Forum: Time to consider starting colorectal cancer screening at 45
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Local celebrity Sheikh Haikel having stage 4 colon cancer diagnosed at the age of 49 is a sobering reminder that colorectal cancer is no longer mainly a disease of older people (Rapper Sheikh Haikel reveals that he has stage 4 cancer, Sept 4).
In Singapore, about 10 per cent to 12 per cent of colorectal cancers occur in people below 50.
The majority of colorectal cancers develop from polyps. The conventional polyp-cancer sequence is thought to take around seven to 10 years.
This long window provides an important opportunity for prevention. Screening colonoscopy can detect colorectal cancer at an earlier, more treatable stage and, importantly, identify and remove precancerous polyps before they have the chance to become cancerous.
Screening therefore has the potential to not only detect cancer early, but also to prevent cancer altogether.
Currently, Singapore recommends colorectal cancer screening for average-risk individuals from age 50. However, someone like Haikel, who developed colorectal cancer at 49, would not yet have reached the recommended screening age. By the time his cancer was diagnosed, it had already advanced to stage 4.
The United States has recognised the changing epidemiology of colorectal cancer. In 2018, the American Cancer Society lowered the recommended starting age for average-risk colorectal cancer screening from 50 to 45, in response to the increasing incidence of colorectal cancer among younger adults.
Haikel deserves credit for speaking openly about his diagnosis and personal struggles. His experience may help raise awareness among younger Singaporeans that colorectal cancer can occur before 50.
It may now be time for the Ministry of Health to review the evidence and consider lowering the recommended starting age for average-risk colorectal cancer screening from 50 to 45.
Earlier screening could potentially prevent cancers such as these before they develop, or detect them while they are still curable.
Desmond Wai Chun Tao