Colonoscopy, unloved ritual of turning 50, moving 5 years ago

For almost a generation, colonoscopy was a rite of passage at the age of 50, followed by repeated procedures every 10 years until the age of 75. Today, this unpopular test has a long lifespan.

An influential US commission last week lowered the recommended age for initial colonoscopy from 50 to 45. Also, a major new study calculates that continuing scanning among healthy people over the age of 75 can save lives.

Among those at average risk, “45 is the new 50 for colorectal screening,” said Robert Smith, who leads the development of screening guidelines. American Cancer Society.. “Ideally, they should have this test in the 45th year and we need a clinician to emphasize this.”

The expanding time frame adds impetus to innovative, less invasive alternatives to the procedure, including fecal and blood tests.

Most cases of colon and rectal cancer occur in the elderly. However, the proportion of people under the age of 50, who make up 11% of the total colon in the United States, is rising rapidly. cancer In 2020, it increased from 5% in 2010. By 2030, colon and rectal tumors are expected to kill more people in their 20s and 40s than any other type of malignancy.

The US Preventive Care Expert Board, an advisory board that assesses health practices, provides evidence to reduce the age of colonoscopy to grade 45 of “B.” This is strong enough that federal law requires health insurance companies to cover 45-50. Age group.

“Reducing the recommended age to start screening makes colorectal screening available to millions of people. America“Kimmy Ng, who heads the Center for Young-onset Colorectal Cancer, said. Dana-Farber Cancer Institute..

Racial difference

The shifts discovered by the Task Force will benefit in all races. In a statement, Ng said the risk was particularly high for black patients who were “about 20% more likely to get colorectal cancer and about 40% more likely to die from the disease.”

While Task Force guidelines suggest a personalized approach up to age 85, on the other side of the age group, patients generally stop undergoing colonoscopy at age 75.

“It’s not the default to quit,” said Andrew Chan, a gastroenterologist at the Massachusetts Cancer Center and director of the Department of Cancer Epidemiology, at the age of 75. “Unless other health concerns suggest something else, we need to presume that we should continue more and more.”

In a study that examined data from more than 56,000 patients over a 28-year period, Chan et al. Found that colonoscopy in healthy people over the age of 75 reduced the risk of colorectal cancer and its death by about 40%. I found that. However, in patients with heart disease and other serious health problems, colonoscopy offers no benefit and the procedure offers the potential for complications such as bleeding and perforation.

The findings of the journal JAMA Oncology increase the chances of more doctor-patient encounters, as we did this month with healthy 70-year-old Chan, who thought colonoscopy would be the last. He “realigned her expectations,” he said, and she was happy about it-when patients were often told that they could expect years of health.

“It’s a little disappointing that they have to prepare,” Chan added, referring to an unpleasant liquid regime to clean the intestines before the procedure. “But as long as you know you’re doing something good that can extend your life, I think people will take it every ten years.”

Easier screening

As the number of people requiring colonoscopy increases as eligibility grows, he predicts that “supply and demand will become more and more inconsistent” to screen for colon and rectal cancer. Motivate new, less invasive methods.