Early detection urged for this common but preventable killer
New guidelines released last week by the American Cancer Society recommend that most U.S. adults start colon cancer screening at age 45 – rather than age 50, as was previously recommended.
Colorectal cancer is the third-most commonly diagnosed cancer in both women and men in the United States. Colorectal cancer is also the third-leading cause of cancer death in the United States. Annually, over 130,000 people are diagnosed with colorectal cancer, and approximately 50,000 will die from the disease.
Evidence reveals that there is a 52 percent increase in colon cancer for those under the age of 50 since 1994. Shockingly, doctors have discovered anyone born after 1990 has twice the risk of developing colon cancer as someone born in 1950.
Even more alarming, anyone born after 1990 has four times the risk of developing rectal cancer as someone born in 1950. The risk of developing colon cancer for those over 55 has actually decreased. This reduction is thought to be a result of increased screening and the removal of premalignant polyps at those screenings.
Doctors are uncertain why there is such a dramatic increase in colon cancer for those under the age of 50. Some speculate it is a combination of poor diet, lack of exercise and obesity. Others believe it may be a result of changing our intestinal microbiome (the millions of friendly bacteria that live in our gut) as a result of the widespread use of antibiotics and diet.
It is also well known that African Americans and Native Americans have a higher risk of developing colorectal cancer. The good news is that the vast majority of these deaths can be prevented with early detection and treatment.
Sadly, only about 50 percent of people over age 50 get the recommended colorectal screening tests (colonoscopy) consistent with prior medical guidelines, and much fewer under the age of 50 get screened for colon cancer. American Cancer Society’s new guidelines recommend that most “normal risk” U.S. adults start colon cancer screening at age 45.
A “normal risk” adult is one who:
- has no family history of colon cancer;
- has no genetic conditions linked to colon cancer; and
- does not have inflammatory bowel disease.
For those who are of higher risk, screening may need to be done before age 45. Detection prevents colorectal cancer by detecting the precursor lesions, known as polyps, in the rectum and colon. These are non-cancerous growths. Only a small percentage of polyps will turn cancerous, but the screening identifies them, and the polyps are all removed.
Regular screening identifies polyps early, significantly increasing the chance that they will be removed and will not progress into cancer. Early and frequent testing can also identify colorectal cancer in the early stages, considerably increasing the odds that it can be effectively treated and cured.
For these reasons, physicians will now recommend screening tests starting at the age of 45, and even sooner for those who are at higher than normal risk (often with a strong family history of the disease). Screening for colorectal cancer according to your doctor’s guidelines is good.
In addition to colorectal cancer screening, the following measures can decrease the risk of developing colorectal cancer:
- Exercise regularly.
- Maintain a healthy weight.
- Don’t smoke.
- Drink alcohol in moderation.
- Eat a healthy diet.
Precancerous polyps are silent. That is why it is so important to get screened before cancer develops. Here are seven warning signs of colorectal cancer:
Frequent bleeding when you evacuate
Bleeding may occur in the lower areas of the digestive system, or in some instances in the rectum. When bleeding occurs above the rectum, the color of stool changes to a dark, tar-like consistency that some liken to “coffee grounds.” In the case of rectal bleeding, blood is visible almost as a separate bright red discharge in the stool.
Change in bowel habits
Most people with colon cancer notice a difference in the pattern of bowel movements. They may have unexplained and recurrent episodes of either constipation or diarrhea. Everyone experiences bouts of constipation or diarrhea, but if these symptoms continue over an extended period of time, be sure to talk to your doctor about a plan.
Persistent bloating and abdominal discomfort
Patients with colorectal cancer often experience significant abdominal discomfort and bloating on a regular basis, almost on a daily basis. The bloating can occur without eating and may be accompanied by cramps and burping. Sometimes patients will experience episodes of nausea and vomiting, too.
Excessive or constant gas
This comes as a dramatic and noticeable change to regular “passing gas” habits.
Thin ribbon-like stools or small diameter pencil-like stools
The stool quality commonly changes with colorectal cancer. The stool becomes, dark, long and flat like a ribbon or thin like a pencil.
This can result from a slow loss of blood that leads to anemia. Feeling fatigued can also be affected by energy sapped by the immune system in fighting the cancer. Also, anemia can produce shortness of breath as the body is not able to efficiently get oxygen to the cells and tissues and organs.
Weight loss without explanation
Weight loss associated with colorectal cancer can be the result of several causes. These include loss of appetite and an increase in calories needed by the immune system to fight the disease.
The bad news is that colorectal cancer is a leading cause of death in America. The good news is that over 95 percent of colorectal cancer deaths are preventable. Talk to your doctor about developing a timeline for screening for colorectal cancer for you (colonoscopy or other tests), and for your loved ones.
If you have any of the symptoms listed above, do not panic but definitely make an appointment with your physician. The sooner you do, the better.
Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations, and president of the Minnesota Association of Black Physicians.