According to the American Cancer Society, an estimated 152,000 individuals will be diagnosed with new colorectal cancer in 2024, with 53,000 dying from the disease. Historically, colorectal cancer has been perceived as an ailment affecting older adults; however, incidence rates have declined over the past 50 years due to multiple factors — chief among them is the widespread uptake of screening in older individuals. Despite this, there has been a concerning trend — a steady rise in colorectal cancer incidence rates among individuals under 55 years of age. Whereas mortality rates have plummeted over the past five decades for older adults, mortality rates have surged by about 1% per year since the mid-2000s for younger adults. These statistics emphasize the pressing need for appropriate screening measures in younger individuals. While there are many screening tests available to detect polyps, which may eventually lead to colon cancer, colonoscopy remains the gold standard for polyp removal for all ages and may be the key to changing this alarming statistic.
Colorectal cancer screening is recommended for adults aged 45 to 75 but may be indicated earlier in those with a family history of colon cancer. The decision for additional screening for adults 76 to 85 is made on an individual basis. Among the various screening options available, including stool tests, imaging tests and blood tests detecting cancer cells' DNA, endoscopic evaluation emerges as the gold standard. Unlike other screening modalities, endoscopy offers a comprehensive approach, allowing for both diagnosis and treatment in a single session. It boasts superior sensitivity in detecting small lesions that may be missed by alternative methods, enabling more accurate risk assessment and future screening strategies.
When considering endoscopic options, individuals are often presented with the choice between full colonoscopy and flexible sigmoidoscopy. While flexible sigmoidoscopy may appeal to some due to its less intensive bowel preparation, it falls short in detecting lesions in the entire colon. Given that up to 45% of colon cancers occur in the right side of the colon, an area not reachable via sigmoidoscopy, the limitations of this screening test become evident. In contrast, colonoscopy offers a complete evaluation of the entire colon and remains unmatched in its ability to detect cancer and precancerous lesions across all screening methods. Despite potential apprehensions, colonoscopy is well tolerated, with complications being rare. The inconvenience of thorough bowel cleansing the day before is a small price to pay for the peace of mind that comes with knowing one's colorectal health status.
Colonoscopy remains a pivotal tool in the fight against colorectal cancer and may be the key to slowing the growing rates of colorectal cancer in younger individuals. By prioritizing screening and early detection, we can hope to reverse the upward trajectory of colorectal cancer rates among younger populations. For more information about colorectal cancer screening, indications or procedures, consult your local GI specialist.
Learn more about colorectal cancer care at Northside Hospital Cancer Institute.
Reference:
American Cancer Society. Cancer Facts & Figures 2024. Atlanta: American Cancer Society, 2024.
