A colonoscopy before age 45? Here's what young people need to know about colon cancer screening
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Each time I visit my gastroenterologist, I can’t help but notice that I’m usually the youngest person in the waiting room by several decades.
At age 33, I’ve had two colonoscopies, even though screening guidelines recommend most people have them starting at age 45.
What’s the rush to undergo an invasive, unpleasant procedure?
Nearly six years ago, my father, then 53, was diagnosed with colon cancer. Coupled with some risk factors of my own, my doctor decided it would be best for me to undergo a colonoscopy soon after Dad’s diagnosis in 2011. I was 28.
Let’s face it: Colonoscopies are – forgive the choice of words – crappy. You go on a diet of clear liquids (Gatorade, juice, water, chicken broth) for a day. You drink a foul-tasting laxative – often, two doses. Then you spend hours in the bathroom, often in the middle of the night.
Bleary-eyed and queasy, you go to your doctor’s office, are given anesthesia or light sedation, and a doctor inserts a thin tube with a camera into your rectum. It takes about 30 minutes to examine your colon for cancer or polyps, which might develop into cancer.
It’s an unpleasant experience, but one that more people should be doing – especially in Hampton Roads.
Our region is a hot spot for colon cancer deaths, according to a study reported on by my colleague Elizabeth Simpson last year. From 2009 to 2011, southeastern Virginia and northeastern North Carolina had a colon cancer death rate 9 percent higher than the rest of the country.
Various medical organizations, as well as the U.S. government, issue colorectal cancer screening guidelines. Most, including those from the American College of Gastroenterology, call for a colonoscopy every 10 years, starting at age 45.
I called David Johnson, chief of gastroenterology at Eastern Virginia Medical School and co-author of the ACG’s screening guidelines, for some insight.
Colorectal cancers tend to be slow-growing, said Johnson, a past ACG president. Age 50 is one “where we’d recognize that we’d pick up more precancerous lesions.”
The ACG’s most recent guidelines were published in 2009. Among the biggest changes, Johnson said, was recommending that African Americans begin screening at age 45. The guidelines cite research that shows black people have an increased incidence of colorectal cancer, often at a younger age.
So – what about colon cancer in people younger than 50 or 45? I found a 2014 study from the MD Anderson Cancer Center in Texas, which examined diagnoses over a 35-year period. Researchers projected out to 2030 and found that more than one in 10 colon cancers and nearly one in four rectal cancers will be diagnosed in people younger than 50.
Johnson, who also works at Digestive & Liver Disease Specialists in Norfolk, shared a more recent study that had a similarly troubling outlook: Younger patients are more likely to be diagnosed with more advanced colorectal cancer.
What could be behind these concerning predictions? Johnson, and my doctor, Alex Williams, both said obesity and diet could contribute. Smoking, too, Johnson added.
The studies’ results beg the question: Might younger adults be included in future colorectal screening guidelines?
Williams cautioned that more studies have to be done. Johnson said he expects the review panels “to give it thoughtful and careful attention.”
So, what should young people do to protect their colon health?
Monitoring relatives’ health is important – specifically, that of parents and siblings. In the past, Williams said, people were often reluctant to share these details.
“If people don’t talk about it, if your parents don’t talk about it, there is no way you’re going to know,” said Williams, who works at Gastroenterology Associates in Norfolk. “You’ve got to ask them to be more open.”
Grandparents’ colon cancer isn’t especially a factor for grandchildren, Williams said, unless they are diagnosed at a young age – around 40.
One of the most important things is: No matter your age, don’t ignore problem signs, like blood in the stool or a change in your bowel output.
“Those should never be taken as, ‘Well I’m too young to be getting these things,’ “ Johnson said. “Patients should always report things and never be their own diagnostician.”
The tricky thing about colon cancer is it can be a silent killer. By the time symptoms show up, Williams said, it’s often rather advanced.
That was certainly the case for my dad. He had been experiencing sporadic hand cramps, and when he went to the doctor, his bloodwork showed severe anemia.
Within weeks, he had a colonoscopy to look for internal bleeding – his first since around age 40. And that’s where his Stage 2 cancer was found.
He had part of his colon removed. Five years later, he’s a cancer survivor.
To say my dad was fortunate would be understating it. He had symptoms. He had surgery, and no chemotherapy or radiation was needed.
As Johnson put it, the goal of colorectal screening isn’t to detect cancer, it’s to prevent cancer. With any luck, I, and others who vigilantly monitor their digestive health, can avoid a cancer diagnosis, too.