The recommended age for colorectal cancer screenings is rising, but is it in the best interest of patients?

During the first week of August, the American College of Physicians updated its guidance for colorectal screenings in asymptomatic, average-risk individuals, raising the recommended screening age from 45 to 50. Some experts are not in agreement with the new recommendations. 

According to research from the American Cancer Society, adults ages 40 to 54 are seeing the steepest increase in colorectal cancer rates. In the last 20 years, rates have fallen in adults over 50, mostly because more people are getting recommended screening tests. 

The Centers for Disease Control and Prevention still recommends that routine colonoscopies for average-risk individuals begin at age 45. 

Shrujal Baxi, MD, chief medical officer at Iterative Health, a gastroenterology medtech company, talked with Becker's about her thoughts on changing colorectal cancer screening guidelines and what is coming down the pipeline next for Iterative Health. 

Question: Why do you think the ACP has raised the recommended age for colorectal cancer screenings?  

Dr. Shrujal Baxi: The move to increase the recommended age for colorectal cancer screenings is a bit surprising to me given the rising rates of colorectal cancer we've seen in younger patients, and the U.S. Preventive Services Task Force's recommendation that colorectal cancer screening begin at age 45 for average-risk individuals. However, as in other cancer screening guidelines, in the absence of a consensus, the decision needs to be made by patients and providers. The ACP's increase in the recommended age for colorectal cancer screening is in part due to the perceived burden of screening on the healthcare system, as well as the cost and risks to patients.  

Q: The report mentions some harms/dangers of colorectal cancer screenings – do you find physicians and patients are generally concerned about negative effectives from screenings? 

SB: Patients view colonoscopies as time-consuming and unpleasant, which directly impacts compliance with screening colonoscopies. Additionally, procedural complications are infrequent, but remain top of mind for physicians. However, the benefit of not only detecting a precancerous lesion early, but also having the ability to immediately remove it during a colonoscopy, is seen to outweigh the risks and the burden to the patient.

Q: What are the implications of removing DNA stool tests as a recommended screening tool?  

SB: We have seen a rise in popularity in noninvasive screening tests for CRC among patients. The recommendation to remove DNA stool tests is in part due to the higher false-positive rate to detect CRC than for other noninvasive screening tests such as fecal immunochemical tests or fecal occult blood tests. Where noninvasive tests are utilized, it is critical for patients and providers to understand that these are two-step tests and colonoscopy is the only screening method endorsed by the ACP that not only identifies precancerous lesions but also enables their resection. Colonoscopy has seen significant technological advancements in recent years to enable high quality procedures. For patients coming in for colonoscopy following a positive result from a noninvasive test, it's important for healthcare providers to utilize everything in their toolbox to ensure that the patient receives the highest quality procedure. 

Q: What other negative implications are you concerned about from these recommendation changes?

SB: Inconsistencies in screening guidelines could contribute to public confusion and may have a negative impact on the public perception of CRC screening. Increasing the rate of compliance with screening for CRC remains a major public health priority, and we expect medical societies to continue to focus on ensuring patients get screened and that it is done so with the highest quality.

Q: How is Iterative Health responding to the ACP's changes? 

SB: Iterative Health is on a mission to empower physicians with technology to enhance the standard of patient care. Like the ACP, we recognize that colonoscopy comes with risks and burdens to patients, and we're committed to helping physicians provide the highest quality of care possible.

Q: Does Iterative Health have any updates or new technology coming down the pipeline regarding CRC screenings? 

SB: Gastroenterology is primed for innovation – the proliferation of new screening options indicates this – but with colonoscopy unique in its role as both a screening and preventative tool, it is clear that we must innovate to further the quality of that procedure. Physicians are now using artificial intelligence to increase the number of precancerous lesions (adenomas) they detect and remove during colonoscopy, adding an extra layer of assurance to the patient's exam. Skout, a real-time polyp detection device from Iterative Health, uses artificial intelligence to assist endoscopists with detection of adenomas in the colon, equipping patients and physicians with an extra degree of confidence that a high-quality colonoscopy was conducted.

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