Dr. Mitchell Kang is a board-certified gastroenterologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Caton Hill Medical Center.
Up until a couple of years ago, doctors told their patients ages 50 and older that they should be screened for colon cancer.
Now, we tell patients ages 45 and older to get screened.
Why the change?
Although the overall incidence of colon cancer has been dropping, rates have been increasing in people younger than 55. With the goal of preventing cancer before it starts, the U.S. Preventive Services Task Force now recommends that people at average risk of developing colon cancer get screened starting at age 45.
Colorectal Cancer Awareness Month is in March. As a board-certified gastroenterologist, I want to use this opportunity to make people aware of the symptoms of colon cancer and to urge people to get screenings.
Colorectal Cancer Statistics
Colorectal cancer is the third most common cancer in men, and the second most common cancer in women across the world. It is the second leading cause of cancer deaths in the United States, with 52,500 deaths annually, according to the National Cancer Institute.
Approximately 153,000 new cases were diagnosed in the United States last year, representing almost 8 percent of all new cancer cases.
Also of note, more than 15 percent of new cases are in people ages 45–54.
Colorectal Cancer Screening
I firmly believe that early detection saves lives. The five-year survival rate is 91 percent if treated before the cancer has spread, but only about 13 percent once the cancer has affected other body parts.
Most cases of colorectal cancer start as precancerous polyps called adenomas, or small growths. Fewer than 10 percent of these polyps will turn into cancer. This process is slow, oftentimes taking about 10 years.
There are two main ways we screen for colon cancer: a fecal immunochemical test kit or a colonoscopy. Patients at average risk of colon cancer can choose a FIT kit as a screening method. This test looks for hidden blood in the stool. It is a noninvasive way to check for colon cancer without leaving your house. Simply follow the directions on the kit to obtain a stool sample and return it to a lab.
Unlike a colonoscopy, no sedation is needed. And since it’s a quick and painless test, many patients are very willing to follow through. Kaiser Permanente patients receive FIT kits in the mail and reminders on kp.org to complete the test. Our centralized electronic medical record alerts doctors to send test kits to those who meet testing guidelines.
If the FIT kit detects blood in the stool, the patient will then be scheduled for a colonoscopy.
If no blood is detected, the test should be repeated the following year.
A colonoscopy, which long has been the gold standard in colorectal cancer screening, is recommended for anyone at high-risk for colon cancer, including those with precancerous polyps or those who have a first-degree relative with a diagnosis of colorectal polyps or cancer at age 60 or younger. A lighted scope is used to view the inside of the colon.
I understand that many patients are scared about undergoing a colonoscopy. The bowel preparation isn’t pleasant. Colonoscopies are invasive, and that can be scary. People worry about possible complications from sedation; however, complications are extremely rare. Colonoscopies truly save lives. When gastroenterologists perform colonoscopies, they can remove polyps before they have the potential to turn into cancer. And colonoscopies can detect other gastrointestinal problems in their early stages.
If colonoscopy results are clear (and depending on your risk factors), you likely won’t need to repeat the test for a decade.
Talk to your doctor about which screening method is best for you and at what age to begin screening.
Early detection leads to better outcomes. At Kaiser Permanente, we pride ourselves in saving lives by having one of the highest colorectal cancer screening rates in the nation: 76 percent of our eligible patients get screened, compared with a national average of 57 percent. An estimated 7,800 lives could be saved every year if everyone screened for colorectal cancer at the same rate as Kaiser Permanente.
Symptoms of Colorectal Cancer
Colorectal cancer often doesn’t cause any symptoms until it has spread; that is why early detection is so important. Symptoms of colon cancer may include the following:
- Persistent abdominal pain;
- Waking up during the night with abdominal pain;
- Unintentional, unexplained weight loss;
- Blood in the stool;
- Changes in bowel habits;
- Iron deficiency.
If you have any of these symptoms, reach out to your doctor.
Risk Factors for Colorectal Cancer
Risk factors for colorectal cancer fall into two broad categories: Those we can change and those we cannot.
Risk factors that we can’t change include the following:
- Family history. People with a first-degree relative who had colorectal cancer are at increased risk of developing colorectal cancer, especially if the family member was diagnosed under the age of 60. People with multiple distant relatives with colorectal cancer also are at increased risk.
- Inherited gene changes, such as Lynch syndrome or familial adenomatous polyposis.
- Age. In general, your risk increases as you get older.
- People who previously had polyps removed during a colonoscopy.
Risk factors that you can change:
- Smoking. Smoking comes with an increased risk of developing polyps.
- Eating red meat.
- Drinking too much alcohol, especially more than four drinks a day. We also know that drinking even two drinks a day can increase risk of developing polyps.
People who are at high risk may need to start screening for colorectal cancer at younger ages and/or more frequently. To lower your risk, quit smoking, minimize alcohol consumption, exercise regularly, and eat a diet with plenty of fruits and vegetables.
Bottom line: Colon cancer is a disease that can largely be prevented through regular screenings. If you are eligible for a screening, please go ahead and schedule it. And if you aren’t sure whether you are eligible, reach out to your doctor. Screening saves lives.
Featured images, stock.adobe.com
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