Many journalists do not question the new guidelines for detection of colorectal cancer by the Cancer Society



The American Cancer Society (ACS) has updated its colorectal cancer screening guidelines, reducing the recommended age to begin screening from 50 to 45.

Many national media picked up the potentially changing news with these headlines: [19659003] Why does the ACS recommend that people undergo screening tests at a younger age?

The rate of colon cancer in younger people is increasing, according to the stories, all of them present some version of this appointment of NBC coverage:

"People born in the 80s and 90s have double of risk of developing colon cancer and four times more risk of developing rectal cancer compared to people born decades ago, such as the 40s and 50s, "said Dr. Richard Wender, chief cancer control officer for the Society American Cancer

"We are actually looking at developing colorectal cancer in people in their teens, which is something extraordinarily rare in the past, and it is very common that" However, in all these histories the quantification of the actual rate of colon cancer is missing in these groups, which could help readers understand what the ACS spokesperson means by "too common." "

As the New York Times pointed out last year, a person who was born in 1950 had a risk of three million in developing colon cancer in their twenties, compared with a risk of five per million for a person born in 1990 The risk of rectal cancer for someone in their twenties increased from 0.9 per million for those born in 1950, compared to 4 per million for someone born in 1990.

Those increases are in the same stage as the risk of being struck by lightning 19659002] In comparison, the incidence of colon cancer in people over 50 was 119 per 100,000 in 2013, several orders of magnitude higher.

A modeling study is not a clinical trial [19659009] Perhaps most importantly, some of the stories Miré raised any concerns about the evidence that supports the new guide, even when they noticed that other professional groups remain true to their recommendations. current mendations to begin screening at age 50.

Kenny Lin, MD, MPH, professor of clinical family medicine at Georgetown University, offered a counterpoint to the predictions that the new guide would save lives.

"The rationale for screening at a younger age is that the incidence of colorectal cancer is higher [than in the past] … so there are more cancers that are detected by screening," he wrote in an email. But he noted that this logic makes badumptions, particularly that cancers that are found in younger adults behave in the same way and can be treated with the same effectiveness as in older adults. It also badumes that the results are better when these cancers are detected by screening, before they begin to cause symptoms (eg, rectal bleeding).

"If any of the badumptions is not true, an earlier screening might not improve mortality from colorectal cancer in real life, no matter what the models say," Lin said.

Richard Hoffman, MD, MPH, director of the Division of General Internal Medicine at the Carver School of Medicine at the University of Iowa, noted another presumption incorporated in the guidelines – that patients will follow SCA screening recommendations at the foot of the letter and will look for tracking screens at the appropriate intervals.

"Since we are told that only 2/3 of adults 50 to 74 are adherents [with screening recommendations] This raises questions about the potential effectiveness of the evaluation of younger patients, especially with uncertain insurance coverage," said Hoffman .

Internists Pieter Cohen, MD and Michael Hochman, MD raised other concerns in their e-newsletter Updates in Slow Medicine, noting that the data did not come from a clinical trial.

The change … is not based on the results of a new clinical trial but on study models based on the increasing prevalence of colorectal cancer. American adults in their 40s. The updated guide encourages physicians to badyze different screening modalities with patients, but unfortunately it does not suggest to patients that there are various expert opinions on when to start screening and that starting screening before age 50 has known risks but only theoretical benefits.

Little attention to damage

Although there are several ways to detect colon cancer, some professional groups, including the American Gastroenterology Association, support colonoscopies instead of other methods. But is this the safest approach? Cohen and Hochman point to recent data showing that "they are eight times more likely to end up in the hospital within a week of their screening colonoscopy than to be saved from death from colon cancer in 10 years."

USA Today was one of the few points of attention that drew attention to these potential harms, which include bowel perforation and complications of anesthesia. He also presented an extensive discussion on costs, noting that the ACS recommendation was "qualified" due to limitations in the evidence. According to an author of the ACS guide, this means that "we hope that doctors will badyze it and at least begin discussions about screening for colorectal cancer with their 45-year-old patients."

However, Hoffman wondered if doctors have enough data to make these kinds of meaningful discussions. He noted that truly personalized decision-making "requires informing patients about the benefits and harms of early detection and it is not clear if we have enough clinical data to support these decisions."

In his honor, and reflecting the emphasis in the news from the ACS publication announcing the guidelines: most stories generally did a good job of badyzing screening options for non-invasive colorectal cancer, such as blood tests and stool

But, in general, few companies challenged the narrative that more lives would be saved with an earlier start, the benefits would outweigh the damage. These claims are speculative and may be plausible, but are not yet proven. Some experts believe that care focused on younger patients could be channeled more effectively elsewhere.

"Something like 1/3 of the population between 50 and 75 years old is not up to date in any colorectal cancer screening method," Lin said. "The benefits of extending the age of onset of screening in 5 years, even if they exist, are pale in comparison to the potential benefits of getting more people in the universally agreed upon age range."

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