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Thursday, August 28, 2014
Current Colon Cancer Screening Guidelines?
I am a 40 year old woman with a family history of colon cancer (my father died of it at 83). My understanding of the current screening recommendations was that people from age 40 should be screened every 5 years, however my insurance won’t pay until I turn 50. When I asked them about it, they said that the guidelines had been changed again, and now people in my situation have the same screening recommendations as the general population. What is the best source for screening information and what are the most current guidelines?
This is a good question without a simple answer. Guidelines for colorectal cancer screening are provided by a number of medical societies, resulting in variations in recommendations depending upon the source. Guidelines are typically updated periodically based on the most recent evidence. One of the most recent guidelines was released jointly in 2008 by the US Multi-Society Task Force on Colorectal Cancer, the American Cancer Society, and the American College of Radiology. According to these guidelines, someone with a single first-degree relative (i.e. parent or sibling) who was diagnosed with colorectal cancer at age 60 or older should begin screening at age 40, but if that screening is negative, the interval until the next screening can be the same as someone who does not have a family history of colorectal cancer. If, for example, you were able to have a colonoscopy at age 40, assuming no polyps were found and the colon was relatively free of stool such that the examiner was able to get a good look at the colon lining, your next colonoscopy for screening would be in 10 years.
On the other hand, the American College of Gastroenterology (a gastroenterology society) published guidelines in 2009 recommending that individuals with a single first-degree relative diagnosed with colorectal cancer at age 60 or older should begin screening at the same age as individuals with no family history: age 50 unless you are African-American, in which case the ACG recommends screening at age 45. However, the other GI societies have not adopted the ACG's recommendation of beginning screening at age 45 for African-Americans.
In general, the guidelines for screening in individuals with a single first-degree relative diagnosed with colorectal cancer at an advanced age likely reflect the uncertain benefit of screening these individuals at an earlier age. These guidelines I mentioned do assume you have no additional family history of colorectal cancer or polyps. There are also cancer syndromes that run in some families that increase risk for colorectal cancer and affect screening recommendations. Finally, the guidelines apply to screening, which assumes that an individual has no symptoms such as weight loss, blood in the stool, abdominal pain, or diarrhea.
Linda Cheng Cummings, MD, MS
Assistant Professor of Medicine
School of Medicine
Case Western Reserve University