Study Confirms Older Americans Need to Have
Colonoscopy at Age 50
Cancer's precursor polyps, known as adenoma, sharply
increase after age 50
Below
see...
Medicare's coverage of tests for colorectal cancer.
More about colon cancer.
Sept. 3, 2008 People over age 50, who are still
wrestling with the decision of whether they should have a colonoscopy,
received another wake-up call this week from a study detailing the rapid
increase of polyps the precursor of virtually all colorectal cancers
that begin to occur at that age.
These precursor polyps, known as colorectal
adenoma, occur infrequently in younger adults, but the rate sharply
increases after age 50, the study found. Additionally, African Americans
have a higher rate of proximal, or right-sided, polyps, and may have a
worse prognosis for survival if the polyps become cancerous.
These results further emphasize the importance of
colonoscopies, which view the entire colon, for the prevention of
colorectal cancer. It is recommended to begin at age 50.
The results of this study, which
represents the largest investigation, by several-fold, of this kind,
were published in Clinical Gastroenterology and Hepatology, the official
journal of the American Gastroenterological Association (AGA) Institute.
"While colorectal polyps are rare in adults aged 30
to 50, our study reveals an increase in polyp prevalence with age and a
dramatic increase in colorectal adenoma incidence occurring in adults
over the age of 50," said Francis M. Giardiello, MD, of The John Hopkins
University and lead author of the study.
"Understanding the natural occurrence of colorectal
polyps, especially in younger adults, is important to the development of
colorectal cancer prevention strategies."
Findings
Researchers found the prevalence of colorectal
polyps in younger adults increased from 1.72 percent to 3.59 percent
from age 30 to 50. This rate sharply increased after age 50 with the
prevalence of polyps ranging from 10.1 to 12.06 percent in the sixth and
ninth decade, respectively.
About
Colorectal Cancer
Also called: Colon cancer, Rectal cancer
Cancer of
the colon or rectum is also called colorectal cancer. In the
United States, it is the fourth most common cancer in men and
women. Caught early, it is often curable.
It is more
common in people over 50, and the risk increases with age. You
are also more likely to get it if you have
● Polyps - growths inside the colon and rectum that may become
cancerous
● A diet that is high in fat
● A family history or personal history of colorectal cancer
● Ulcerative colitis or Crohn's disease
Symptoms
can include blood in the stool, narrower stools, a change in
bowel habits and general stomach discomfort. However, you may
not have symptoms at first, so screening is important. Everyone
who is 50 or older should be screened for colorectal cancer.
Treatments include surgery, chemotherapy, radiation or a
combination.
Also see
statement below news story from Medicare on testing for colon
cancer.
The study results quantified the number of adenomas
typically found in people under the age of 50. It is important to note
that those with two or more adenomas under 50 years of age represent
unusual individuals who might merit closer colonoscopic surveillance for
subsequent adenoma development, according to the researchers.
In younger adults, adenomas were more prevalent in
Caucasians compared to African Americans; however, in older adults, the
reverse was true. Regardless of age, adenomas were more prevalent in men
than women.
In the general population, left-sided adenomas are
most common, but among older adults (age 50+), who have more adenomas,
there is a relatively greater prevalence of right-sided adenomas.
African Americans in both age groups had predominately right-sided
polyps.
Implications for Colorectal Cancer Screening
The use of sigmoidoscopy as a screening test for
colorectal cancer does not allow gastroenterologists to view the
right-side of the colon to screen for polyps, only the rectum and the
lower end of the colon. If a polyp or abnormality is found, patients may
require a regular colonoscopy for further evaluation. Right-sided
adenomas cannot be viewed using a sigmoidoscopy.
Colonoscopy, which provides the most comprehensive
view of the colon, is the definitive test for colorectal cancer
screening. Colonoscopies allow gastroenterologists to view the entire
colon and rectum for polyps or cancer and during the same exam remove
pre-cancerous polyps. It is the test most gastroenterologists recommend
as the single best screening exam for colorectal cancer. It is the only
method that combines both screening and prevention (by removal of
pre-cancerous polyps).
Study Design
The study evaluated the large intestine of 3,558
autopsy subjects, aged 20-89, that had colorectal cancer undetected or
unsuspected during life. Subjects were categorized by sex, race and age
in 10 year groups. Location and number of colorectal adenomas detected
was measured by using epidemiologic autopsy in individuals; results were
standardized to the general population. The study's researchers
evaluated the large intestine of 1,001 individuals undergoing necropsy
between the ages of 20 and 49 for the presence of adenomas.
Medicare
Preventive Services Says:
Colon Cancer Screening
(Colorectal)
Colorectal cancer is usually found in
people age 50 or older, and the risk of getting it increases
with age. Medicare covers colorectal screening tests to help
find pre-cancerous polyps (growths in the colon) so they can be
removed before they turn into cancer. Treatment works best when
colorectal cancer is found early.
How often is it covered?
● Fecal Occult Blood Test - Once every
12 months
● Flexible Sigmoidoscopy - Once every 48 months
● Screening Colonoscopy - Once every 24 months (if you're at
high risk); once every 10 years, but not within 48 months of a
screening sigmoidoscopy (if you're not at high risk)
● Barium Enema - Your doctor can decide to use this test
instead of a flexible sigmoidoscopy or colonoscopy. This test is
covered every 24 months if you are at high risk for colorectal
cancer and every 48 months if you aren't at high risk.
For whom?
All people with Medicare age 50 and older,
except there is no minimum age for having a screening
colonoscopy.
Your costs in the Original Medicare
Plan?
You pay nothing for the fecal occult blood
test. For all other screening tests, the coinsurance or
copayment applies, but the Medicare Part B deductible is waived.
However, if a screening test results in a biopsy or removal of a
lesion or growth, the procedure is considered diagnostic and the
deductible is applied. If the flexible sigmoidoscopy or
colonoscopy is done in a hospital outpatient department or
ambulatory surgical center, you pay 25% of the Medicare-approved
amount.
What factors increase risk for
colorectal cancer?
Risk for colorectal cancer increases if...
● You have had colorectal cancer before, even if it has been
completely removed
● You have a close relative, such as a sister or brother,
parent, or child, who had colorectal polyps or colorectal cancer
● You have a history of polyps
● You have inflammatory bowel disease (like ulcerative
colitis or Crohn's disease).
Risk for colorectal cancer increases with
age. It is important to continue with screening, even if you
were screened before you entered Medicare.
Your risk for developing colorectal cancer
may also increase if you
● Have a diet high in fat, especially fat from animal sources
● Don't exercise
● Are overweight or obese
● Smoke
● Have 2 or more alcoholic drinks every day
To learn more about colorectal cancer,
click on the following links:
While the incidence of colorectal cancer has
declined in recent years, more than 153,000 people in the U.S. will be
diagnosed with this cancer and more than 52,000 will die from the
preventable disease. Americans have a 6 percent lifetime risk of
colorectal cancer, which is the second leading cause of cancer death.
When diagnosed early, colorectal cancer patients have a five-year
survival rate of about 90 percent; however, fewer than 40 percent of
patients present at an early stage.
To find more information about colorectal cancer
and colonoscopies and locate a gastroenterologist in their area,
patients can visit
www.gastro.org/patient.
About the AGA Institute
The American Gastroenterological Association (AGA)
is dedicated to the mission of advancing the science and practice of
gastroenterology. Founded in 1897, the AGA is one of the oldest
medical-specialty societies in the U.S. Comprised of two non-profit
organizationsthe AGA and the AGA Instituteour more than 16,000 members
include physicians and scientists who research, diagnose and treat
disorders of the gastrointestinal tract and liver. The AGA, a 501(c6)
organization, administers all membership and public policy activities,
while the AGA Institute, a 501(c3) organization, runs the organization's
practice, research and educational programs. On a monthly basis, the AGA
Institute publishes two highly respected journals, Gastroenterology and
Clinical Gastroenterology and Hepatology. The organization's annual
meeting is Digestive Disease Weekฎ, which is held each May and is the
largest international gathering of physicians, researchers and academics
in the fields of gastroenterology, hepatology, endoscopy and
gastrointestinal surgery. For more information, please visit
www.gastro.org.
About Clinical Gastroenterology and Hepatology
The mission of Clinical Gastroenterology and
Hepatology is to provide readers with a broad spectrum of themes in
clinical gastroenterology and hepatology. This monthly peer-reviewed
journal includes original articles as well as scholarly reviews, with
the goal that all articles published will be immediately relevant to the
practice of gastroenterology and hepatology. For more information, visit
www.cghjournal.org.
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Medicare's coverage of tests for colorectal cancer.