Colorectal cancer, the second leading cause of cancer death in the United States, is on the rise among people under age 50. However, when caught early, it is one of the most treatable forms of cancer.
In May 2021, the U.S. Preventive Services Task Force recommended that screening for colorectal cancer start at age 45. It expanded the recommended ages for colorectal cancer screening to 45 to 75 years (previously, it was 50 to 75 years).
This short video, brought to you by Minhhuyen T. Nguyen, MD, AGAF, FACP, Professor in the Department of Medicine and Director of Clinical Gastroenterology at Fox Chase, discusses what's new in colorectal cancer screening—from lowering the age of screening, to the efficacy of screening tests, to new techniques to improve colonoscopy.
Hello. I'm doctor Min Hyung Win professor Department of medicine at Fox Chase Cancer, Temple Health. Today I will give you an update on colon cancer screening. three topics I would like to discuss one lowering the age of screening to efficacy of the currently available screening tests And three. A new technique to improve colonoscopy. As you know. Over the past two years, the screening Asia for quality rectal cancer screening has been lowered to 45. This was supported by multiple organizations including the american Cancer Society, The Youth US preventive Services task force, american College of Gastroenterology, National Comprehensive Cancer Network and the US Multi Society Task force on Colorectal cancer. The recommended age Range for colon rectal cancer screening in an average risk adult is now 45-75 years of age Gray. A for dots between 50 to 75 years Gray be for adults between 45 to 49 years And Gracie for a. 76- 86 years on selected patients. Yeah. Why early onset colorectal cancer on the rise. As you know, colorectal cancer is a major problem in the United States. And in 2019 alone, about 52,000 people die of colorectal cancer. Second only to lung cancer Over the past 20 years. The rate of colon cancer decrease in patient 50 years or older. But this rate, it's increased about 2.2% in patients younger than 50 years old. The mortality rates for colon cancer also wrote 1.3% per year in patients younger than 50 and approximately 10% of newly diagnosed colon cancer cases In patients younger than 50 years of age. What drives early onset colorado cancer? I don't know cause normal rates increase in many early onset subgroups, But not in colon only cases in the group of 20-29 years And 50 to 54 years. This substantial rise in both colon and rectal cancer Incident race in 40 to 49 years of age. The steepest rate of rectal cancer was is in 20 to 29 and 30 to 39 years, although the absolute numbers are low. Rectal carcinoid tumors are also increasing in young patients. But we must keep it in perspective. The seer database highlight a 22% relative increase in colorectal incidents In 40 to 49 years. But that means going from 5.9 to 7.2 cases per 100,000 person years, as opposed to 22 cases per 100,000% years in The age group, 50 to 59 In 70 cases per 100,000 years in people older than 60 years of age, up to 20 percent of colon only Cancer and up to 30% of rectal cancer are composed of Carson noise. Carcinoid tumors are generally indolent and do not require screening. These recommendations are based on modern analysis and the new recommendation is an efficient balance of benefits and burdens of colon cancer screening. The risk factor for colorectal cancer are still sedentary lifestyles changes in gut microbiome with antibiotic use in childhood antibiotic use in the food. Change an increase in cesarean section that may have disrupted vertical transmission of good microbiome from mother to child. The metabolic syndrome driven by sugar, latin, diet, processed meat, alcohol and smoke. Now the efficacy of colon cancer screening tests, the most available and readily used in the US right now is still colonoscopy. Ah Fico immuno chemical tests or fit tests And the color guard of fit DNA tests The fit and the 50 n. A stew based. And if they become positive they will need a colonoscopy. The colonoscopy is different because it can remove polyps before it become cancer. As you can see The sensitivity for colon cancer and all these tests are high in the 85, 84- 95%. The sensitivity for adenoma greater than 10 millimeter is also high in Um colonoscopy but dropped in the 5th And the 5th d. n. a. test. Um The specificity somewhat equivalent going between 86 to 93 across the test. The most important thing to remember is whichever screening tests that the patient do is is a good test. And the colon cancer deaths averted by these Screening test as somewhere between 22 24. Uh huh. Per 1040 years old being screened. Other screening tests that um available but not used often include the colon capsule endoscopy. This the patient in this test. The patient swallow a wireless video camera in a capsule and had to take a bow prep with no sedation. This test that does not allow biopsy a polyp removal and currently approved to be used only in patients with incomplete colonoscopy. The sensitivity and specificity for add enormous um a pretty decent blood tests for colon rectal cancer screening. I still have somewhat low sensitivity in early color rectal cancer and it includes stepped in and colon century. These are not often use tests because there's a better test available. There's a new technique to improve colonoscopy. The so called GI Genius That's approved by the FADA in April 2021. This is a medical device that uses artificial intelligence to assist endoscopy and detect signs of colon cancer. It based on machine learning and use ai algorithm to highlight portion of the colon where the potential legion. Maybe it will alert the endoscopy ist with short low volumes sound and display them on the video screen in the segment of the colon that it's thought that it thinks that maybe there's a lesion and the endoscopy will decide to look at the area further do tissue sampling or treat the GI genius with in was able to identify lab confirmed at enormous of casa Loma In 55% of patients compared to 42% of patients with standard colonoscopy with that the Gi genius. However, there are also a slight uptick in the number of lesions that biopsy that we're not at enormous. The G. I. Genius strictly identified the region of the colon within the endoscope endoscope field of view, where the Apollo the lesion could be located. It does not provide any diagnostic assessment of the polyps classify a lesion, replace lab sampling as a means of diagnosis. Thanks so much for watching, and I hope you have a great day.