Childhood Cancer Epidemiology: Overview, Tools of Study, Cancer Incidence
It May Be Safe For Some To Wait 15 Years For Repeat Colonoscopy, Study Suggests
New research suggests patients with an average risk of colon cancer may only need to undergo a colonoscopy screening every 15 years instead of the recommended 10.
Swedish researchers found that waiting an extra five years after a first negative colonoscopy carried about the same risk of later having a colorectal diagnosis or dying from the disease as getting screened every 10 years. Extending screening time could reduce "unnecessary invasive examinations," according to the study published Thursday in JAMA Oncology.
Colorectal cancer is the fourth most common cancer diagnosed in the U.S. And the second most deadly behind lung cancer. The American Cancer Society recommends that screening begin at age 45 for people who don't have a family history of colorectal cancer or other risk factors, such as inflammatory bowel disease.
In an editorial accompanying the new study, gastroenterologists suggested that future screening guidelines may safely be prolonged for some people, noting that "15 has the potential to be the new 10."
While rates are going down among people over 50, colorectal cancer diagnoses are on the rise among younger people, opening up a potentially large new group of people who may require colonoscopies.
Doctors are grappling with how to best allocate appointments.
"We do not have enough gastroenterology doctors to do a colonoscopy every 10 years in everyone over 50," said Dr. Otis Brawley, the Bloomberg distinguished professor of oncology and epidemiology at Johns Hopkins University, who was not associated with the new research.
For the new study, researchers looked at national registry data of more than 110,000 people whose first colonoscopy had a negative result for colorectal cancer. They compared these people with more than 1 million in a control group.
The average age in both groups was 59 years, and about 60% of the patients were female. Taking family history into account, they found that after having a first negative colonoscopy, the risk of later having a colorectal cancer diagnosis or dying from the disease was about the same among people who had a colonoscopy every 10 years and those who stretched it to 15.
They estimated waiting an extra five years between colonoscopies would miss two colorectal cancer cases, and cause one colorectal cancer-related death, for every 1,000 people, while potentially saving 1,000 colonoscopies for other patients.
Employing cheaper, less invasive screening methods 10 to 15 years after a negative colonoscopy could greatly reduce the number of missed screenings, said the study's lead author, Dr. Mahdi Fallah, head of the Risk Adapted Cancer Prevention Group at the German Cancer Research Center in Heidelberg.
"The best screening test is the one that is actually done. So, if a test like colonoscopy is unaffordable for a person, an alternative cheaper valid test is much better than no test at all," said Fallah, who is also a visiting professor in the department of clinical sciences at Lund University in Sweden.
More diverse populationThe research was conducted in Sweden, which has a mostly white population and a health care system that looks very different from that of the U.S. The national health care system also collects information on the family health history of its citizens, meaning the researchers could be sure those who reported no colorectal cancer in their family were correct.
"It would be really hard to apply these findings to the U.S.," said Dr. Cassandra Fritz, a gastroenterologist at Washington University in St. Louis. "When we ask patients about colorectal cancer in first-degree relatives, most people don't know." Fritz was not involved with the new study.
The U.S. Is also much more racially and ethnically diverse, but the research does provide important context that will help doctors understand how they can best delegate their limited resources, Fritz added.
"We need to think about how we can potentially save resources and impact more people with the resources we have," said Dr. Andrew Chan, a gastroenterologist and director of epidemiology at Massachusetts General Cancer Center in Boston and a co-author of the JAMA editorial.
The proportion of colorectal cancer that occurred in people under age 55 doubled from 1995 to 2019, from 11% to 20%. But the total number of cases in this population is still relatively low.
"Once you get younger than 50, the incidents of colorectal cancer are probably not going to require screening everyone. The risk benefit doesn't outweigh the cost," Dr. Robert Bresalier, professor of medicine in the department of gastroenterology hepatology and nutrition at the University of Texas MD Anderson Cancer Center in Houston. Bresalier was not involved with the new research.
That only goes for people without a family history, he added. People who have a parent or sibling who has had colorectal cancer should begin screening 10 years before that parent or sibling was diagnosed, Brawley said.
Other means of screening, mainly stool tests, have been honed to be more precise in recent years. Fecal occult blood tests detect blood in the stool, which can be a warning sign of colon polyps or cancer. FIT-DNA tests, such as Cologuard, detect altered DNA in the stool, which could indicate cancer, and are about 90% effective at detecting cancer, but are less effective at detecting precancerous polyps.
These tests are noninvasive and relatively cheap compared to colonoscopy screening. The catch is, they need to be done more often — every one to three years — than colonoscopy. If the test is positive, the person should get a colonoscopy, which could trigger getting one sooner than every 10 years.
Still, the tests could be a good option for cutting down on the number of colonoscopies given after a negative first screening, Chan said.
"It is important to get screened, but there is a finite number of resources to screen people," he said. "To screen as many people as we can, we need to make choices about what type of screening we're doing and how often we're doing it."
Better screening in the U.S. Will likely be more tailored to risk factors other than age, which experts don't yet know much about, Bresalier said.
"One size may not fit all. We know a lot about the genetics of colorectal cancer, but most of that research was done in white people. There are potential differences among men and women and among different ethnicities," he said. "We may get to a point where we get to risk-based intervals even in normal risk people, based on these other factors."
Warning signs of colon cancerSymptoms of colorectal cancer often don't show up until later stages and can be difficult to differentiate from other, less serious conditions.
"You can't rely on the symptoms," Chan said. "Many people don't have symptoms at all and that highlights how important screenings are."
Having blood in bowel movements, which can appear as red or black, a change in how often you go, abdominal pain and weight loss can all be warning signs of colorectal cancer — and they can also be signs of irritable bowel syndrome, inflammatory bowel disease and a host of other less-serious issues.
Nonetheless, people with new symptoms should make an appointment to see a doctor, Fritz said.
Anyone over age 45 should start getting screened. What that looks like may be determined by where you live.
"In some areas, it's more feasible to get a colonoscopy than in others. In some areas, it might be more realistic to get a stool-based test," said Chan.
This includes people living in rural areas or areas without access to a gastroenterologist. For those who are underinsured or uninsured, Fritz said it is possible to pay cash for a stool-based test, though a positive stool test will require a colonoscopy later on.
Something everyone should do is understand their risk, Fritz said.
"A lot of people avoid having conversations about bowel movements, but it's really important to talk to your family so you know if you are at high risk," she said.
This article was originally published on NBCNews.Com
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Tricare Lowers Age For Colon Cancer Screenings To 45
Tricare beneficiaries at average risk for colorectal cancer can now receive covered screening exams and lab tests five years sooner, at age 45, following a recent coverage change.
The change in coverage comes as people younger than 50 are getting colon cancer more often, according to the American Cancer Society. The incidence of colorectal cancer in the U.S. Rose steadily from 2011 to 2020 in people younger than 50, increasing at a rate of 2% per year. Cases of advanced colon cancer in patients under 50 grew even faster during that time, at about 3% per year.
The Defense Health Agency published the Tricare Policy Manual change April 30. Because professional associations no longer provide a definition of "increased or high risk" for colon cancer, Tricare is leaving the decision up to patients and their doctors whether earlier screenings, prior to age 45, are appropriate.
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Despite the rise in colon cancer among younger Americans, overall cases have declined since 1985, which the American Cancer Society credited in part to more screenings.
However, that decline has flattened in recent years, it said, likely because screenings reached "saturation" while younger people's rates went up. By 2019, 20% of colon cancer cases were in people 54 years or younger, an increase from 11% in 1995.
Tricare considers patients to be "average risk" if they don't have:
Tricare now covers the following tests and treatment exams for average-risk patients starting at age 45:
In addition to colon cancer screenings, Tricare covers screenings for:
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Story ContinuesSymptoms That May Signal Early Colon Cancer
Not Everyone Is Symptomatic in the Beginning
Medically reviewed by Robert Burakoff, MD
Diagnosing colon cancer early is important so that it can be treated most effectively. Paying attention to any possible symptoms is key. While there may be symptoms of early colon cancer, sometimes there aren't.
Early symptoms can be vague and nonspecific, such as changes in bowel habits (frequency, volume, consistency, color, control of defecation) or blood in the stool.
See a healthcare provider if you notice any changes in your bowel habits or any symptoms that don't feel right. These can be symptoms of various ailments, and getting an appropriate diagnosis and subsequent treatment as soon as possible helps with the likelihood of positive outcomes.
Photo composite by Tara Anand for Verywell Health; Getty Images
Early Colon Cancer: Symptoms to KnowPeople tend to use the terms symptoms and signs interchangeably, but they have different medical definitions. Symptoms are things you feel in your body, and signs are changes that can be measured, like blood work numbers or blood pressure.
Very early colon cancer is typically asymptomatic (doesn't have any symptoms), which makes regular screening extra important.
Colon cancer usually arises from a polyp—a clump of cells. Many polyps are not cancerous, but even for cancerous polyps, they can take 10 to 15 years to turn into cancer. It then takes time to grow and spread, causing symptoms.
However, symptoms can occur, and it's important to be aware of them. These symptoms might also indicate other conditions. If you have any symptoms, see a healthcare provider.
Colon Cancer and Young AdultsThe incidence of colon cancer is rising in young adults. They're more likely to ignore symptoms that may indicate disease, which leads to later diagnosis and treatment. Don't put off seeing a healthcare provider if you notice any symptoms. Early diagnosis and treatment are key for optimal results and a greater chance of survival.
Common in Early Colon CancerSymptoms that can occur, especially in the earlier stages of colon cancer, include:
Changes in your bowel habits, such as having more diarrhea or constipation than usual
A feeling that you haven't emptied your bowels completely after a bowel movement
Bleeding from the rectum or blood in your stool
Thinner or narrow stool
Cramping or stomach pain
Unintentional weight loss
While fatigue may be present in early colon cancer, it's more likely to show up as time goes on. This is because colon cancer causes bleeding from the rectum or digestive tract. Over time, this blood loss becomes more significant, causing a low red blood cell count (anemia), which causes fatigue.
What If You're Asymptomatic?As colon cancer progresses, symptoms will eventually show up. But in the earlier stages, there is the chance of being asymptomatic.
If you are at elevated risk for colon cancer because of family history, genetics, or lifestyle factors, talk with a healthcare provider about your concerns. Sometimes, you may be able to be screened for colon cancer based on established risk, but this is not always the case.
Colon Cancer and Overlapping Symptoms in Other ConditionsMany symptoms of colon cancer are similar to symptoms of other conditions, which is why it's so important to see a healthcare provider if you notice any symptoms. They can do an exam, get a thorough medical history, and order any screening or diagnostic tests that can help with an accurate diagnosis.
Other conditions that have overlapping or similar symptoms can include:
Screening to Detect Early Colon CancerEarly colon cancer can often be found or prevented through screenings, which can find and remove polyps before they become cancerous or when they start to become cancerous. Your provider should discuss with you when screening starts based on your age, family history, medical history, and lifestyle.
Certain risk factors indicate that you should start screening at an earlier age and/or have screening more often, and these include:
A personal history of colon cancer
Strong family history of colon cancer or polyps (i.E., in a first-degree relative such as a parent or sibling younger than 60 or two first-degree relatives of any age)
Personal history of inflammatory bowel disease
Family history of any hereditary colon cancer syndrome, including familial adenomatous polyposis (FAP) or Lynch syndrome
The United States Preventive Services Task Force (USPSTF) recommends that people between the ages of 45 and 75 get regular screening. However, they don't recommend a specific test. For most people of average risk, insurance will cover a colonoscopy every 10 years.
Tests that can be used for screening include:
Colonoscopy: Uses a thin tube with a camera and tools on it inserted through the rectum to examine the entire rectum and colon and also remove polyps
Computed tomography (CT) colonography: Also called "virtual" colonoscopy, it uses CT to produce detailed images of the colon and rectum.
Sigmoidoscopy: This procedure is similar to colonoscopy, but it cannot check the upper part of the colon.
Fecal occult blood test (FOBT) and fecal immunochemical test (FIT): These are tests to find blood in the stool.
Stool DNA test: This test checks the stool for signs of tumor genetic material.
Localized colon cancer, or cancer that has not spread beyond any local tissues to lymph nodes or any distant organs or tissues, has a five-year survival rate of 91%. Localized colon cancer typically refers to stages 0 through 2A.
When to Get a Provider OpinionSo when should you see a healthcare provider?
If you have any chronic bowel issues and notice a change in your bowel habits, blood in your stool, or unexplained bloating or fatigue, it's worth calling a healthcare provider to see if there's something that needs addressing.
If you have a family history of colon cancer, polyps, or any hereditary colorectal cancer syndrome, your screening guidelines are likely different than the general population. You should speak with a healthcare provider about when you should get screened, and any signs or symptoms to watch for.
Tell a healthcare provider about your concerns or anxiety about symptoms getting worse or your risk factors. They may be able to provide you with concrete information that may help ease your fears or help mitigate your anxiety.
Can You Lower Your Colon Cancer Risk?Anyone can get colon cancer, but certain risk factors can increase the likelihood of the cancer developing. However, it's important to remember that risk factors don't necessarily mean you will develop cancer; they increase your risk. It's also possible to develop colon cancer with no risk factors.
Some risk factors that are out of your control include things like:
Older age: Your risk of colon cancer increases as you get older.
Having inflammatory bowel disease (IBD) like Crohn's disease or ulcerative colitis
Genetic syndromes like familial adenomatous polyposis (FAP) or Lynch syndrome
Talk with a healthcare provider about these risk factors and how they may impact screening for you.
Some other risk factors relate to behavior or lifestyle and can be modified. High-risk lifestyle factors include:
Using alcohol and tobacco
A diet low in fiber and high in fat or a diet high in processed meats
Lack of fruits and vegetables in your diet
Minimal physical activity
Overweight or obesity
If you have one or more modifiable risk factors, talk with a healthcare provider about steps you can take to address your risk and reduce it. Sometimes, you may want additional help, like a nutritionist or a counselor, to help change behaviors and choices.
SummaryEarly colon cancer doesn't always have symptoms, but when they do arise, they are often general and nonspecific, like bloating, gas, or changes in bowel habits. Sometimes, more serious symptoms like bloody stools, significant weight loss, or fatigue may occur.
It's important to note any changes in bowel habits and see a healthcare provider if you notice anything different about your body or how you feel. Talk with them about when you should start screening for colon cancer, depending on your family and medical history, and what steps you can take to help reduce your risk of developing colon cancer.
Read the original article on Verywell Health.
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