- Recommendations for screening for colorectal cancer should begin at 45 years old.
- In 2023, an estimated 19,550 people under 50 will be diagnosed with colorectal cancer.
- A new poll uncovers the reasons why this age group avoids screening.
Meredith Huetter had just turned 46 years old when she was diagnosed with stage 3 colorectal cancer (CRC) in December 2020.
“My symptoms started in March 2020…I started to experience some changes in bowel habits. That means anything from constipation to diarrhea to having this flip-flop of things happening from a bowel standpoint,” Huetter told Healthline.
In April, she spotted bright red blood in her stool, which prompted her to talk with her primary care physician, who chalked up the cause of blood to hemorrhoids. After six months of living with symptoms, she pushed for more information.
In November, she had a CT scan of her bowel, rectum, and colon that detected inflammation. Then in early December, a colonoscopy determined she had stage 3 colorectal cancer.
“Having a coloscopy at my age at that time wasn’t standard of care. At the time, the recommendation was 50 and I was newly 46,” said Huetter.
Immediately following the colonoscopy results, Huetter began treatment that involved surgery to install a port and 28 days of chemoradiation, which included five days of radiation treatment while wearing a pump to deliver chemotherapy.
She also underwent six months of chemotherapy followed by infusion and surgery to remove her anus, resulting in a permanent colostomy and her backside being sewn closed.
“Who knows what my world would have been had I been able to detect this earlier,” Huetter said.
Screening for colorectal cancer should begin at 45 years old
In 2021, the U.S. Preventive Services Task Force (USPSTF) released a recommendation that adults aged 45 to 75 be screened for CRC.
While CRC is most frequently diagnosed among those 65 to 74 years old, it is estimated that 13% of new CRC cases occur in people younger than 50 years old.
Additionally, CRC in those aged 40 to 49 years old increased by almost 15% from 2000-2002 to 2014-2016. In 2023, an estimated 19,550 people under 50 will be diagnosed with colorectal cancer, and 3,750 will die from the disease.
“We are seeing younger people get diagnosed with colon cancer (there is no settled agreement on why this is happening), and starting screening earlier can allow us to impact this spike in incidence of cancer in younger population,” Dr. Arun Swaminath, chief of gastroenterology at Northwell Lenox Hill Hospital, told Healthline.
The disease disproportionately affects different socioeconomic groups, races, and regions in the United States, with higher rates being observed in certain communities, such as Black and American Indian or Alaska Native communities.
Despite the increase, awareness of CRC is still lagging, said Dr. Paul Limburg,chief medical officer of screening at Exact Sciences.
“Unless a person sees a healthcare provider on a regular basis, a 45-year-old is very likely limited in what they know and understand about CRC, the importance of screening, and the various options available including a noninvasive test like Cologuard,” he told Healthline.
Cologuard is a simple stool test that you collect at home and mail in to check for hidden blood and certain DNA changes indicative of colon cancer — but if a person has a positive test, it’s essential to have a colonoscopy.
Although a colonoscopy is more invasive and requires significant preparation to empty the colon the day before the procedure, it also prevents colon cancer by removing the potentially cancerous polyps before they become cancerous.
Although there are pros and cons with each test, any screening is better than no screening.
The importance of screening comes down to the fact that CRC is the most preventable, yet least prevented cancer, Limburg stressed.
It is estimated that nationwide implementation of an 80% CRC screening prevalence for all eligible adults could save tens of thousands of lives by preventing numerous cases and deaths.
“It’s very simple; we can prevent many colorectal cancers through regular screening…screening can identify cancers that are more easily treated, and even pre-cancers that can be removed to avoid a cancer diagnosis entirely,” said Limburg.
Why 45-year-olds are not getting screened for colorectal cancer
To uncover the reasons why 45-year-olds in the U.S. are not getting screened for CRC, Exact Sciences led a poll “I Am 45” that was conducted online by The Harris Poll and with steering committee collaborators, including the American Cancer Society, the Colorectal Cancer Alliance, and Fight Colorectal Cancer.
Data was collected among 1,005 adults aged 45 years on March 6-14, 2023. The following were identified as barriers standing in the way of screening for this age group:
Lack of time due to everyday life responsibilities
The poll found that 77% of respondents are parents or legal guardians, 79% work full-time or part-time, and most are juggling other responsibilities that may take priority over their health.
“Like everything else, we are learning that we have to take care of ourselves to be here for the long term to look after our loved ones, enjoy life, and be productive in our fields,” said Swaminath. “Maintaining our health should be a priority. Pick a day this year when you’re scheduling this process and block it out on your calendar.”
Lack of awareness of CRC risk factors as well as when and how to screen for CRC
The poll found the following:
- 38% of 45-year-olds know they are of the recommended age to start routine screening for CRC. 27% of Black Americans know they are of the recommended age to start routine screening for CRC.
- One in three 45-year-olds are not at all sure or inaccurately think they only need to be screened for colorectal cancer if they have a family history of the disease.
- Hispanic Americans are more likely to delay or avoid colorectal cancer screening because they do not know how to get screened (20%) compared to white or Black Americans (10% and 5%, respectively).
Limburg noted that people are often not aware that there are many quality options for colorectal cancer screening.
“National organizations, such as [USPSTF], recommend that patients and providers have an ‘informed choice’ conversation to choose the strategy that best meets a person’s needs,” he said.
Colonoscopy technology has improved, including the use of high-definition scopes and carbon dioxide gas to avoid a bloated feeling post-procedure, added Swaminath.
“The preparation for colonoscopy has also gotten more varied with options like small volume preps and pills to help clean the colon prior to the procedure,” he said.
Fear and stigma
More than a quarter (26%) of 45-year-olds would delay or avoid screening for colorectal cancer because they are afraid of learning bad news about their health, while 24% report they are uncomfortable with the process of some screening methods, such as a potentially invasive procedure.
“When people say, ‘I don’t want someone looking there or touching me there,’ I always say ‘Well it’s that or it’s what I did and you don’t want to do what I did so go and get that screening,’” said Huetter. “If you’re not comfortable with a colonoscopy, there are so many other options.”
Seeing how the procedures are done is one way to help with the stigma and fear, Swaminath said.
“Many people would live stream it like the celebrities do (to raise awareness) if given the option. This is a thing that many patients, cancer, and GI advocacy societies have done a lot to demystify the process,” he said.
Lack of health insurance
Nearly one in 10, 45-year-olds who participated in the poll said they would delay or avoid screening for CRC due to lack of health insurance coverage. The number increased to 17% among Hispanic Americans and 14% of those living in rural areas.
Of those without health insurance, 60% said they have no plans to get screened for CRC, and more than two in five Hispanic Americans (43%) and those living in small towns (45%) said health insurance coverage would make them more likely to get screened.
Prioritization of other areas of health
Respondents ranked their top three health priorities as:
- Physical fitness/exercise (51%)
- Mental health (50%)
- Heart health (40%)
Black Americans are more likely to prioritize self-care and spiritual health (37% compared to 21% of white Americans and 22% of Hispanic Americans).
When considering cancer screenings, 57% said it is or might be more important for women to be screened for breast cancer than colorectal cancer.
“As women, we started having mammograms at 40 and pelvic exams in our teenage years,” said Huetter. “We talk a lot nowadays about self-care. It’s hard within this age group because we have a lot of responsibilities and always putting ourselves first is an overall challenge.”
Reasons why 45-year-olds do not get screened for CRC vary, but the increase in cases for this age group is more the reason to talk to your doctor about screening options.