As part of our “Ask an Expert” series, freelance writer Rachel Morrell interviewed Murali Krishna, M.D., of Space Coast Endoscopy Center in Rockledge, Fla., to learn more about his views on whether the screening age for colorectal cancer should be lowered.
Colon cancer is one of the most preventable cancers because doctors can detect and remove precancerous polyps during routine colonoscopies. Currently, the recommended age for colon screening is age 50 for individuals who are at average risk. This guideline was established by the U.S. Preventative Services Task Force. There are a few exceptions to this guideline. African Americans should begin colon screening at age 45, and individuals who have a family history or personal history of colon cancer or colon polyps should be screened earlier as well.
Although colon cancer incidence in individuals over the age of 50 is decreasing, young-onset colon cancer incidence is steadily increasing. According to the Surveillance, Epidemiology and End Results (SEER) database, about 12 to 13 percent of colorectal cancer deaths occur in people under the age of 54. Furthermore, a study published in the journal Cancer found that younger patients are more likely to have advanced stage colon cancer.
What do doctors think of this data? A recent survey revealed that 64 percent of 2,221 doctors in the United States believe that the guidelines for colon cancer screening should be revised to a lower age, and most doctors agreed that age 40 would be more appropriate.
Stop Colon Cancer Now’s physician partner, Murali Krishna, M.D., of Space Coast Endoscopy Center in Rockledge, Fla., shared some insight as an expert in the field of gastroenterology. Dr. Krishna agrees that young-onset colon cancer is on the rise. He is seeing more cases of colorectal cancer in patients in their 30s and 40s. “The majority of these cancers appear to be rectal cancers, which are much harder to treat successfully,” said Dr. Krishna. Because of the increase in colorectal cancer incidence, Dr. Krishna believes that it would be advantageous to begin colon screenings at age 40 instead of 50.
Although lowering the screening age for colorectal cancer would help save lives, there are many barriers to changing the existing guidelines. The most obvious obstacle is cost. Even though studies clearly conclude that the cost of regular colorectal screenings are much less than the price of treating colorectal cancer, colonoscopies are still expensive. Medicare and private insurance companies will incur huge expenses if the USPSTF changes their recommendation. Dr. Krishna observed, “The pendulum seems to be swinging away from prevention. Colonoscopy reimbursement has decreased drastically in the past few years, even though the upstream savings of a quality exam are considerable.”
Another barrier is the low colorectal cancer screening rate of eligible individuals in the United States. In 2013, the Centers for Disease Control and Prevention found that only 60 percent of white, 58 percent of African American, 51 percent of Asian and 42 percent of Hispanic patients between the ages of 50 and 75 were current on their colorectal cancer screenings. Whether it is lack of insurance coverage, fear of the procedure, fear of cancer, or dread of the bowel prep, many men and women are not choosing to be screened. It is difficult to lobby for change when the current screening rate is low (Source: DotMed).
Most doctors agree that one way to improve screening rates is through noninvasive colon cancer screenings. These noninvasive methods are usually less time-intensive and more cost-effective. Although screening methods such as fecal occult blood test and computer tomography (CT) colonography are not as thorough as colonoscopy, they are still very useful. Dr. Krishna underscores the importance of choosing some type of screening, saying, “Early detection is the next best option to preventing cancer through early polyp removal.”
Making colon screening more accessible for younger Americans is an uphill battle, but it is worth fighting. Dr. Krishna believes that every voice is necessary, and that individuals can contact their local congressman or congresswoman to support colonoscopy bills. Most importantly, we need to all take responsibility for our own lifestyle choices because our daily decision-making affects our risk for colon cancer. This is especially important for individuals who are at elevated risk for colon cancer. Dr. Krishna advises, “Begin with primary prevention. Eat plenty of fruits and vegetables. Avoid meat. Talk to [your] primary care physician about annual stool testing for blood or another screening method, which is secondary prevention.”
Dr. Krishna is board certified in Gastroenterology, Internal Medicine and Nutrition and specializes in endoscopy and digestive diseases. Attending medical school at Bangalore Medical College in Bangalore India, he completed his internship and residency in Internal Medicine at New York Medical College. Dr. Krishna also completed a fellowship in Gastroenterology and Liver Disease at New York Medical College. Please visit Space Coast Endoscopy Center for more information about Dr. Krishna and his practice.