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Colorectal Cancer Screening Age Lowered to 45
Dr. Alex Krist shares the new colorectal cancer screening guidelines.
Featuring:
Dr. Krist received his medical and bachelor’s degrees from University of Virginia and a Masters of Public Health from Johns Hopkins University. He completed his residency training in family medicine at Fairfax Family Practice Residency and faculty development fellowship at Virginia Commonwealth University.
Learn more about Alex Krist, M.D
Alex Krist, M.D.; M.P.H.
Alex Krist, M.D., M.P.H. is A member of the Cancer Prevention and Control research program at VCU Massey Cancer Center, Dr. Krist is also a professor at the VCU Family Medicine Residency program at Fairfax Family Medicine Center, where he sees patients and precepts medical students and residents. His research focuses on cancer screening and shared decision-making in preventive care. His areas of clinical specialty include primary and wellness care, health behavior change and chronic disease management. He has published more than 40 peer-reviewed manuscripts, books and book chapters and is the immediate past chair of the U.S. Preventive Services Task Force.Dr. Krist received his medical and bachelor’s degrees from University of Virginia and a Masters of Public Health from Johns Hopkins University. He completed his residency training in family medicine at Fairfax Family Practice Residency and faculty development fellowship at Virginia Commonwealth University.
Learn more about Alex Krist, M.D
Transcription:
Evo Terra (Host): In this episode, we chat with Dr. Alex Krist about new colorectal cancer screening guidelines from the U.S. Preventive Services Task Force. Dr. Krist is a family medicine physician at VCU Health, researcher at VCU Massey Cancer Center and the immediate past chair of the U.S. Preventive Services Task Force.
The Task Force issued updated guidelines in mid-May, lowering the recommended age of first screening to 45 for adults with average risk of the disease. Dr. Krist, who ended his yearlong term as chair of the Task Force in March, helped to develop the guidelines. He explains why the age was lowered, the benefits of colorectal cancer screening and the types of screening tests available.
Welcome to Healthy with VCU Health, where experts from VCU Health share their knowledge, cutting-edge research and the latest innovations to help you achieve optimal health and wellness. Take control of your health!
I’m your host Evo Terra. Dr. Krist, thanks for joining me.
Alex Krist, M.D.; M.P.H. (Guest): Well, thanks for having me today, Evo.
Host: Let’s dive right in and talk about the updated colorectal screening guidelines from the U.S. Preventive Services Task Force.
Dr. Krist: Yeah. So, the U.S. Preventive Services Task Force updated our recommendations this past April. And we’re recommending that all adults age 45 to 75 get screened for colon cancer and then that adults age 75 to 85 talk to their doctors about when’s the right time to stop screening for colon cancer.
Host: So, why was the age of that first screening lowered from 50, where it was when I got mine at 50, now it’s to 45. What’s happening?
Dr. Krist: Yeah. What’s happening is that we’re seeing younger people get colon cancer more frequently. And right now, the rate at which 45-year-olds get colon cancer is similar to the rate that 50-year-olds used to get colon cancer. So, that was a big part of the evidence that led us to recommend starting screening at a younger age. The other thing is we found some data through our modeling work and other studies that showed that we would save more lives if we were to start screening earlier. And that the balance of the benefits and the harms was most appropriate at starting screening at the age of 45.
Host: Why is it that we think that colorectal cancer is on the rise in younger people now?
Dr. Krist: Well, we don’t know exactly why the rates are increasing. There can be a combination of factors. So, this might relate to changes in our diet, not eating as healthy as we used to. It might relate to increasing rates of obesity and overweight in America. And it might be environmental factors. But the fact is, that we don’t exactly know why. And part of our recommendation was to call for more research and more science to try and understand why it’s occurring at an earlier age, so that we could try and do something about this and stop it from happening.
Host: Well, let’s talk about that part right there: Do something about it. One of the things we can do is get screened for colorectal cancer, but I’ll let you expand upon the benefits of colorectal cancer screening.
Dr. Krist: Yeah, I think it’s really important for everyone to know that screening for colon cancer saves lives. And so that’s why the recommendation is recommending that everyone get screened age 45 to 75. So, we know that if about a thousand people get screened, we’ll prevent somewhere from 20 to 26 people from dying from colon cancer, and colon cancer is a preventable death. So, by going and getting screened, someone can prevent the diagnosis of colon cancer at a later stage when we can’t deal with it as well and when they’re more likely to suffer adverse consequences from the colon cancer.
Host: And let’s talk about the screening tests. What’s the procedure like, what’s available out there for colorectal cancer?
Dr. Krist: Well, the good news is that there are two basic strategies on how you can be screened for colon cancer. There’s what we call the visualization tests. So, that’s something like a colonoscopy, where a doctor’s going to take a look inside a person’s colon to see if there’s cancer or polyps. And then there are stool-based tests. These are tests that will check for blood or potentially DNA that might be a marker that there’s something wrong and a person needs further workup. Both of these different types of screening are effective at saving lives from colon cancer. And each of the different tests have some different barriers for people to get them.
So, someone may not want to do a colonoscopy, which is a little bit more invasive and takes a little more time. You have to do a bowel cleanout the day before; you get anesthesia. But on the other hand, you do it, and if it’s normal, you’re good for 10 years.
Other people might want to do something easier, and the stool-based tests are something that you can do at home. You take a kit home from your doctor’s office or from a lab, you do the test, you mail it back in, and it’s really a good test to figure out who needs to get a colonoscopy and further testing and who’s doing fine and doesn’t need any further testing. Now the drawback with the stool-based tests is you have to do them more often, every one to three years.
So, someone who wants to just do a test and forget about it for a while might want the colonoscopy; someone who wants a less invasive test may want to do the stool-based tests.
Host: Is there ever a situation where a doctor might suggest both?
Dr. Krist: Not so much both. And I say, not so much both because if you do a stool test and it’s positive, then the workup is to get a colonoscopy to follow that up. But it’s not really doing the colonoscopy and the stool test for screening. It’s more of an either/or for the screening in people with no symptoms or no risks. But this is something that we encourage people to talk with their doctor about what’s right for them. There are some people who have higher risks, like a family history, or maybe they’re having symptoms. And in those cases, the colonoscopy may be the best test. And for other individuals who are low risk and particularly who may be hesitant to do something like the colonoscopy, we definitely want them talking to their doctor to make sure that they know all the different options to safely be screened for colon cancer.
Host: Well, that’s great information, Dr. Krist. Thank you very much for joining me today.
Dr. Krist: Well, thank you for having me today.
Evo Terra (Host): And thank you for listening to Healthy with VCU Health. To learn more about colorectal cancer care at VCU Massey Cancer Center, visit Masseycancercenter.org. Or call 877- 4MASSEY. To listen to other podcasts from VCU Health, visit VCUhealth.org/podcast. This has been Healthy with VCU Health. I’m Evo Terra.
Evo Terra (Host): In this episode, we chat with Dr. Alex Krist about new colorectal cancer screening guidelines from the U.S. Preventive Services Task Force. Dr. Krist is a family medicine physician at VCU Health, researcher at VCU Massey Cancer Center and the immediate past chair of the U.S. Preventive Services Task Force.
The Task Force issued updated guidelines in mid-May, lowering the recommended age of first screening to 45 for adults with average risk of the disease. Dr. Krist, who ended his yearlong term as chair of the Task Force in March, helped to develop the guidelines. He explains why the age was lowered, the benefits of colorectal cancer screening and the types of screening tests available.
Welcome to Healthy with VCU Health, where experts from VCU Health share their knowledge, cutting-edge research and the latest innovations to help you achieve optimal health and wellness. Take control of your health!
I’m your host Evo Terra. Dr. Krist, thanks for joining me.
Alex Krist, M.D.; M.P.H. (Guest): Well, thanks for having me today, Evo.
Host: Let’s dive right in and talk about the updated colorectal screening guidelines from the U.S. Preventive Services Task Force.
Dr. Krist: Yeah. So, the U.S. Preventive Services Task Force updated our recommendations this past April. And we’re recommending that all adults age 45 to 75 get screened for colon cancer and then that adults age 75 to 85 talk to their doctors about when’s the right time to stop screening for colon cancer.
Host: So, why was the age of that first screening lowered from 50, where it was when I got mine at 50, now it’s to 45. What’s happening?
Dr. Krist: Yeah. What’s happening is that we’re seeing younger people get colon cancer more frequently. And right now, the rate at which 45-year-olds get colon cancer is similar to the rate that 50-year-olds used to get colon cancer. So, that was a big part of the evidence that led us to recommend starting screening at a younger age. The other thing is we found some data through our modeling work and other studies that showed that we would save more lives if we were to start screening earlier. And that the balance of the benefits and the harms was most appropriate at starting screening at the age of 45.
Host: Why is it that we think that colorectal cancer is on the rise in younger people now?
Dr. Krist: Well, we don’t know exactly why the rates are increasing. There can be a combination of factors. So, this might relate to changes in our diet, not eating as healthy as we used to. It might relate to increasing rates of obesity and overweight in America. And it might be environmental factors. But the fact is, that we don’t exactly know why. And part of our recommendation was to call for more research and more science to try and understand why it’s occurring at an earlier age, so that we could try and do something about this and stop it from happening.
Host: Well, let’s talk about that part right there: Do something about it. One of the things we can do is get screened for colorectal cancer, but I’ll let you expand upon the benefits of colorectal cancer screening.
Dr. Krist: Yeah, I think it’s really important for everyone to know that screening for colon cancer saves lives. And so that’s why the recommendation is recommending that everyone get screened age 45 to 75. So, we know that if about a thousand people get screened, we’ll prevent somewhere from 20 to 26 people from dying from colon cancer, and colon cancer is a preventable death. So, by going and getting screened, someone can prevent the diagnosis of colon cancer at a later stage when we can’t deal with it as well and when they’re more likely to suffer adverse consequences from the colon cancer.
Host: And let’s talk about the screening tests. What’s the procedure like, what’s available out there for colorectal cancer?
Dr. Krist: Well, the good news is that there are two basic strategies on how you can be screened for colon cancer. There’s what we call the visualization tests. So, that’s something like a colonoscopy, where a doctor’s going to take a look inside a person’s colon to see if there’s cancer or polyps. And then there are stool-based tests. These are tests that will check for blood or potentially DNA that might be a marker that there’s something wrong and a person needs further workup. Both of these different types of screening are effective at saving lives from colon cancer. And each of the different tests have some different barriers for people to get them.
So, someone may not want to do a colonoscopy, which is a little bit more invasive and takes a little more time. You have to do a bowel cleanout the day before; you get anesthesia. But on the other hand, you do it, and if it’s normal, you’re good for 10 years.
Other people might want to do something easier, and the stool-based tests are something that you can do at home. You take a kit home from your doctor’s office or from a lab, you do the test, you mail it back in, and it’s really a good test to figure out who needs to get a colonoscopy and further testing and who’s doing fine and doesn’t need any further testing. Now the drawback with the stool-based tests is you have to do them more often, every one to three years.
So, someone who wants to just do a test and forget about it for a while might want the colonoscopy; someone who wants a less invasive test may want to do the stool-based tests.
Host: Is there ever a situation where a doctor might suggest both?
Dr. Krist: Not so much both. And I say, not so much both because if you do a stool test and it’s positive, then the workup is to get a colonoscopy to follow that up. But it’s not really doing the colonoscopy and the stool test for screening. It’s more of an either/or for the screening in people with no symptoms or no risks. But this is something that we encourage people to talk with their doctor about what’s right for them. There are some people who have higher risks, like a family history, or maybe they’re having symptoms. And in those cases, the colonoscopy may be the best test. And for other individuals who are low risk and particularly who may be hesitant to do something like the colonoscopy, we definitely want them talking to their doctor to make sure that they know all the different options to safely be screened for colon cancer.
Host: Well, that’s great information, Dr. Krist. Thank you very much for joining me today.
Dr. Krist: Well, thank you for having me today.
Evo Terra (Host): And thank you for listening to Healthy with VCU Health. To learn more about colorectal cancer care at VCU Massey Cancer Center, visit Masseycancercenter.org. Or call 877- 4MASSEY. To listen to other podcasts from VCU Health, visit VCUhealth.org/podcast. This has been Healthy with VCU Health. I’m Evo Terra.