Colorectal Cancer Prevention: What You Need to Know
By Jadd Koury, MD, FACS, FASCRS | UPMC Pinnacle Colon and Rectal Surgery
Colorectal cancer is the second leading cause of cancer-related deaths for both men and women combined in the United States. However, the cure and even prevention of colorectal cancer is possible with the appropriate screening. Unfortunately, only 60 percent of people who need a colorectal cancer screening actually get screened. Doctors, cancer organizations, and others are working to break down these barriers. They are trying to reduce the embarrassment and encourage open communication about colon and rectal health.
You can significantly reduce your chance of getting colorectal cancer or prevent it altogether by knowing the facts.
The Facts and Myths about Colorectal Cancer
Here are some of the top questions I hear from patients.
Can colorectal cancer be prevented?
Answer: Colorectal cancer usually develops from pre-cancerous polyps (adenomatous polyps or serrated polyps). Several screening tests exist to detect these polyps including stool studies for blood and DNA, a flexible sigmoidoscopy, and a colonoscopy.
Unlike other screenings, a colonoscopy allows your doctor to detect and remove pre-cancerous polyps at the same time.
Your doctor can help you decide which test is right for you.
Myth: No one in my family has colorectal cancer so I am not at risk.
While it is true that a family history of colorectal cancer or colorectal polyps increases the risk for colorectal cancer, that is not the only risk factor. In fact, the majority of colorectal cancers discovered during a colonoscopy are found in people with no family history who are of average risk.
Myth: I have no symptoms so my colon is fine.
The hallmark of any screening test is to find the disease before you develop symptoms. Small colorectal polyps and early colorectal cancer produces no symptoms. Early detection of colon polyps or early colorectal cancers before symptoms occur is the only way to prevent or cure colorectal cancer. Once a cancer has grown to a size where it causes symptoms such as “bowel problems” or bleeding, the chance for a cure is greatly reduced.
Who needs to be screened for colorectal cancer?
Answer: Any patient with a positive screening test for colon cancer OTHER THAN COLONOSCOPY (i.e., Cologuard, FIT etc…) must have a colonoscopy. While the incidence of colorectal cancer is declining in patients 50 years or older, there is a notable increase in the incidence in patients younger than age 50. Consequently, the American Cancer Society recommends screening all patients of average risk at age 45 but this is not uniformly accepted by all medical societies. Men and women who have no symptoms and no family history of colorectal cancer should start screenings between the ages of 45-50. African Americans have a higher incidence of colon cancer and average risk screening should occur at age 45. Adults of any age who have symptoms of abdominal or rectal pain, rectal bleeding, or a change in bowel habits should receive a screening.
Who needs to be screened before age 50?
Answer: Patients experiencing symptoms such as abdominal or rectal pain, bleeding, change in bowel habits. Screenings should begin before age 50 in adults who have symptoms as described above or who have a family history. A family history is a first-degree relative (parent or sibling) who has had colorectal cancer or polyps. Patients with a family history of colon or rectal cancer or polyps. In this case, you should be screened 10 years earlier than the age of the family member when he or she was diagnosed, or at age 40—whichever is younger.
Will I ever need another colonoscopy?
Answer: A repeat colonoscopy is recommended every 10 years for patients without polyps who are of average risk. High risk patients with normal colonoscopies should have a follow up screening every 5 years. Patients found to have pre-cancerous polyps should typically have a repeat screening within 3-5 years of the polyp removal.
Other than screenings, what else should I do?
Get over the “ick factor”; Know what’s normal for your body – track your bowel movements and abdominal symptoms. Check your stool for signs of cancer. One of the biggest signs is rectal bleeding or blood in your stool. Life-style changes are known to reduce the risk of colorectal cancer and include: smoking cessation, maintaining a healthy weight with active life-style, avoid excessive consumption of alcohol or red meat, and consume a high fiber diet. Talk to your doctor about any issues you have and get the appropriate screenings.
What does a colonoscopy screening entail?
A colonoscopy procedure examines the colon by using a long, flexible, lighted tube called the colonoscope. Using this tool, the doctor can view the entire colon and rectum for polyps or cancer. During this same exam, the doctor can also remove pre-cancerous polyps. The procedure itself takes about 45 minutes, and usually involves sedation. It’s rarely uncomfortable. A colonoscopy is the single best screening exam for colorectal cancer.
The Prep for a Colonoscopy
Patients switch to a clear-liquid diet the day before. Patients use laxatives or a cleansing preparation to ensure the procedure is accurate and comprehensive. Your doctor will account for any medications you take and any health problems you have. A colonoscopy is well worth any temporary discomfort to protect your health and your life.
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