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Stamford doctor applauds as American Cancer Society cuts recommended screening age for colon cancer

June 20, 2018 GMT

STAMFORD — Early detection is the key when it comes to battling most cancers. But with colorectal cancer, early detection of cancerous precursors could actually prevent cancer from developing, a local surgeon said this week.

It’s one of the reasons the American Cancer Society (ACS) recently lowered the recommended screening age for those at average risk for colon cancer from 50 to 45.

“For a few years we’ve been seeing colon cancer in younger and younger patients,” said Dr. Shahzad Zafar, a colorectal surgeon at Stamford Hospital. “So, the focus shifted to what we can do to increase the screening for those people and really benefit them. Because up until now the screening recommendations targeted individuals 50 years or older, which means we could end up missing some patients.”

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States, according to the ACS, which estimates more than 97,000 new cases of colon cancer and more than 43,000 new cases of rectal cancer will be diagnosed this year. Colorectal cancer is the third leading cause of cancer-related death in men and women in the U.S., and ACS estimates 2018 will bring more than 50,000 such deaths this year.

Zafar said colon cancer takes time to develop and typically follows numerous warning signs, making it one that could easily be prevented if patients get screened regularly.

“It is a totally preventable cancer,” he said.

“Colon cancer develops from an adenoma, which is a benign polyp that over the course of a number of years becomes the carcinoma, which is the cancer,” he added. “So, there is time to detect the polyps and remove them before they become cancer. In essence, you can prevent colon cancer if people get the colonoscopy on time and follow through with continued screening.”

The ACS decision came after “looking closely at evidence that new cases of colorectal cancer are occurring at an increasing rate among younger adults,” the organization said in a statement. “A beginning screening at the age of 45 for adults of average risk will result in more lives saved from colorectal cancer.”

The ACS describes average-risk individuals as those who do not have:

• A personal history of colorectal cancer or certain types of polyps

• Those who do not have a family history of colon colorectal cancer

• Those who do not have a personal history of inflammatory bowel diseases such as ulcerative colitis or Crohn’s disease

• Those who do not have a confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis or Lynch syndrome

• And those who do not have a personal history of having radiation to the abdomen or pelvic area to treat a prior cancer.

The most obvious sign that something is wrong, Zafar said, is bloody stool or rectal bleeding.

“One of the most important things for people to know is if you see blood when you go to the bathroom, or have blood coming from your rectum, that is a very ominous sign that you should not ignore, regardless of your age,” he said. “That is a sign that you need to go and see a doctor and get worked up.”

Though a colonoscopy is considered the “gold standard” for colon cancer screening, the ACS said there are a number of tests a patient can undergo, including stool tests, DNA-based testing or a CAT scan.

“Any test is better than no test,” Zafar said.

However, Zafar said the colonoscopy is best route.

“The colonoscopy is the best test because it’s not just diagnostic, it’s also therapeutic. You can visualize the entire area, you find any polyps that may be there and you can remove them at the same time,” he said.

“Most people with colon cancer are asymptomatic during the early stages of disease, meaning they have no symptoms and no way of knowing they have cancer,” he said. “That is why changing the screening age from 50 to 45 is so important, because a lot of those who develop the cancer at a younger age will actually have no symptoms, and if they’re waiting until 50 or 51 to get tested, we are likely to miss that window where we can either prevent it or catch it at an early stage.”

Zafar said he believes a lot of patients will benefit from getting colon cancer screenings done earlier. Those considered high-risk patients might require screenings earlier than age 45 and doctors may recommend more frequent screenings or specific types of testing, the ASC said.

“I’m glad (the ACS) did this,” he said. “It was something that was long overdue, because we do see a lot of patients with colon cancer at a younger age and now we can finally get those people the screening they need. So, I think it’s going to help people.”