Why wait until 50?
It’s time to update our communication strategy for colon cancer prevention and early detection
Whitney F. Jones, M.D.
Founder, Colon Cancer Prevention Project
Andrea Uhde Shepherd
Executive Director, Colon Cancer Prevention Project
Ann Eisenmenger knew something was wrong: She was constipated, and had been through a day of intense abdominal pain.
But at 48, she was two years shy of the recommended age for a colonoscopy and had never been screened. In fact, she had no family history of colon cancer and knew little about it. It wasn’t until her doctor scheduled a colonoscopy for her that Ann learned the grim truth: She had Stage II colon cancer.
While nationally colon cancer rates are declining, there’s been a noticeable rise for decades now in the number of people like Ann who are under 50 and have colorectal cancer. In fact, the rate of rectal cancer diagnoses in people under 50 rose 3.8 percent per year from 1984 to 2005.
For years, we’ve advised people to start being checked at age 50, and often they don’t hear that message until they turn 50 – or in many cases, years later. Our communication strategy needs to be updated. It’s time to reformulate and re-evaluate how and when we talk about colon cancer, and end this out-dated tradition of starting the communication at age 50. When it comes to colon cancer, 40 is the new 50.
Why? Because this will allow people to have time to identify the risk factors and warm up to the idea of screening. It will also allow people like Ann Eisenmenger to understand the symptoms of colon cancer and ensure it’s diagnosed early.
Nearly 145,000 people are being diagnosed with colon cancer each year in the U.S., and it’s estimated that around 25,000 of those cases are in people age 50 or younger. Even more, most of those cases are late stages of cancer.
We are missing out on an opportunity to save lives.
People should learn the risk factors early
By focusing on 50-year-olds, we inadvertently delay getting the message out to people with the highest risk who need it the most. Due to personal or family history of cancers or pre-cancerous polyps, many people are considered high risk and should begin screenings sometime in their 40s or earlier.
If we begin marketing this message to people under 50, those people will have more time to consider their personal and family history, seek risk-appropriate screening, and even engage other family members in a discussion about the need for screening.
The following considerations also suggest a benefit to reaching younger populations:
- The American College of Gastroenterology recommends that African Americans begin screening at age 45 because African American populations carry a higher burden of the disease and have a higher percentage of late stage cancer diagnosis.
- Between 1992 and 2005, incidence of colorectal cancer for every 100,000 people under 50 rose 1.5 percent per year in men and 1.6 percent per year in women, according to a study by the American Cancer Society.
- The study found that in that same time frame, incidence rose the most in people ages 20 to 29, with a 5.2 percent increase per year in men and a 5.6 percent rise each year in women.
- Some studies have suggested a similar rate of colon polyp formation in the fourth decade of life as in the fifth decade.
- Mayo Clinic researchers have found that around 25,000 people age 50 or younger are diagnosed with colon cancer each year, accounting for up to 17 percent of all cases. They found that colon cancer is one of the top 10 cancers that affect people age 20 to 49.
- A recent study sparks questions of whether men have a higher rate of advanced tumors, and draws into question whether they should be screened at a younger age than 50.
- Smoking and obesity are now accepted risk factors that increase rates of polyps and colon cancer by up to 20% each. These individuals may need to be considered for screenings before they reach 50.
Given this data, what makes age 50 the prime time to start this discussion of prevention and early detection?
It’s time for a change.
People need time to warm up to the idea of screening
The average age of people getting their first colonoscopy is 57. Inherently, people will delay undergoing almost any non-emergency medical procedure. Even when we saturate them with messages about screening, many people put it off because they fear knowing the results, don’t want to make the time, or don’t have the proper insurance coverage.
Marketing experts point to the “rule of seven,” which refers to the fact that people need to hear a message seven times before they take action. The earlier they start hearing our message of screening, the more time they have to warm up to the idea.
People will understand the symptoms
Many symptoms of colon cancer can be disguised as other issues. Rectal bleeding, change in bowel habits, abdominal pain, and unexplained anemia are often blamed on hemorrhoids, irritable bowel syndrome, diet or stress.
These symptoms need to be taken seriously. Earlier communication will educate and motivate people under 50 to not ignore symptoms that may be signs of colon cancer.
The fact that so many people under 50 are diagnosed with a late stage of colon cancer clearly shows there needs to be a more prompt use of diagnostic testing.
Starting this dialogue earlier will increase the effectiveness of colon cancer screening and, as a result, will accelerate improvements in incidence and mortality rates from advanced colon cancer.
It’s time to aim the message of colon cancer symptoms and prevention to people starting at age 40. This is everyone’s responsibility.
Early education can and will save lives. This is our chance to make a change.
“I just remember being in a decent amount of shock.”
--- Ann Eisenmenger, diagnosed at age 48
“When these cancers occur in these women that are young, these children lose their mothers. Not only do we have the death of this woman, but a mother of young kids.”
--- Phyllis Turner, whose daughter Lisa was diagnosed at 41
“My doctor encouraged me to get a screening at 50…and I put it off for a year. I finally went in and have it, and they found colon cancer. I was completely shocked; I had no symptoms.”
-- Crit Luallen, diagnosed at 51
“A good friend of mine one day came by to see how I was doing. I said, ‘Have you had your colonoscopy?’ ‘No,’ he says, ‘I’ve kind of put it off.’ I said, ‘Please go get it.’ They took 15 polyps out of him.” ….“If I would have gone when I turned 50, I wouldn’t be going through what I’m going through now.”
--- Ted McCoy, diagnosed in his 50s and passed away at age 61