Why Colorectal Cancer Awareness Month Is Really Something To Celebrate This Year

Colorectal cancer remains a major source of cancer incidence and mortality worldwide. The American Cancer Society recently estimated that in 2021, there will be 149,500 new cases of colorectal cancer and 52,980 deaths in the U.S. alone. Franklin G. Berger, professor emeritus in biological sciences, writes in The Conversation about two significant developments that could save lives.

March is National Colorectal Cancer Awareness Month. I recognize you’re not likely to throw a party to celebrate, since most of us are not comfortable talking about our butts and our bowel habits. However, there really is reason to talk about this disease, which kills over 50,000 people each year in the U.S.

As a research scientist and colorectal cancer advocate, I am particularly excited over two significant developments that have occurred recently. These could save lives.

First, in an effort to stem the growing numbers of younger adults who are diagnosed with the disease, a national panel has recommended lowering the age when screening should start to 45.

Second, federal law has changed the Medicare reimbursement to make sure the cost of a screening colonoscopy is fully covered.

For quite some time, national guidelines have recommended colorectal cancer screening begin at the age of 50, when risk of the disease starts to climb markedly. However, in recent years, researchers and physicians have observed colorectal cancer is increasing in people under age 50. Screening has generally not been recommended for those under 50 unless major symptoms occur.

Those of us who study the disease do not fully understand the reasons behind this increase, but there is growing concern among doctors, researchers and, of course, patients and their families. This concern has led to reconsideration of screening guidelines by the federal panel that recommends them.

In October 2020, that panel – the United States Preventive Services Task Force – conducted a comprehensive and in-depth evaluation. It recommended adults aged 45-49 be screened for colorectal cancer. This brings the Task Force in line with what the American Cancer Society recommended in 2018.

The revised recommendations are formally in draft form now, but they should be finalized within the next several months. The Affordable Care Act mandates that colorectal cancer screening follow these guidelines, and that private insurers and Medicare cover approved screening tests with no co-payments.

Once the new guidelines are in place, young adults aged 45-49, who are increasingly vulnerable to colorectal cancer, will become eligible for insurance that fully covers screening.

After many years of advocacy and lobbying around this issue by organizations such as Fight Colorectal Cancer and the American Cancer Society Cancer Action Network, the loophole was finally closed in December 2020, when Congress passed, and President Trump signed, the Removing Barriers to Colorectal Cancer Screening Act of 2020. This act, part of the COVID-19 Economic Relief Bill, requires the waiving of co-insurance charges associated with colorectal cancer screening tests, regardless of whether tissue is removed during the test. It will be phased in during an eight-year period beginning in 2022.

President Biden, in a proclamation to the nation on March 1st, encouraged “all citizens, government agencies, private businesses, nonprofit organizations and other groups to join in activities that will increase awareness and prevention of colorectal cancer.” The new screening guidelines will help make that happen in the future.

A number of effective options for colorectal cancer screening were approved under the new guidelines. These include tests that look for the presence of blood or specific DNA biomarkers in fecal samples, and visualization tests that directly examine the inner lining of the colon and allow removal of tumors or precancerous lesions.

New technologies are emerging that should make screening easier and more effective. For example, liquid biopsies involve analysis of easily obtained bodily fluids, such as blood or urine. Doctors may soon be able to isolate and analyze cells or DNA that come from tumors and that are present within the bloodstream.

Also, molecules in urine may be potentially important as biomarkers for detection of colorectal lesions.

Though the utility of technologies such as these is still under study, it is clear in the near future, we should witness the appearance of simpler, more accessible and more sensitive tests for colorectal cancer. It is important to note, however, these noninvasive tests must be followed up by a colonoscopy if anything of concern is noted.

As National Colorectal Cancer Awareness Month reminds us, it is important for people of all ages to be aware of risk factors for colorectal cancer, of symptoms that may be indicative of the disease, and of strategies and guidelines for screening and prevention.

Talk to your doctor and your insurance provider about colorectal cancer and its prevention. The more you know, the better.