Report Shows Increased Risk of Colon Cancer for Adults After Screenings Plummet

WASHINGTON — A recent report from AMSURG, a recognized leader in the strategic and operational management of surgery centers, finds in 2021 there were increases in advanced stage colorectal cancer and precancerous growths in adults of all ages when compared to 2020.

“People who have this type of screening have a lower chance of ever developing cancer. Not all polyps turn into cancer. We think that about 10% of them turn into cancer over 10 years. So, we actually have a fairly long opportunity or window to capture those, and actually remove those polyps,” said Dr. Jocelyne Miller, a gastroenterologist at Associated Endoscopy, an ambulatory surgery center, in a phone interview with The Well News.

“In that sense, doing a colonoscopy not only detects early colon cancers, which are more treatable, but we can actually prevent colon cancer,” continued Miller. 

Colorectal cancer, also known as colon cancer, is currently the second leading cause of cancer death in the United States, and recent estimates show about 151,000 adults were diagnosed with colon cancer in 2021. 

Screening for colon cancer involves detecting the precancerous polyps, which are abnormal tissue growth in the lining of the colon which appear as small bumps and can grow bigger over time. Risk factors for colon cancer range from lifestyle choices like diet, exercise, or smoking — to genetic factors. 

In 2020, AMSURG reported that more than 200,000 patients had missed their colonoscopies.

In the report, colon cancer was detected in .58% of patients aged 45 to 49, and .53% of patients aged 40 to 44. 

A significant portion of the patients included in the study also had polyps present even if they did not have a documented family history of colorectal cancer. 

Miller said that the increase in advanced stage colon cancer and polyps detected in 2021 from the previous year might be attributed to a decline in colonoscopies during the pandemic.

The AMSURG report shows that polyps which had the greatest possibility of becoming cancerous were found in 7.5% of patients aged 45 to 49, and 5.8% of patients aged 40 to 44.

“We see a push now to do screenings earlier, and that’s come out of a lot of data that’s being developed that’s basically showing that we are seeing colon cancer earlier in the population, and so we want to catch it earlier,” said Miller.

Last year, the U.S. Preventive Services Task Force changed their guidance to lower the screening age for colon cancer from 50 to 45.

From the nearly 3 million colonoscopies performed at 120 AMSURG ambulatory surgery centers, the data shows that most people screened in 2021 were an average of 57.6 years old. In 2016 most people screened were 58.5 years old.  

“We use these ages to recommend screening and those should be really when you start to do that, but not when you have symptoms… colon cancer generally does not give you symptoms until it’s very advanced,” said Miller.

“If we can catch it early before symptoms have shown themselves, then we are going to have much better outcomes,” continued Miller.

According to Miller, when an individual does experience symptoms from colon cancer, they often occur as blood in stool, abdominal pain or changes in bowel habits. 

Outside of a colonoscopy, individuals can also screen for colon cancer polyps through stool tests, which use blood or other types of DNA for screening.

This month, the Erie County Department of Health in New York began encouraging screening for residents ages 45-75 by distributing what are called FIT kits, an at-home colon screening test kit which uses stool test sampling that gets sent to a lab for analysis. 

“Other forms of screening like stool tests that test blood or other types of DNA are going to be more geared toward detecting early cancers rather than preventing them,” said Miller.

Miller said that anyone who has positive results from a stool test will still need to get a colonoscopy.  She added that while most insurance carriers cover the cost of colon cancer screenings, money remains an issue for many patients in deciding whether to get screened.

“We certainly want to hold insurance companies accountable for making it easy to access screenings… because that’s the number one thing we hear [from patients] is ‘How much will this cost?’” said Miller. 

Miller said outside of the costs for screening, there are communities which are disproportionately impacted by colon cancer which might signal a need for better screening methods. 

“In the Black community colon cancer rates are higher, and I don’t think we’ve fully vetted out whether their rates are higher because of a genetic issue or whether it’s because they haven’t had as much screening, and why those kinds of disparities or differences exist,” said Miller.

A recent study from Kaiser Permanente looked at how organized screening might improve colorectal cancer outcomes for Black members. 

To conduct the study, researchers looked at colorectal cancer screening participation, incidence, and death rates for Black and White Kaiser Permanente members in North California between the ages of 50 to 75 from 2000-2019. 

The 19-year time period spanned six years before and 11 years after a colorectal cancer screening program was rolled out in 2006 through 2008.

In 2009, the colon cancer death rate per 100,000 individuals was 54.2 for Black members and 32.6 for White members. 

By 2019, death rates had fallen by more than half among Black members–decreasing to 20.9–compared to 19.3 for White members, essentially eliminating the previous disparities.

Miller said screening programs that address cultural barriers are a key piece of encouraging screening for any patient and helping to develop a better relationship of trust between patients and providers.

“Overall, people get screened, in my experience, when doctors they trust encourage them to get screened,” said Miller.

Alexa can be reached at [email protected]