- New research suggests that for people deemed low risk, the benefits of getting screened for colorectal cancer after age 50 don’t outweigh the risks.
- However, some experts say screening is effective and they don’t think the research will change any guidelines.
- It’s still recommended that people talk to their doctors about getting screened at this age, and possibly earlier if there’s a family history of colorectal cancer.
If you’re 45 or older, the American Cancer Society
But new research suggests that, for most people, such screening isn’t necessary.
A panel of international experts
Lise Mørkved Helsingen, a study co-author and a medical student at the Clinical Effectiveness Research Group at Oslo University Hospital in Norway, told Healthline that given the new findings, it’s somewhat surprising that so many current guidelines strongly recommend screening.
“Physicians and health authorities should acknowledge that routine bowel screening for everyone aged 50 to 79 is not necessarily the optimal choice for everyone,” she said. “The panel emphasizes shared decision-making based on balanced information of absolute benefits and harms, and suggests the use of a calculator to get an estimate of the risk of developing colorectal cancer in the next 15 years.”
While the research represents an intriguing glimpse at how personalized medicine could change screening procedures, a pair of doctors interviewed by Healthline said that the current screening procedures should still be followed.
“I was very surprised to read this research,” Dr. Peter Stanich, a physician at The Ohio State University’s Wexner Medical Center who specializes in colon cancer prevention, told Healthline.
“Colon cancer screening has been very effective and colon cancer incidence has been coming down since we started screening, so I was very concerned to be seeing this. I’m hoping we don’t take a step backward,” he said.
Regular screening for colon cancer can provide early warning signs of trouble — no small thing when about 1 in 23 people develop colon cancer during their lifetime.
The screening process can include testing fecal samples, along with visual inspections and colonoscopies.
While the process is generally safe, it can be invasive — and in rare cases, bleeding or a tear in the bowel can occur.
With this in mind, the international research group set out to determine if the benefits of screening outweighed the risks. They determined that, for people deemed low risk, it just wasn’t worth it to get screened.
The researchers noted that the vast majority of people aged 50 would be at a low risk of developing bowel cancer within the next 15 years, so they determined that screening at this age doesn’t justify the risk.
They did recommend screening for people with a 15-year bowel cancer risk above 3 percent, acknowledging that future research will yield more results.
“The panel emphasizes that the evidence for benefits and harms from modeling is a useful indicator, but there is a high chance that new evidence will show a smaller or larger benefit, which in turn may alter the recommendations,” Helsingen said. “What is the most effective screening test or combination of tests, and at what age and interval they should be used, is still uncertain.”
To anyone dreading a colonoscopy or other test, this research seems unlikely to change their doctor’s advice.
Dr. Stanich said that at his institution more than 40 percent of 50-year-olds coming in for their first screening procedure have adenomas, a pre-cancerous type of polyp that can turn into cancer over time.
“It would be very concerning to me if these people weren’t coming in to get those polyps removed,” he said.
“Personalized medicine is likely the wave of the future and I have no doubt that at some point we’ll be able to personalize this for every patient and come up with an optimal time to start screening,” he added. “But I don’t think we’re there yet, and I think this is premature.”
Elena A. Ivanina, DO, a gastroenterologist at Lenox Hill Hospital in New York, noted that the research clashes with current guidelines in the United States.
“How much should this publication affect clinical decision-making and policy? Not much, considering the recommendations are classified as ‘weak recommendations’ with substantial uncertainty (low-certainty evidence) regarding the 15-year benefits, burdens, and harms of screening,” she told Healthline.
Dr. Ivanina explained that the clinical definition of “weak recommendations” means that clinicians should recognize that different choices are appropriate for different patients and act accordingly. With this in mind, she said that the research should not be adopted into policy.
“In the current healthcare landscape of limited resources, it’s not surprising that these guidelines were published, but in the real world of increasing cancer rates in young patients and the undeniable preventive success of colonoscopy screening, I suspect most clinicians will continue to follow the current guidelines,” she said.
In the United States, where colorectal cancer cases in people under the age of 50 are on the rise, doctors agree that following the current guidelines is the best course, at least until it’s better understood how personalized medicine can be applied to the screening process.
“I would still follow recommendations that are put forth,” Stanich said. “This research shouldn’t change any recommendations in the United States at this point until we see stronger evidence that this is beneficial. I would continue to recommend that everyone discuss colorectal screening with their doctors starting at age 45 to 50, and potentially earlier if there’s a family history.”