Earlier Colorectal Screenings for Men?

Sept. 27, 2011 -- Men and women should be screened for colorectal cancer starting at different ages, a new study suggests.

The Austrian study, published today in the Journal of the American Medical Association, found that men frequently have advanced polyps that could lead to colorectal cancer at ages 45 to 49, a decade earlier than women. These findings have prompted the researchers to conclude that men should likely have their first colonoscopy earlier than 50, the age that current guidelines recommend.

"Our study underlines the results from previous studies on this field, and I hope that now is the time for sex-specific age for referring patients to screening colonoscopy," researcher Monika Ferlitsch, MD, of the Austrian Society for Gastroenterology and Hepatology in Vienna, writes in an email. "Try to go at age of 45 if you are a man and at age of 50 if you are a woman."

Not everyone agrees, however. David Bernstein, MD, chief of gastroenterology at North Shore University Hospital in Manhasset, N.Y., says that more research needs to be done before doctors change what they tell their patients. Also, given that the study was conducted in Austria, its results may not apply to American patients.

"Making recommendations based on gender rather than age is something that needs to be explored," says Bernstein, who was not involved in the research, "but our current screening regimen seems to be impactful for reducing the risk of colorectal cancer."

Risk Factors Appear in Men 10 to 15 Years Earlier Than in Women

The study, conducted across Austria between 2007 and 2010, included 44,350 people whose average age was 60. A nearly equal number of men and women participated in the study.

Each of them underwent a colonoscopy, a procedure in which a tube-mounted video camera is inserted into the rectum and then snaked through the colon, where it is used to identify cancerous and potentially precancerous growths. Colonoscopies are considered the gold standard tests for detecting colorectal cancer.

Just over 60% of the study participants were given a clean bill of colon health -- no abnormalities were found. Among those whose exams revealed a type of precancerous polyp known as an adenoma, men were much more likely to develop them at a younger age than women. For example, 18.5% of men aged 50 to 54 had adenomas compared to 10.7% of women that age.

It isn't until women are 65 to 69 years old that their likelihood of adenomas matches men in their early to mid 50s, the researchers note.

According to the study, the likelihood that women have polyps increased as they entered their 60s. For men, a similar increase occurred when they were much younger, between the ages of 45 and 49.

Men were also twice as likely as women to have advanced adenomas, growths that have greater potential to lead to cancer. Overall, men were twice as likely to be diagnosed with colorectal cancer.

About Colorectal Cancer

Colorectal cancer is the third most common cancer for men and women, according to the American Cancer Society. They estimate that just over 100,000 new cases of colon cancer and nearly 40,000 new cases of rectal cancer will be diagnosed this year. In 2011, nearly 50,000 people will die from both cancers combined.

Diagnosing precancerous colon polyps and colorectal cancer at an early stage -- the goal of screening -- vastly improves a patient's chances of survival. For colorectal surgeon Meagan Costedio, MD, of the Cleveland Clinic, the study results may influence current recommendations on when men should have their first colonoscopy.

"People might be willing to decrease the age to 45 in men and see if it changes things," says Costedio, who was not involved in the research. "If we see a drop in incidence of cancer, that would be a good change in practice."

However, she cautions that colonoscopies are not risk-free procedures. Tears, bleeding, and perforations of the colon are rare but possible complications.

"We don't want to increase the risk of hurting people," Costedio says.

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