PHILADELPHIA, Oct. 2 (UPI) — While an increase in screening for colorectal cancer during the last 40 years has resulted in fewer deaths due to the disease, an editorial published in the journal Gastroenterology suggests some people are being over-screened.
Some doctors and experts have previously called attention to over-screening and over-treatment of growths and precancerous tumors, saying they cause undue stress on people who think they have life-threatening cancer and increase healthcare costs.
“The accumulated evidence shows that the risk of a colorectal cancer diagnosis in patients associated with having a family history of the condition becomes progressively smaller with increasing age, as does the association between family history and death from colorectal cancer,” said Dr. Chyke Doubeni, chair of the department of Family Medicine and Community Health at the University of Pennsylvania, in a press release. “Current standards recommend aggressive screening until age 75 to 85, but now a growing body of evidence show that it is not necessary to continue to screen most older people with a family history that aggressively.”
The Centers for Disease Control and Prevention estimates more than 130,000 people are diagnosed with colon and rectal cancers every year. Colorectal cancer is the second leading cancer killer of men and women in the United States, and the fourth most commonly diagnosed. With this in mind, the CDC recently announced it awarded $22.8 million to 31 states and universities to increase screenings in at-risk populations.
Doubeni’s editorial, partially based on a recent study that followed 144,768 men and women between the ages of 55 and 74 for 13 years to determine the risk factor for people with a first-degree relative diagnosed with colorectal cancer.
The study found a modest increase in risk for people above the age of 55 with one relative who had one of the cancers, while those with two or more relatives had a continued risk as they got older. Current recommendations are for people with two or more relatives who had colon cancer to start being screened at age 40, or ten years earlier than their youngest relative was diagnosed.
Guidelines for people with an average risk of the disease recommend a colonoscopy every 10 years starting at age 50, a signoidoscopy every 5 years, or a stool occult blood test every year. Doubeni recommends people with only one diagnosed relative be kept on this screening schedule, rather than the more intense schedule currently used.
Doubeni’s view is in line with recent research on overtreatment of breast, colon and other cancers, specifically in terms of the cost, stress, and potential health risk that cancer therapy can pose for people who don’t actually need it.
The National Cancer Institute in 2014 called for reconsideration of the way the cancer is detected and treated, specifically expressing concern about overtreatment.
“We have thrown the net very, very widely and eliminated some of the sharks,” Dr. Ian Thompson, a urologist at University of Texas Health Science Center and co-chairman of the NCI advisory panel, told the Wall Street Journal. “But we’ve also netted a lot of goldfish and assumed they’d behave the same way.”
