Colon Cancer Screening: What You Need to Know at 45

Colorectal cancer is a serious disease, but it's highly treatable when detected early. Still, misconceptions about screening methods and recommended ages for testing often cause delays in disease detection. "There's an urgent need for clearer public understanding of screening methods and recommendations," says colorectal surgeon Punam Amin, MD, Assistant Professor of Colorectal Surgery at Baylor College of Medicine. "When people understand the facts, they are empowered to make informed decisions that can save their lives."

Dr. Amin, who practices at both Baylor St. Luke's Medical Center and St. Luke's Health - Sugar Land Hospital, notes that the misunderstanding largely surrounds the screening tools. "Many people think the Cologuard test and a colonoscopy are interchangeable—that an individual can do one or the other, and that both provide the same benefit, but that is not the case." Understanding the distinctions between these colon cancer screening options is crucial for making informed health decisions.

Cologuard vs. Colonoscopy

Cologuard is a non-invasive, stool-based test that looks for altered DNA and blood, which may detect colorectal cancer and some larger precancer polyps. Cologuard is a screening tool for colorectal cancer in adults 45 years of age and older who are at average risk for colon cancer. It is not a replacement for colonoscopy in high-risk individuals such as those with a family history of polyps or colorectal cancer. A positive Cologuard result necessitates a follow-up colonoscopy to investigate further and remove any polyps.

According to the American Society of Colon and Rectal Surgeons, a colonoscopy is considered the "gold standard" screening option for colorectal cancer and prevention. Colonoscopy offers a direct and comprehensive examination of the entire colon and rectum. During this procedure, a doctor can visualize the colon lining and identify even the smallest polyps, which can be missed on cologuard testing. The physician can remove polyps before they have a chance to grow into a cancer. This ability to both detect and prevent cancer is a key advantage of a colonoscopy. While Cologuard can detect cancer, it cannot prevent it by removing polyps.

Screening Age Recommendations 

Another significant area of misinformation, according to Dr. Amin, concerns the recommended starting age for screening. "The recommended age is not 50 anymore," she says. "It's 45 for the average risk person." This change reflects updated guidelines from organizations like the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF), which now recommend that average-risk individuals begin regular colorectal cancer screening at age 45. This adjustment is a response to rising rates of colorectal cancer in younger adults. In fact, the rate of colorectal cancer in people younger than 50 years of age increased by 2.9% per year from 2013 to 2022, according to the American Cancer Society.

It's important to remember that individuals with a family history of colorectal cancer or other risk factors may need to begin screening even earlier.

The Life-Saving Impact of Screening and Early Detection

Colorectal cancer screening and early detection are powerful tools in the fight against this disease. When colorectal cancer is detected at an early stage, before it has spread, the 5-year survival rate is 90%, according to the American Cancer Society, utilizing data provided by the Surveillance, Epidemiology, and End Results (SEER) database. This drops significantly if the cancer has spread to distant parts of the body, with a 5-year survival rate of 13-14.7%. Unfortunately, only about 4 out of every 10 colorectal cancers are found at this early, localized stage.

Regular screening not only detects cancer early but can also prevent it. Screening tests can identify precancerous polyps, which can then be removed before they ever develop into cancer. Colonoscopy has been associated with a 52% reduction in the incidence of colorectal cancer and a 62% reduction in mortality, according to an article published in the Journal of Cancer.

"It’s important to have a conversation with your health care provider about your personal risk factors and the screening options that are best for you,” advises Dr. Amin. “Don't wait until you have symptoms. Most colorectal cancers exist silently in the colon for years before a patient may feel symptoms, at which point the disease may have spread."

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