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Experts say there are lifestyle choices, including diet and exercise, that can reduce your risk of colorectal cancer. Getty Images
  • New guidelines were issued today on colorectal cancer screenings for adults age 50 to 75.
  • The American College of Physicians recommends a fecal test every 2 years with the possible addition of a colonoscopy or flexible sigmoidoscopy every decade.
  • Doctors note that the incidence of colorectal cancer is rising in younger adults, so earlier screenings are vital.

Healthy adults should plan on getting regular screenings for colorectal cancer starting at age 50 and continuing through age 75.

That’s according to new guidelines issued today by the American College of Physicians (ACP).

People with a higher risk or family history of the disease should speak to their doctor and get screened more regular than that, the guidelines state.

In addition, the ACP suggests several screening choices. These include a fecal immunochemical test (FIT) or a high sensitivity guaiac-based fecal occult blood test (gFOBT) every 2 years as well as a colonoscopy every decade or a flexible sigmoidoscopy every 10 years with a FIT every 2 years.

Those colonoscopy alternatives allow people to skip some of the discomforts of the more invasive procedures while still having many of the benefits.

Colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer-related deaths in the United States, according to Wendy Nickel, vice president of prevention at the Colorectal Cancer Alliance.

In 2019, about 145,000 people will be diagnosed with the disease and 51,000 people will die from it, making screening critically important.

“We can encourage more people to get screened by raising awareness of the danger and prevalence of colorectal cancer,” Nickel told Healthline. “Physician or healthcare provider recommendation is extremely important, and data shows that the trust and influence of this relationship can have the greatest impact on encouraging individuals to get screened.”

Even age 50 might be older than optimal to start getting colorectal cancer screenings, according to Richard Wender, MD, chief cancer control officer at the American Cancer Society (ACS).

The ACS recommends average-risk adults start getting colorectal cancer screenings at age 45 based on their review of research and the increasing prevalence and earlier onset of colorectal cancer in recent years.

“People born recently have a higher risk of developing colorectal cancer,” Wender told Healthline. “This effect began a few decades and has been increasing year after year. The more recently someone was born, the higher the risk of colorectal cancer before the age of 50.”

“While the incidence of this cancer is going down in individuals over age 55 due to screening and polyp removal, the incidence is actually going up in people 50 to 54,” he added.

This happens in part because only half of the adults between ages 50 and 54 get screened.

One reason many adults delay colorectal cancer screening is discomfort, fear, or embarrassment about getting a colonoscopy, said Michael Chen, MD, a doctor of internal medicine and medical advisor for Ezra, a company that combines MRIs and artificial intelligence to help detect cancer.

“Drinking a medical solution to completely clear out your bowels can be an uncomfortable experience where you are continuously getting up to use the restroom and unable to sleep,” Chen told Healthline. “Others dislike the idea of having a medical instrument inserted into their bowels (even if they’re comfortably sedated) and the possibility of a complication such as a bowel perforation.”

Ezra might represent the future of noninvasive screenings, using advanced MRI machines in conjunction with artificial intelligence algorithms to diagnose cancer.

“There is evidence that supports that MRI is the ideal imaging modality for multiple organs,” said Emi Gal, the chief executive officer of Ezra. “Take the prostate as an example. A January 2017 study showed that the MRI is able to detect 90 percent of prostate cancers, while the gold standard blood tests, which look for a marker called a prostate-specific antigen, are only about 21 percent accurate, according to a 2012 review.”

Beyond that, at-home stool sample tests might be just as effective at detecting cancer as colonoscopies, experts say.

That said, if a person tests positive, they’ll still have to go in for a full colonoscopy, according to Renee Williams, MD, a gastroenterologist and an associate professor of Medicine at NYU Langone Health in New York.

Whatever method is convenient and available to you, however, it’s important to get regular colorectal cancer screenings starting at age 50 at the latest.

“Screening makes a difference because through screening you can detect precancer lesions (i.e., polyps) and remove them to prevent cancers from ever developing and detect cancers at an earlier stage so that they can be more readily treated with higher chance of cure,” said Daniel I. Chu, MD, associate professor of gastrointestinal surgery at the University of Alabama at Birmingham.

“Building evidence does suggest that your diet plays a central role in cancer development. Diets high in fiber, low in red meat, and low in processed meats (hot dogs, sausage, etc.) may help decrease that risk of developing colorectal cancers,” Chu told Healthline. “Like I tell all my patients, however, the best life habits are to eat a healthy diet as above, exercise, avoid smoking, and avoid excess alcohol. Doing all of these things can decrease the risk of many other diseases, too.”

“Unfortunately, there are risk factors that cannot be controlled including inflammatory bowel disease, genetic predisposition, and family history,” Williams told Healthline. “In these cases, it is even more important to maintain a screening schedule. “

So even if you adhere to all of those practices, don’t skip the screenings, said Andrew Rosenstein, MD, a gastroenterologist at the University of Maryland St. Joseph Medical Center.

“Doctors have to keep talking about it and nudging patients, letting them know that the test isn’t as bad or uncomfortable as it’s portrayed — and it can save lives,” Rosenstein told Healthline.