March is National Colorectal Cancer Awareness Month, which provides an opportunity to highlight the importance of screening for this deadly disease. Following national screening guidelines for colorectal cancer (CRC) allows for removal of precancerous polyps and detection of CRC at earlier, more manageable stages.
Colorectal cancer is the third most common cancer type worldwide and the second most common cause of cancer death. The lifetime risk of CRC is similar for men and women, approximately 4 percent (one in 24 people!), which can be reduced to nearly 0 percent with age-appropriate screening. Unfortunately, only two thirds of eligible adults receive appropriate screening. This may be due to many people believing they are not at risk for colorectal cancer, especially if they do not have a family history of the disease. In fact, most patients who are diagnosed with colorectal cancer are the index case (only person in their family).
There are several other reasons why people may not get screened for CRC including lack of awareness, fear, and cost. Some people may be afraid of the screening process, which includes a colonoscopy. Nearly all patients who have had a colonoscopy can attest to the fact that it is essentially painless and simple. The worst part of the process is the bowel preparation, which has been improved in recent years to several different options of low-volume preparations. Finally, cost has historically been a significant barrier; however nearly all insurances cover the process completely including the office visit, colonoscopy procedure, and anesthesia. Your healthcare provider can check your eligibility prior to incurring any costs.
Individuals may develop symptoms of CRC which include change in bowel habits, feeling of incomplete evacuation, rectal bleeding, abdominal pain/cramping, weight loss, and/or generalized fatigue. However, many times patients do not develop symptoms until the cancer has grown to a significant size. Several factors are thought to be related to individuals having CRC including genetics, environmental exposures, and diet. The only modifiable risk factor includes diet – due to the amount of highly processed foods consumed and the low-fiber, high-fat readily available meals. In order to decrease a person’s risk of developing CRC, some recommendations include weight loss, physical activity, and diets rich in fish, fruits, and vegetables.
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Thanks to national efforts to increase screening awareness, the rate of CRC has steadily decreased over the past couple of decades – except for younger adults. In fact, according to a new American Cancer Society (ACS) study, the number of people under the age of 55 with newly diagnosed colorectal cancer has nearly doubled since 1995. That’s why both the ACS and the U.S. Preventative Services Task Force have issued new recommendations for people at average risk of colorectal cancer to start regular screening at age 45 and continue until at least the age of 75 (in some individuals, it is recommended to continue until the age of 85).
The most common and effective method of screening is a colonoscopy. The procedure involves receiving adequate and appropriate anesthesia; thereafter the gastroenterologist advances a flexible scope to examine the entire colon. This procedure has improved with up-to-date instruments, quicker and shorter anesthesia time, and newer technology including the use of carbon dioxide for insufflation (essentially eliminating post-procedure pain). Most often, the procedure is done at an ambulatory surgical center, which is not only quicker (usually 2 hours from when you walk in to when you walk out), it also reduces the cost substantially than performing the procedure at a hospital. Other screening options in average-risk individuals include fecal immunohistochemistry testing, multitarget stool DNA (MT-sDNA) testing (Cologuard), and flexible sigmoidoscopy. Individuals with a family history of CRC need to undergo screening at age 40 or even earlier depending on the age of the family member.
In conclusion, CRC is a deadly disease that affects thousands of people each year in the United States. National Colorectal Cancer Awareness Month provides an opportunity to raise awareness about the importance of screening and to encourage more people to get screened for this preventable disease. By talking about colorectal cancer and sharing your own screening story, you can help to save lives and prevent colorectal cancer from taking a toll on our communities.
Dr. Varun Patel, M.D. is a gastroenterology specialist with Gastroenterology Associates in Crystal River.
