29
May
2019

Given rising rates in under 50s - does the starting age of bowel cancer screening need to change?

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A new global study of seven high-income countries has found that in the decade up to 2014, Australia’s second most deadly cancer is on the rise in people under 50.

Published in the Lancet Gastroenterology & Hepatology the study found the number of people aged under 50 diagnosed with colon cancer increased significantly each year in Australia and New Zealand (by 2.9%), Denmark (by 3.1%) and the UK (by 1.8%).

Significant increases in the number of people under age 50 diagnosed with rectal cancer each year were also noted in Australia (2.6%), Canada (3.4%) and the UK (1.4%).

“Given the increasing rates of bowel cancer among younger Australians, we may need to review screening guidelines and consider lowering the starting age from 50 to 45 as the American Cancer Society now recommends,” Bowel Cancer Australia CEO Julien Wiggins said.

“Never assume you’re too young for bowel cancer. While bowel cancer is more common in people over 50, almost 1 in 10 new cases now occur in Australians under 50,” he added.

In May 2018, the American Cancer Society changed its screening guidelines to recommend lowering the starting age from 50 to 45 years, because of the increasing incidence among younger people.

For 47-year-old Kate Shew, early screening might have made all the difference to her bowel cancer diagnosis. In February 2018 she was diagnosed with stage four rectal cancer and some months later underwent surgery to remove a large tumor.

“I believe had I screened from age 45 my cancer would have been picked up sooner,” Ms Shew said.

“A lower start-age for bowel cancer screening could be part of the solution, together with ways to reduce risk through diet and lifestyle changes, as well as improved symptom awareness among both patients and GPs,” Colorectal Surgeon and a Director of Bowel Cancer Australia, Graham Newstead AM said.

“It may be ambitious, but we should be able to increase screening participation rates for people over 50 and also begin to screen those aged 45-49,” he said.

Professor Newstead said the new data mirrored his own experience treating increasing numbers of younger patients and called for urgent action to address this trend.

“I encourage young people to arm themselves with potentially lifesaving information about bowel cancer, including their risk factors, such as diet, lifestyle and family history as well as recognising any symptoms.”

“The age at which bowel cancer screening starts should clearly be reviewed. Most importantly, bowel cancer should not be dismissed by patients and GPs as a potential underlying cause of symptoms simply because the patient is younger,” Dr Newstead said.

A consensus-based recommendation contained within Australian medical guidelines already state that GPs can offer an at-home screening test ever two years to people aged 45-49 who request it, after being fully informed of the benefits (and any possible harms) of testing.

Meanwhile, figures published in the Lancet show a fall in the number of people aged 50-74 diagnosed with colon cancer (by 1.6%) and rectal cancer (by 2.4%) each year in Australia, a reduction which the authors noted, could at least in part be attributed to screening participation in this age group.

Conversely, another study of 144 million people aged 20-49 from 20 European countries showed bowel cancer incidence among those aged 40-49 years increased 1.6% per year between 2004 to 2016.

Published in Gut , the study showed bowel cancer incidence increased by 7.9% per year in those aged 20-29 years and by 4.9% per year in those aged 30-39 years respectively.

Bowel cancer is Australia’s second deadliest cancer. 103 people die every week from the disease.

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