WEDNESDAY, June 5, 2002 (HealthDayNews) -- High-profile colon-cancer cases in younger individuals -- including former baseball star Darryl Strawberry and "Today" show anchor Katie Couric's husband, Jay Monahan -- have led many to wonder if the medical community was correct in recommending that screenings for the disease start at age 50.
But a new study says that advice is right on target.
Researchers at Indiana University School of Medicine have found that the risk of precancerous polyps and colorectal cancer in individuals under 50 is extremely low, indicating that we should keep on screening just the way we have been.
"I think [the results] have provided some reassurance that we're probably doing the right thing by starting at 50," says Dr. Thomas Imperiale, lead author of the study that appears in tomorrow's New England Journal of Medicine.
"The results of this paper come as no surprise," says Dr. David Weinberg, director of the gastroenterology section at Fox Chase Cancer Center in Philadelphia. "The most important message for the public is that colonoscopy (or colon-cancer screening in any accepted format) is a basic component of health maintenance and cancer prevention. Everyone should participate in some form starting at age 50. This paper simply supports what should be standard practice."
Imperiale and his Indiana colleagues reviewed the procedures and pathology reports of 3,421 people who had undergone colonoscopies to detect abnormalities in the colon. In that group, 906 were between the ages of 40 and 49, while 2,515 were 50 and over.
The under-50 group had no instances of cancer. The over-50 group had 13.
This is all well and fine for people who match the statistical curve. But 7 percent of those who do develop colon cancer are people under the age of 50. And most don't have any of the risk factors normally associated with the disease, such as a family history, previous ovarian, uterine, breast or colorectal cancers or ulcerative colitis.
"What about those 7 percent?" Imperiale asks. "Is there some way we can improve what we are doing?"
If we had better information about additional risk factors, probably yes, Imperiale says.
Other possible risk factors -- obesity, smoking, a diet heavy in red meat, and beer drinking -- have shown up in epidemiological studies, but it's not clear if these can be used to identify risk.
"Right now, most doctors don't use those factors, and the reason is that it's just not that well known," Imperiale says. "We know these factors are related to risk, but whether we can take those factors and apply them to individuals and have them help us stratify the risk has been untested."
But perhaps not for long. Imperiale is planning a pilot study to identify risk factors in individuals under the age of 50 who do not appear to have a genetic predisposition for the disease.
In the meantime, the experts recommend you follow American Cancer Society guidelines, which say that all people over the age of 50 get screened with a colonoscopy every 10 years.
People under the age of 50 who have worrisome family histories, inflammatory bowel disease (in some cases) and other symptoms that might raise red flags (such as unexplained weight loss or blood in stools) should also be screened, Weinberg says.
What To Do
For more information on colorectal cancer and screenings, visit the
American Society of Colon and Rectal
Surgeons, or the National Cancer Institute.
