45 Is the New 50 – Why are Colorectal Cancer (CRC) Screening recommendations changing? 

Nearly 43,000 people are diagnosed with colorectal cancer (CRC) every year in the UK and in 2022 the disease remains a leading cause of cancer death for both men and women. Whilst nearly 53% of people diagnosed with Colorectal Cancer survive for 10 years or more, each year, almost 17,000 people die of it in the UK each year. But it doesn’t have to be this way. Screening for Colorectal cancer definitely saves lives!  

There are currently 6 accepted CRC screening tests.  Faecal Occult Blood (FOB) and Faecal Immunochemical Tests (FIT) look for blood within a stool sample whilst the more complex FIT-DNA (or stool DNA) test looks for both blood and altered (cancerous) DNA in the stools. 

Flexible sigmoidoscopy (telescope examination) checks for the presence of polyps, or cancers in the lower 1/3 of the colon (which is where CRCs most commonly develop).  Alternatively, a full colonoscopy allows for the whole colon to be checked for abnormal growths / polyps.  In some patients a CT Colonogram (Virtual Colonoscopy) which utilises CT (X-ray) scans to create images of the colon which are reviewed by a specialist doctor may be a more suitable investigation.  

Most of these tests have been part of the medical armouratorium for many years enabling many patients with early CRC to be diagnosed early (before the disease became advanced) and have curative treatment. 

Based on US national statistics and observations about CRC incidence and earlier age of presentation, reviewed by the US Preventive Services Task Force, (an independent volunteer group of experts in prevention and evidence-based medicine), in 2021 the National Comprehensive Cancer Network (NCCN) in the USA published new guidelines recommending that CRC screening should start at the age of 45 for people of average risk and even younger in higher risk groups. 

Of course, CRC screening isn’t anyone’s idea of a fun afternoon, regardless of which test option you choose or at what age you start doing it!  But all joking aside, any inconvenience or discomfort that comes along with screening is worth it if you are found to have a small precancerous or cancerous polyp in the colon that can be removed before it has become advanced or worse still spread outside the colon. CRC screening truly is an opportunity to prevent and cure cancer. 

People who have a close relative (grandparent, parent, or sibling) who has had colorectal polyps or CRC (particularly at an early age) may need to be screened even earlier than 45. 

People who may fall into this earlier screening group include those who have an inflammatory bowel disease such as Crohn’s disease or ulcerative colitis.  People with a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome)  should also consider starting an early screening programme. 

These days several screening tests are available for finding polyps or early CRC but there is no single “best test” for any person. Each test has advantages and disadvantages. Some tests need to be done yearly whilst colonoscopy may only be required once every 5 – 10 years. 

Colorectal Cancer is serious but talking about screening doesn’t have to be. If you or someone you know is 45 or turning 45 soon, talk to them about getting screened for colorectal cancer.  

At the Specialist Medical Clinic our General Practitioners and Specialist General Surgeon / Surgical Gastroenterologist are experienced in talk to you about the pros and cons of each test, and how often to be tested.