Tom Brady will be passing the football again when he turns 45 this year. He also shouldn’t pass on getting his first colonoscopy.

Why the rush? Because about 12% of all colorectal cancer patients are under the age of 50, so three national medical groups, including the American Cancer Society, have lowered the age for a first colonoscopy or other approved screening from 50 to 45 years old.

“Colon cancer has been increasing 1% per year over the past decade in the younger population so the impetus for screening in younger patients is related to the successful reduction in colon cancer” among those 50 and older who have undergone screening, says Sacramento gastroenterologist Dr. Roger Mendis.

Dr. Mendis is one of a trio of Northern California gastroenterologists who are getting the word out about the new screening age during the month of March, designated as National Colorectal Cancer Awareness Month. The three physicians with Sutter Health belong to the American College of Gastroenterology, which has also endorsed the earlier age for colorectal cancer screening.

“Colon cancer is one of the most common cancers and causes of cancer death, claiming more than 50,000 lives in the United States every year,” says Dr. Aly Mohamed, who is a gastroenterologist for Palo Alto Medical Foundation in Santa Cruz. “Patients diagnosed early have a much higher survival rate than those who are diagnosed late.”

Dr. Nihar U. Shah, a Berkeley gastroenterologist with Sutter East Bay Medical Foundation, advises that some folks younger than 45 should also be screened.

“If you have a family history of colon cancer or polyps, that puts you at higher risk,” Dr. Shah says. “You may need to be screened sooner than 45, and that should be discussed with your doctor.”

Dr. Mendis, who is with Sutter Medical Foundation, says a common myth is that colonoscopies are only for men. “The truth is that colon cancer is slightly more common in women,” he says. “All individuals should undergo colon cancer screening at age 45.”

Regular screening for colon cancer is also important because most people with colon cancer may not have any symptoms, especially in the early stages of the disease, says Dr. Allen Li, a board-certified medical oncologist and hematologist with Sutter Gould Medical Foundation in Modesto.

“If found early and with appropriate treatments, colon cancer remains a very curable disease. Regular screening is the best way for early disease detection and is lifesaving,” he said.

The new recommendation comes at an opportune time, as many people put off their cancer screenings during the pandemic. The physicians recommend if you’re 45 or older and have not yet been screened for colorectal cancer, schedule your screening right away.

Colonoscopy vs. Other Screenings

“Colonoscopy is the gold standard for colon cancer prevention,” Dr. Shah says. Why?

There are other screening tests to detect polyps and cancer, and Dr. Mohamed says they differ in their sensitivity, specificity, frequency of testing, effectiveness, availability and cost. They include a Fecal Immunochemical Test (or FIT) and new stool-based DNA tests.

“We do have some patients who are apprehensive and are not comfortable with the colonoscopy,” Dr. Shah said, “and for that population the FIT is ideal.”

Another plus: Patients can take the stool-based colorectal cancer screening tests from the comfort of their own home, Dr. Mohamed said. “While these tests are diagnostic, they are not therapeutic and do not have any ability to prevent colon cancer like colonoscopy does,” he adds.

Each of the gastroenterologists highly recommend getting a colonoscopy instead of any of the other tests for these main reasons:

• A colonoscopy isn’t just diagnostic, but can be preventative by removing polyps while the screening is in process. Says Dr. Mohamed: “Endoscopic evaluation with colonoscopy is the preferred method of screening as it detects pre-cancerous polyps far better than any other examination or screening test. If doctors detect and completely remove polyps with colonoscopy when they are pre-cancerous, they can prevent the cancer from occurring.”
• Even if a stool-based test comes back positive, you usually will then need to have a colonoscopy anyway. “If either stool-based test is positive, the next step is a colonoscopy. The colonoscopy is a direct examination and evaluation of the inner lining of the colon and it can detect polyps that might be missed in the stool (FIT) test,” Dr. Shah said.
• The stool-based tests have to be done every year, but “the advantage of colonoscopy is that, if it’s normal, you are good for 10 years,” Shah says.

However, colonoscopies have received a bad rap over the years for being uncomfortable, but the physicians say it isn’t justified.

“With sedation, most patients are very comfortable and often have little memory of the entire exam,” Dr. Mendis says.

The real bad rap, Dr. Shah says, is the preparation the day or two leading up to the colonoscopy, which includes a laxative the night before and clears your colon for the procedure.

“That’s what most patients are apprehensive about,” Dr. Shah says. “I tell them it’s OK to go through one day of some unpleasantness compared to having to have a colostomy bag or go through chemo if you have colon cancer. If you can prevent all those things from happening by this one procedure, then it’s worth it.”

Dr. Li says that treatment for colon cancer has come a long way, given the collaboration among specialists and the advances in recent years including multiple new medication approvals. Specialists can now also able better predict treatment outcomes beyond the usual clinical parameters with better understandings of the tumor’s molecular make-up. While in some cases chemotherapies are still used to treat colon cancer, Dr. Li says that as a field, oncologists have gotten better at managing chemotherapies and their potential side effects, making treatment much more tolerable.

Even so, Dr. Li points back to things individuals can control that can help lower the risk of developing colon cancer or catching it early: be mindful of your own bowel health, eating a balanced diet high in vegetables and fruits, and low in processed meats, maintaining a healthy weight, staying physically active–and of course–getting that colonoscopy when eligible.

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