The invasive and expensive nature of colonoscopies has led to significant research efforts focused on determining how to maximize their usefulness in the context of follow-up screenings. While there is no denying that surgical-based tests can save lives, establishing the optimal timing for these procedures remains a complex task.
In 2018, the U.S. Preventive Services Task Force reduced the recommended age for an individual’s first colorectal cancer screening from 50 to 45 years old. Now, attention has shifted towards the gap between the first and second tests conducted on patients. Dr. Carl Bryce, a family physician, emphasized that “the sooner the treatment, the much better the outcomes” when it comes to colorectal cancer diagnosis and treatment.
Although not official, one study found that the risk for people without an immediate family member affected by colorectal cancer may be lower than previously thought. Conducted in Sweden, this research examined 29 years of patient data, focusing on a group of 110,000 patients with no family history and negative colonoscopy results. These individuals were then compared to 18 age-matched controls with the same type of negative findings.
The study found that, for the first 10 years, the risk of colorectal cancer and colorectal cancer death was lower by 72% and 55%, respectively, in the group with no family history and negative results. The statistics were used to determine risk at the 15-year mark and every year afterward up to 20 years. Researchers discovered that extending the screening interval to 15 years might result in 2.4 more cases of colorectal cancer per 1,000 people being missed, with this rate increasing gradually to 11.9 additional cases per 1,000 individuals by year 20.
However, Dr. Cedrek McFadden, a member of the Colorectal Cancer Alliance’s medical scientific advisory committee, expressed concerns about the study and its findings. Not only was it conducted in Sweden and may not hold true for the United States, but he is also worried that narrow qualifications might be misconstrued by the media or overlooked by patients making decisions based on “headlines” or social media content instead of official guidelines and conversations with their doctors.
The JAMA study recommendation also considered family history when determining risk levels for patients. Despite this, Dr. McFadden noted that more work is needed to fully understand which patient populations are most likely to benefit from surveillance, as well as the ideal surveillance interventions for optimizing colorectal cancer prevention and early detection.
As a result of these complex and changing guidelines, both doctors and patients need to engage in more conversations with one another, while patients should also discuss their family history among themselves. Dr. McFadden pointed out that his patient population is often unaware of their family’s medical background.
Several other types of tests can be used as alternatives or supplements to traditional colonoscopies, such as fecal occult blood tests (FOBT), which identify hemoglobin proteins, DNA biomarkers, and blood; or virtual colonoscopies, which employ CT scans to determine whether there are polyps or abnormalities in the colon. Additionally, Dr. McFadden emphasizes the importance of discussing diet with patients since the microbiome is associated with dietary habits.
Colorectal cancer is becoming more common among younger individuals and disproportionately affects black Americans at a higher rate. This highlights the need for continued research and better understanding of best practices in screening, prevention, and early detection efforts to address this concerning public health issue.