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Evidence suggests it’s time to lower the bowel cancer screening age


Doug Hendrie


24/06/2020 4:17:23 PM

Experts and a young GP with bowel cancer are pushing for screening to start earlier.

People reviewing colonoscopy
Bowel cancer diagnoses in younger people continue to rise year on year, accounting for almost 10% of new cases.

Two years ago, the American Cancer Society recommended the bowel cancer screening age be lowered from 50 to 45, to pick up these dangerous cancers earlier. 
 
Bowel Cancer Australia now says new evidence suggests Australia should follow suit, given bowel cancer diagnoses in younger people continue to rise year on year, accounting for almost 10% of new cases.  
 
Almost 2% of people aged under 50 were found to have bowel cancer in a study of 557 colonoscopy patients, with adenomas, polyps that can turn into cancer, detected in one in five patients.
 
All study participants who were diagnosed had stage 3 or 4 cancer, and were showing symptoms.
 
That research follows a 2019 Cancer Epidemiology, Biomarkers and Prevention study that found Australia’s incidence of bowel cancer has increased by up to 9% in people aged under 50 since the 1990s.

Similar trends have been seen in the US, where bowel cancer rates have been increasing among young people since the mid-1980s. 
 
Colorectal surgeon and Bowel Cancer Australia Director Associate Professor Graham Newstead said the new study suggests lowering the age for screening ‘could be part of the solution’ alongside improved symptom awareness among GPs and patients.
 
‘Over 1500 bowel cancer cases occur in people under age 50 each year, so we need to be bold and begin screening those between 45–49 while also increasing screening participation rates for those over 50,’ he said.
 
Associate Professor Newstead told newsGP he is ‘madly keen’ to get the screening age lowered to 45.
 
‘When I was a medical student, bowel cancer was a disease of 60-year-olds and up. Now we are seeing people in their mid-30s and they are increasing in number and presenting later,’ he said. 
 
‘If GPs see a patient in their 30s or 40s with bleeding, we can’t presume it’s just haemorrhoids. They need assessment.’
 
The cancer charity is lobbying for Australia to follow the US and lower the age of screening.
 
Bowel cancer was the leading cause of death from cancer in men aged 30–34 and women aged 25–34 in Australia in 2019.
 
The Federal Government this year announced that faecal occult blood tests will be sent out to Australians aged 50–74 every two years, rather than every five, in a bid to tackle rates of bowel cancer that are high by world standards.
 
Last year, 35-year-old Gold Coast GP Dr Sean Mitchell was diagnosed with stage 4 bowel cancer. He told newsGP he strongly supports the push to lower the cancer screening age.
 
‘Far from being the odd one out, I am part of an increasing cohort of patients in our early 30s with bowel cancer, over 70% of whom have stage 3 or 4 cancer,’ he said. 

Graham-Newstead-Article.jpg
Bowel Cancer Australia Director Associate Professor Graham Newstead said the new study suggests lowering the age for screening ‘could be part of the solution’ alongside improved symptom awareness among GPs and patients.

Dr Mitchell said neither age nor genetic risk factors applied to him, with no one in his extended family ever having been diagnosed.
 
‘More research is required into why incidence in young people without risk factors is increasing year on year,’ he said.
 
‘We rightly have a robust system for detecting cervical cancer, and we have dramatically improved the picture for young women. How can we do the same for colon cancer?
 
‘At the moment, the best we have is active case-finding, and that falls on us as GPs. I ask my colleagues to consider early referral for colonoscopy in patients with abnormal symptoms regardless of age.
 
‘Hopefully over the next decade we can make a dent in the incidence of late-stage cancers for those under 50, with a particular focus on symptomatic patients in their late 20s, and reduce the disease burden of the largest cancer killer for men and women in their early 30s.’
 
In a 2018 Cancer Epidemiology, Biomarkers and Prevention study, Australian researchers modelled the lowering of screening to 45 and found that it could be cost-effective, though with a less favourable incremental benefits-to-harm trade off compared to screening from 50–74 years of age.
 
The study also found the change would increase colonoscopy demand, which could potentially lead to longer waiting times for high-risk people.
 
Only around 40% of people who receive the faecal occult blood test actually complete it, leading bowel cancer experts to last year suggest that boosting screening coverage rates to 60% of Australians could save around 84,000 lives by 2040.
 
‘That is why screening is so effective … This would represent an extraordinary success,’ they wrote in The Conversation.

‘In fact, bowel screening has potential to be one of the greatest public health successes ever achieved in Australia.’
 
June is Bowel Cancer Awareness Month.
 
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