New research suggests that patients at average risk of colon cancer may only need to undergo a colonoscopy every 15 years, rather than every 10 years as recommended. Masu.
Researchers in Sweden found that if you wait another five years after your first colonoscopy is negative, you are at greater risk of having a colorectal diagnosis later or dying from a colorectal exam every 10 years. I discovered that it is the same as receiving. Extending screening times could reduce “unnecessary invasive testing,” according to a study published Thursday in JAMA Oncology.
colorectal cancer It is the fourth most common cancer diagnosed in the United States and the second most deadly cancer after lung cancer.of Recommended by the American Cancer Society that sieving Start at age 45 for people without a family history of other risk factors, such as colorectal cancer or inflammatory bowel disease.
In an editorial accompanying the new study, gastroenterologists suggested that future screening guidelines may be safely extended for some people, saying, “15 becomes the new 10.” There is a possibility.”
Diagnosis rates of colorectal cancer are decreasing among people over 50, while diagnoses of colorectal cancer are increasing among younger people, who may require a colonoscopy. New groups may emerge.
Physicians are struggling with how to best allocate appointments.
“We don’t have enough gastroenterologists to perform colonoscopies every 10 years on everyone over 50,” says Johns Hopkins Distinguished Professor of Oncology and Epidemiology, Bloomberg. said Dr. Otis Brawley, who was not involved in the new study.
For the new study, researchers looked at national registry data for more than 110,000 people whose first colonoscopy tested negative for colorectal cancer. They compared these people to a control group of more than 1 million people.
The mean age of both groups was 59 years, and approximately 60% of patients were female. Considering family history, after a negative initial colonoscopy, the risk of later diagnosis of colorectal cancer or death from colorectal cancer is lower than the risk of having a colonoscopy every 10 years. The results were found to be almost the same for those who received it every 15 years and those who received it every 15 years. .
Researchers found that waiting an additional five years between colonoscopies would result in two missed cases of colorectal cancer per 1,000 people and one colorectal cancer-related death, while estimated that 1,000 colonoscopies could be saved.
Using cheaper, less invasive screening methods 10 to 15 years after a negative colonoscopy could significantly reduce the number of missed screenings, the study said. said Dr. Mahdi Farah, lead author and head of the Risk Adapted Cancer Prevention Group at the German Cancer Research Center. Heidelberg.
“The best screening test is the one that is actually done. Therefore, if an individual cannot afford a test like a colonoscopy, an alternative, cheaper and more effective test is better than not doing the test at all.” It’s much better than that,” said Fara, who is also a visiting professor at the Department of Clinical Sciences at Lund University in Sweden.
more diverse people
The study was conducted in Sweden, a country with a large white population and a health care system that is very different from the United States. Because national health systems also collect information about people’s family health histories, researchers can be confident that: Those who reported no family history of colorectal cancer were correct.
“It will be very difficult to apply these findings to the United States,” says Dr. Cassandra Fritz, a gastroenterologist at Washington University in St. Louis. “When you ask patients about their first-degree relatives with colorectal cancer, most people don’t know,” said Fritz, who was not involved in the new study.
Although the United States is much more racially and ethnically diverse, this study provides important context to help physicians understand how to best delegate limited resources, Fritz said. added.
“We need to think about how we can conserve resources and use the resources we have to impact more people,” said Digest of the Massachusetts Comprehensive Cancer Center in Boston. said Dr. Andrew Chan, an internist, chief of epidemiology, and co-author of JAMA. Editor.
Percentage of colorectal cancers occurring in people under age 55 doubled From 1995 to 2019, from 11% to 20%. However, the total number of infections in this group is still relatively small.
“Before the age of 50, colorectal cancer probably does not require screening for everyone. The benefit of the risk does not outweigh the cost,” says the Gastroenterologist at the University of Texas MD Anderson Cancer Center in Houston. said Dr. Robert Bresaglia, professor of medicine in the Division of Pathology and Liver Nutrition. Bresalier was not involved in the new study.
Latest news about colorectal cancer
That only applies to people with no family history, he added. Brawley said people who have a parent or sibling with colorectal cancer should start screening 10 years before that parent or sibling is diagnosed.
Other screening tools, primarily stool tests, have been improved in recent years to become more accurate. A fecal occult blood test detects blood in the stool. This could be a warning sign of colon polyps or cancer. FIT-DNA tests, such as Cologuard, detect changes in DNA in stool that can indicate cancer and are about 90% effective at detecting cancer, but are less effective at detecting precancerous polyps. Not very effective.
These tests are non-invasive and relatively inexpensive compared to colonoscopies. The problem is that it needs to be performed more often than a colonoscopy, every 1 to 3 years. If the test result is positive, you should have a colonoscopy, which may allow you to get a colonoscopy sooner than every 10 years.
Still, the test could be a good option to reduce the number of colonoscopies after an initial negative screen, Chan said.
“Getting tested is important, but we have a finite number of resources to test people,” he said. “To test as many people as possible, we need to choose what kind of testing to do and how often to test.”
Improvements in screening in the U.S. will likely be geared toward risk factors other than age, which experts still don’t know much about, Bresalier said.
“One size does not fit all. We know a lot about the genetics of colorectal cancer, but most of that research has been done in white people. Men and women. “There are potential differences between people and between different ethnic groups,” he said. “Based on these other factors, we may be able to do risk-based spacing for people who are at normal risk.”
Colon cancer warning signs
Symptoms of colorectal cancer often do not appear until later stages and may be difficult to distinguish from other less serious conditions.
“You can’t rely on symptoms,” Chan said. “Many people have no symptoms at all, which highlights how important screening is.”
Blood in your stool that appears red or black, changes in the frequency of your bowel movements, abdominal pain, and weight loss can all be warning signs of colorectal cancer and may also be signs of irritable bowel syndrome or inflammatory bowel disease. . There are many other, less serious problems.
Nevertheless, people with new symptoms should make an appointment to see a doctor, Fritz said.
Anyone over the age of 45 should start getting tested. What that looks like may depend on where you live.
“In some areas, it may be more practical to have a colonoscopy than in others. In some areas, it may be more practical to have a stool-based test,” Chan said.
This includes people living in rural areas or areas without access to a gastroenterologist. For people who are underinsured or uninsured, Fritz said it is possible to pay cash for a stool-based test, but if the stool test is positive, a colonoscopy may be required later. He said it would be necessary.
What everyone should do, Fritz said, is understand their risks.
“Many people avoid conversations about bowel movements, but it’s really important to talk to your family to find out if you’re at high risk,” she said.
