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The American Cancer Society Now Says Colorectal Cancer Screening Should Start At Age 45 Not 50

More people are getting colorectal cancer at younger ages for reasons that are a bit mysterious.

Posted on May 30, 2018, at 5:53 p.m. ET

People are getting colorectal cancer at younger ages than they have in the past.

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The risk of getting colorectal cancer — particularly rectal cancer — before age 50 has increased by 51% since the mid-1990s, according to the American Cancer Society. The group issued new guidelines on Wednesday recommending that people begin screening for the disease by age 45 rather than 50.

"Someone born in 1990 has twice the risk of developing colorectal cancer in their lifetime as someone born in 1950, and four times the risk of developing rectal cancer, or cancer of the lower colon," Dr. Andrew Wolf, the lead author of the new guidelines, told BuzzFeed News.

Colorectal cancer is the fourth most common cancer in the US in both men and women, and the second-leading cause of cancer deaths. Black people, American Indians, and Alaska Natives have a greater incidence and mortality compared with other people. Overall, there are 97,000 new colon cancer cases and 43,000 new rectal cancer cases each year.

"This is a condition that I think has traditionally been considered a risk for older people but it is reaching into younger populations," said Wolf, who is an associate professor of medicine at the University of Virginia School of Medicine in Charlottesville. "It’s still uncommon but younger folks, millennials, need to be thinking about it and need to be talking to their health care providers about it."

So what kinds of tests do you need for colorectal cancer screening?

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Colorectal cancer screening can include a colonoscopy — a test you've probably heard of. It starts with drinking a laxative to clean out the colon (i.e., lots and lots of diarrhea). Then a doctor inserts a lighted probe into the anus and examines the entire colon while the patient is under anesthesia.

But there are also other tests for colorectal cancer. They can include stool tests, scans, and examination of the colon that are less invasive than colonoscopies.

"Folks should know they have options besides colonoscopy," Wolf said. "Colonoscopy is an excellent test but we have other excellent tests that are less invasive and simpler to do and just as good or almost as good if they are done regularly."

So why are people getting colorectal cancer at younger ages?

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The reasons younger people are getting this type of cancer are unclear, Wolf said, although some dietary patterns — including eating too much meat and too few fruits and vegetables — and a sedentary lifestyle are known to increase the risk. Other risk factors include smoking and drinking alcohol.

"There is an association between colon cancer and poor diet and inactivity and obesity and smoking. We do know that," he said. "But as to why is it increasing in the young population, we don’t believe that to be the whole answer."

One thing that's probably not causing the uptick: HPV, or human papillomavirus. The sexually transmitted virus is linked to a higher risk of anal cancer, but not colorectal cancer.

Colorectal cancer symptoms include a change in bowel habits like diarrhea, constipation, or narrowing of stool that lasts longer than a few days; rectal bleeding; dark stools or blood in the stool; abdominal pain; a feeling like you need to have a bowel movement that doesn't go away after having one; fatigue; and weight loss.

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