There are different opinions on the American Cancer Society’s recent announcement that it has lowered its recommendation on when you should get a colon cancer screening. University of Iowa doctor Alan Gunderson says he can go along with the change. “Because who gets colon cancer seems to be changing. It’s younger people, and changing it to 45 for all instead of just African Americans establishes a sort of uniformity and kind of speaks to the changing epidemiology of the disease, so I agree with it,” Gunderson says.

The screening is commonly done with a colonoscopy and can also be done with a stool test. Gunderson says the stool testing has to be done every year to be effective, while the colonoscopy doesn’t have to be done as often if no problems are found. He says it may take some time for all doctors to immediately recommend everyone get checked at 45. “Still the main gastroenterology groups and the U-S Preventative Services Task force, which is sort of the governmental recommendation, still are 50. They haven’t changed. So, this is the early adopter change,” according toe Gunderson. “So, I don’t think you are going to see a big groundswell of practice change yet.”

But Gunderson, who is gastroenterologist, says people will take notice of the Cancer Society recommendation. “The American Cancer Society is a heavyweight and they are basing this change on their data. And it is registry data from people with colon cancer that goes from the 1890’s to today,” Gunderson says. Another University of Iowa doctor, Richard Hoffman, says there needs to be more of a breakdown on the numbers.
“What’s happened in the last 20 years now, we’ve been much more aggressive about screening. And we also recognize that people who have a family history of colon cancer should start getting screened earlier. And most of the time that recommendation is to start screening at age 40,” Hoffman says. “So my concern is that these numbers are really inflated by the fact that you are appropriately screening higher-risk patients at a younger age.”

Hoffman says when he started he was trained on a procedure that look at a smaller section of the colon first. But he says other evaluations are used as much now. “What I am seeing in practice now is that when people come in with symptoms they are now getting colonoscopy, and so there is more of an opportunity to find an early cancer because you are looking at the whole colon,” according to Hoffman. “But what we don’t know is whether finding these cancers early is going to lead to any better outcomes.” And he says getting a colonoscopy is not always a simple procedure. “When you do colonoscopies there is a one in a couple hundred chance of causing bleeding or perforation. They are very expensive, people have to miss a day of work….you need to get sedated, someone has to drive you home. And the question is, is it really a good use of resources to now lower the age of screening?”

Hoffman, is director of the Division of General Internal Medicine for the Carver College of Medicine, and says he’d like to see more of an age breakdown on the colon cancer numbers. He agrees with Doctor Gunderson that there won’t be an immediate change in practice by most doctors.

(Radio Iowa)