The recent issue of Clinical Gastroenterology & Hepatology addresses the American Cancer Society’s new recommendation to lower the age of initial screening for colon cancer from 50 to 45. The recommendation follows a small spike in younger patients having colon cancer. However, those patients are not necessarily 45-50. Actually, patients in their 20’s are the most rapidly rising population segment with colon cancer, but most everyone agrees screening all Americans starting in their 20’s is impractical and not cost-effective. The ACS recommendation reflects a nudge towards younger patients, but is it the right move for the right people?
Dr. Thomas Imperiale and co-authors present a concise discussion of the pearls and pitfalls of this issue. The authors conclude, “In the big picture, whether to begin screening at age 45 or 50 seems relatively unimportant when compared with using individual patient risk for advanced neoplasia in practical, feasible models that are implemented to achieve substantial adherence to efficient and cost-effective screening.”