Colonoscopy screening: is 45 the new 50?

In 2018, the American Cancer Society lowered its recommended age for a person’s first colorectal screening from 50 to 45 for people at average risk. Their research showed the rate at which colorectal cancer is diagnosed in the U.S. is:

  • Decreasing for people 65+, but
  • Rising in younger age groups.

These findings led the ACS to adjust their recommendations.

But many other experts still recommend starting to screen at age 50 years for adults with average risk levels. These groups include:

  • The US Preventive Services Task Force (USPSTF)
  • The American College of Gastroenterology (ACOG)
  • The Centers for Disease Control and Prevention (CDC)
  • The American Academy of Family Physicians (AAFP)
  • The American College of Physicians (ACP)

To find out more about the conversation on initial screening age, WellTuned spoke with Dr. Daniel Cusator, a medical director in care management for BlueCross BlueShield of Tennessee.

Why haven’t these organizations endorsed the new recommendations?

“Most physicians consider the guidelines from the USPSTF to be the go-to preventive guideline,” says Dr. Cusator. “That doesn’t mean the new recommendations are wrong or that they won’t ever be adopted. It just means there is still discussion within the scientific community as to what the standard should be. At BlueCross, we look for consensus of scientific evidence when making policy and coverage decisions.”

What should patients do in the meantime?

“Talk to your primary care provider,” says Dr. Cusator. “That is always the first step. Your PCP can discuss the pros and cons of earlier screening, taking into account your health and family history. Your PCP can review the different screening approaches and which would fit your specific situation.”

“Overall, the recommendation is still to have regular screenings from ages 50-75 — but that doesn’t mean you can’t start asking questions at your next appointment. Peace of mind is important, and so is staying educated.”

Here are 3 things Dr. Cusator says all patients should know about colonoscopies:

1. Screening has never been simpler or more accurate.

“The technology of testing has improved in the past few decades,” says Dr. Cusator. “All our tests are more sensitive and accurate, and there are many alternatives to a traditional colonoscopy. So if you’ve been putting off getting screened because you’re anxious about the procedure, you don’t need to.”

Alternatives to colonoscopies include stool-based tests, CT colonography, and flexible sigmoidoscopy. Your doctor can help you decide which is best for you. Once you’ve been screened, if no abnormalities are found, continue getting screened every 10 years for colonoscopy and 5 years for the other tests.

2. Polyps are the target.

“Polyps are the main thing we’re looking for during a colonoscopy,” says Dr. Cusator. “A polyp is a small growth of the tissues that line the colon. It’s similar to a skin tag — a growth of the cells that, over time, can turn into cancerous lesions if left untreated.”

If a polyp is found, it should be removed. That can be done immediately during a colonoscopy, which is a key benefit of that procedure. If evidence of blood or a polyp is found using an alternative screening tool, a colonoscopy will need to be scheduled.

3. Family history and other risk factors are important.

If your family has a history of colon cancer or if you’re in a higher risk category, your doctor may recommend you start screenings earlier, or that you get screened more frequently than every 5 years.

“The closer the relative who had colon cancer is to you, the more concerned we are about family history,” says Dr. Cusator. “It’s similar to what we see in breast cancer screenings. If you have a first degree relative, such as a parent, who had colon cancer, we need to take extra care with your colon health. The risk decreases for grandparents or aunts and uncles, but it still exists. Other risk factors include race as African-American men are at higher risk for colorectal cancer than other groups.

“The good news is that if colon cancer is diagnosed early, the survival rate is 90%. That’s why knowing your family history and talking with your doctor are so important.”

Below, hear from one BlueCross employee why knowledge is power when it comes to colorectal cancer. When caught early, it can be prevented or treated successfully 92% of the time.


To learn how to create a family history, click here

To learn more about colon cancer screenings, click here.

Ashley Brantley

Ashley Brantley has been writing about food, culture and health for more than a decade, and has lived in three of Tennessee’s four major cities (Memphis, Nashville and Knoxville).

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