the logistical hurdles of colonoscopies. Health systems could offer weekend or after-hours appointments for colonoscopies.
The new recommendation "represents an important policy change," the authors wrote, "to drive progress toward reducing colorectal cancer incidence and mortality."
INFORMATION:
The co-authors of the JAMA editorial are Folsade P. May, PhD, MPhil, and Deborah Schrag, MD, MPH.
About Dana-Farber Cancer Institute
Dana-Farber Cancer Institute is one of the world's leading centers of cancer research and care. Dana-Farber's mission is to reduce the burden of cancer through scientific inquiry, clinical care, education, community engagement, and advocacy. The Institute provides the latest treatments in cancer for adults through Dana-Farber/Brigham and Women's Cancer Center and for children through Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Dana-Farber is the only hospital nationwide with a top 6 U.S. News & World Report Best Cancer Hospital ranking in both adult and pediatric care.
As a global leader in oncology, Dana-Farber is dedicated to a unique and equal balance between cancer research and care, translating the results of discovery into new treatments for patients locally and around the world, offering more than 1,100 therapeutic and non-therapeutic clinical trials. END
CLEVELAND - According to new study results, a team of researchers led by Cleveland Clinic's Thaddeus Stappenbeck, M.D., Ph.D., have found that a diet high in fat and sugar is associated with impaired intestinal immune cell function in mice. The findings, published in Cell Host & Microbe, provide novel insights into pathways linking obesity and disease-driving gut inflammation, and have implications for developing targets to treat inflammatory bowel diseases (IBD) in patients.
Using data from more than 900 patients, the researchers found that elevated body mass index is associated with abnormal Paneth cells among patients with Crohn's disease and non-IBD patients.
Paneth cells are a type of anti-inflammatory immune cell found in ...
Eating a Western diet impairs the immune system in the gut in ways that could increase risk of infection and inflammatory bowel disease, according to a study from researchers at Washington University School of Medicine in St. Louis and Cleveland Clinic.
The study, in mice and people, showed that a diet high in sugar and fat causes damage to Paneth cells, immune cells in the gut that help keep inflammation in check. When Paneth cells aren't functioning properly, the gut immune system is excessively prone to inflammation, putting people at risk of inflammatory bowel disease and undermining effective control of disease-causing microbes. The findings, published May 18 in Cell Host & Microbe, open up new approaches to regulating gut immunity by restoring normal Paneth cell function.
"Inflammatory ...
Scientists led by Dr. Salvador Aznar-Benitah, head of the Stem Cells and Cancer laboratory at IRB Barcelona, have described the alterations that occur during mammary gland formation when heterochromatin (the part of DNA that does not actively produce proteins) is poorly regulated. The results, which have been published in the journal Cell Stem Cell, indicate that incorrect DNA packaging makes retrotransposons (a type of transposable element originated in ancestral fragments of viruses integrated into the cell genome) more accessible.
As these fragments are more accessible, they can be "read" and copied ...
The frequency and intensity of heat waves in cities is increasing due to climate change, with a great negative impact on the health and mortality rates of the population. Anthropogenic activities and urban materials affect heat accumulation in cities, and solar radiation stored throughout the day on asphalt and buildings is released slowly during the night, generating significant heat stress. To face this growing problem, cities must establish effective mitigation strategies that allow reducing the temperature during heat waves.
A study carried out by researchers from the Institut de Ciència i Tecnologia Ambientals ...
As lockdown measures ease this week in the UK, environmental psychologists are urging that before rushing back to business as normal, we take advantage of the shifts observed over the past year to lock-in new, greener behaviours.
Writing in the journal END ...
HAMILTON, ON May 18, 2021 -- Five years after the disastrous wildfire in Fort McMurray, Alberta, researchers are warning that the complex role of peatlands, a factor critical to projecting the risk and behaviour of future fires, is missing from the forecasting model.
The Fort McMurray fire burned out of control from May 1 to July 5, 2016, though it continued to smoulder until it was finally declared extinguished Aug. 2, 2017.
Peat deposits - which are prevalent across Canada, especially in Alberta - are complex threats that can complicate and magnify the risk of severe, long-lasting fires and heavy smoke, but they are not yet part of the standard assessment tools that fire managers use.
It's a critical ...
A study published this May in the journal Clinical Infectious Diseases suggests that people who have had dengue in the past are twice as likely to develop symptoms of COVID-19 if they are infected by the novel coronavirus.
The findings of the study were based on an analysis of blood samples from 1,285 inhabitants of Mâncio Lima, a small town in the state of Acre, part of Brazil’s Amazon region. The principal investigator was Marcelo Urbano Ferreira, a professor at the University of São Paulo’s Biomedical Sciences Institute (ICB-USP) in Brazil. The study was supported by FAPESP.
“Our results show that the populations most exposed to dengue, possibly owing to socio-demographic factors, are precisely ...
COLUMBUS, Ohio - With pandemic lockdowns still in place last summer, The Ohio State University couldn't host its in-person Summer Success Program to help preschoolers from low-income families prepare for kindergarten.
Staff and teachers quickly pivoted to a fully virtual program, but they were worried: Could this really work with 4- and 5-year-olds who had no previous experience with preschool?
A new study suggested it did.
Researchers found that the reimagined Summer Success at Home program was feasible to operate, was popular with teachers and parents, and had at least modest success in helping the children learn ...
MINNEAPOLIS/ST. PAUL (03/18/2021) -- A research team, led by the University of Minnesota Medical School, found that regardless of socioeconomic status, Twin Cities residents of underrepresented racial and ethnic backgrounds endure worse COVID-19 outcomes compared to people who are white.
The study was just published in the Journal of General Internal Medicine and is one of the first papers to discuss which social and cultural factors, including non-English speaking, may or may not contribute to racial and ethnic health disparities related to COVID-19.
"For people of color, even in the highest socioeconomic status, our data shows they still have worse COVID-19 outcomes compared to people who are white," said Nicholas Ingraham, MD, a third-year fellow in the ...
More than three quarters of Iran's land is under extreme groundwater overdraft, where the rate of human uptake is higher than the rate of natural recharge. This is according to a new study led by Concordia researchers published in the Nature journal Scientific Reports.
The article was co-authored by Samaneh Ashraf, a former Horizon postdoctoral researcher now at the Université de Montréal, and Ali Nazemi, an assistant professor in the Department of Building, Civil and Environmental Engineering. Amir AghaKouchak of the University of California, ...
