New guidelines could help millions more Americans get colon cancer testing

(NEW YORK) — New guidelines from the American Cancer Society are expanding colon cancer screening options beyond colonoscopies and established stool-based tests.

The recommendations still call for colorectal cancer screening in people at average risk starting at age 45 and continuing through age 75 for those with a life expectancy of 10 more years.

And colonoscopy is still considered the gold standard test.

But for the first time, the updated guidelines now include a blood-based screening test done in a doctor’s office. They also add new stool sample kits and a recently FDA-approved at-home test that looks for blood and different molecular markers in stool samples.

Experts note that offering more choices is critical to address gaps in screening for this highly preventable disease, which is most treatable when caught early.

“Individuals who decline or do not complete [testing] are probably a greater number than are actually appreciated,” Dr. William Dahut, chief scientific officer for the American Cancer Society, told ABC News. “And I think a lot of our data on colorectal screening probably overstates the number of people actually up to date on their screening guidelines.”

As the new guidelines point out, the most effective colorectal cancer screening test is the one people are willing to get. More than 20 million eligible Americans remain unscreened, according to the ACS.

While stool-based tests are reasonable options for most people, the new guidelines stress that the blood tests should be considered a last resort for people unable or unwilling to get any other form of testing because they are less likely to catch issues compared to other types of screening.

People who choose colonoscopy should be tested every 10 years. Other screening tests should be done every one, three, or five years, depending on the specific method selected.

These new guidelines come as colon cancer rates rise in younger adults across the US. ASC statistics show that 1 in 5 new colorectal cancer cases now occur in people younger than 55, up from about 1 in 10 in the mid-1990s.

“This is a disease that historically, we saw in older individuals, so people 50 and over or maybe even 60 and over. And now we are starting to see an inching up of incidents in people who are less than age 50,” Dr. Fola May, associate professor of medicine at the David Geffen School of Medicine at UCLA, told ABC News.

She said she hoped that having a range of choices would push more people to get tested.

The ACS likely wants to “make sure that patients understand that these tests can be done at home. So you don’t need to take a day off of work. You don’t need an escort, you don’t need to have an invasive procedure,” May said.

The ACS advised people to work with a trusted healthcare provider to decide which test is best for them.

Dahut stressed that the recommendations apply only to people of average risk without symptoms and with no family or personal history of colorectal cancer. Consumers should check with their insurance provider to see which options their plan covers.

It’s important to be aware of the symptoms and take them seriously, he added.

“So if one has symptoms, blood in their stool, symptoms of obstruction, abdominal pain that’s persistent or change in stool patterns, then they need to have a workup for those symptoms and not have a blood-based test like this or a stool-based test,” he said.

Ari Goldstein, MD, MPH, is a board-certified family physician and preventive medicine resident at Johns Hopkins Bloomberg School of Public Health

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