A New Age for Colorectal Cancer Screening

New colorectal cancer screening guidelines no longer make colonoscopies a rite of passage for 50-year-olds. Instead, 45-year-olds will celebrate their mid-forties by making an appointment most people dread.

Colorectal cancer starts in the colon or the rectum; it can also be called colon cancer or rectal cancer, depending on where it begins. The two cancers are grouped together because of their similar features, such as affecting the large intestine.

Typically a cancer found in people older than 50, colorectal cancer is the third most common cancer among men and women and the third leading cause of cancer-related deaths.

The guidelines for colorectal cancer screenings were changed due, in part, to data showing an increase in the rate of the cancer among younger populations.

Younger rectal patients are unique

A study led by UF cancer researcher Dr. Atif Iqbal, M.D., found that younger patients with stage two or three rectal cancer did not see the same survival benefit from receiving the current recommended treatments, chemotherapy and radiation, as did older patients. The findings suggest that early-onset colorectal cancer may differ biologically in its response to treatment.

“The standard of care was established using previous studies that are predominantly based on patients who are older than 50 years of age,” said Iqbal. “However, something is different about this younger group — perhaps biologically —leading to these results.”

Prior to the study, colorectal screening guidelines recommended people aged 50 or older seek screenings due to the cancer being historically considered a disease for the older adults. Now, with the number of younger patients with colorectal cancer on the rise, the age has decreased to 45.

The study is the largest study of rectal cancer to date to include specific survival data for the younger population.

“This is important because the data we are providing right now in our clinics is not accurate, as the data has not been individualized for the younger population,” Iqbal said. “However, our study provides practicing physicians with the ability to offer prognosis, which is personalized to the younger population.”

What’s next?

Iqbal’s research highlights the paths future studies for this population should take and could drastically change how colorectal cancer is treated in younger patients.

“There are previous studies that show that, overall, the mortality rate for colorectal cancer is improving, but the rates for younger patients have increased progressively over the last 50 years,” Iqbal said.

Future care for younger colorectal cancer patients should focus on the possibility of avoiding extra treatment toxicity, such as chemotherapy and radiation, he said.

“Because older individuals established the standard of care, we’re using it on everybody — but now we see that younger patients don’t really respond that well to it,” Iqbal said.