In February 2000, President Clinton designated March as National Colon Cancer Awareness Month. Each year, in growing numbers, patients, survivors, physicians, and other advocates work together to heighten the awareness of the prevalence and the preventable nature of the disease.
Colorectal cancer (“CRC”) is the No. 2 leading cause of cancer deaths in the U.S., comprising approximately 10% of them. Following the current screening guidelines, promulgated by the U.S. Preventative Services Task Force (USPSTF), can help safeguard you from this disease.
Factors associated with an increased risk of colon cancer include:
• Age. While CRC can occur in younger people, and is doing so at increased rates, the majority of patients diagnosed with colon cancer are older than 40.
• Ethnicity. African-Americans have a greater risk of colon cancer than do people of other races.
• History. A family history and/or personal history of colorectal cancer or polyps.
• Inflammatory bowel disease (“IBD”) conditions. Gastrointestinal inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, increase your risk.
• Diet. CRC is often associated with diets low in fiber, high in fat and calories, and diets high in red meat and processed meat.
• Lifestyle. A sedentary lifestyle, and inactivity, with low levels of physical exercise.
• Diabetes. Chronic conditions like diabetes and insulin resistance contribute to increased risk.
• Weight. Obesity increases your risk.
• Tobacco. Smoking heightens CRC risks.
• Alcohol. Heavy or frequent use of alcohol is a significant risk factor.
Prevention through screening
• Age 40-80
The rates of new colon and rectal cancer have been steadily declining in the U.S. primarily due to improvements in screening for this targeted age group for whom routine screenings are recommended. While this is good news, there are still a large portion the adult population who don’t get screened regularly, or worse don’t get screened at all. 1 in 3 adults are NOT up to date with recommended screenings. So, the opportunity exists to continue to reduce the incidence of this preventable disease.
•Under 40 in age
10% of colon and rectal cancer occurs in this age bracket. Unfortunately for this age group, the rates of cancer incidence is rising sharply. Primary reasons are thought to include diet and lifestyle factors, such as smoking, red and processed meats, fried foods, alcohol, physical inactivity- although the other risk factors listed above apply as well. And worst of all, mortality rates for cancer incidence is disproportionately high for this group because the cancers are not often diagnosed until at more advanced stages. So, for this group it’s a “self help” screening protocol, with support from their physical is critical.
•Over age 80
While the USPSTF does not recommend routine screening for this age group, it acknowledges “there may be considerations that support colorectal cancer screening in an individual patient.”
Patients who are otherwise in good health with good life expectancy who want to maintain their active lifestyle may prefer to continue their defensive screening program. When one considers that the median age for detection is 69, and that the frequency of increased occurrence correlates with advancing age, this may make sense for a senior with otherwise good health status.
For example, the direct correlation with increasing in age is reflected in the increased number of colonic precancerous polyps. In Highlands County, our recent clinical data has shown that there is 25 to 30% of precancerous polyp detection incidence when patients above age 80 have undergone a colonoscopy for diagnostic reasons.
The typical indicative symptoms involve changes in bowel movements (color or size of stool or bowel habits), abdominal pain, rectal bleeding, anemia, and/or sudden changes in weight. While these are also common with other GI problems , like irritable bowel syndrome (IBS), it’s important to follow up timely with your doctor to be sure.
To do or not to do: that is the question. It is helpful testing in certain patients but not for everyone. Those who had colonic polyps on prior colonoscopy, then it is not recommended to get cologuard test. Cologuard test has about 70-80% sensitivity which means it will test positive in 70-80 times out of 100 in detecting precancerous polyp or colon cancer. In contrast, colonoscopy has 95-98% sensitivity in detecting polyp or colon cancer. Cologuard test will also test positive with very small amount of blood emanating from internal hemorrhoids. Cologuard test only checks for colonic polyp or colon cancer but will not detect other colonic diseases such as mild colitis, ulcers, diverticulosis, benign colonic lesions like GIST/lipoma etc; as colonoscopy can discover in individuals without any symptoms. A positive cologuard can create unnecessary anxiety and increase cost for further testing with colonoscopy. Cologuard would be considered as screening test and a subsequent positive cologuard that requires colonoscopy is not considered screening; therefore it will cost patient more out of pocket.
More importantly, cologuard is not indicated in patients with previous history of polyp and family history of colon cancer.
So, if you exhibit any of these symptoms, be proactive is seeking appropriate diagnostic testing through your primary care physician or by directly contacting a gastroenterologist, a physician specializing in such conditions.
Statistics from USPSTF, CDC American Cancer Society, American Gastroenterological Association.
Dr. Pankaj J. Patel (of Thakkar, Patel, Avalos & Ferretti) is a board certified gastroenterologist and internal medicine physician, who is specially trained in advanced digestive diagnostic procedures.