Colon Cancer Prevention
Who should get a colonoscopy? This is always a topic of discussion between Primary Care providers and patients and can be a daunting one. Many people feel embarrassed by the idea of a colonoscopy, and it is important that they are well educated and counseled on the need for this procedure.
As per the World Health Organization (WHO), Colorectal cancer (CRC) is the third most common cancer worldwide, accounting for approximately 10% of all cancer cases and is the second leading cause of cancer-related deaths worldwide. Multiple societies such as the American Cancer Society (ACS) and the U.S. Multisociety Task Force (MSTF) have now advocated that the age for colon cancer screening be reduced from 50 to 45 in average risk patients due to the rising incidence and mortality in colorectal cancer in young and middle-aged populations. For average risked patients, colonoscopy is recommended until the age of 75.
There are many risk factors that increase the risk of CRC such aging, personal or family history of CRC or advanced polyps, personal history of inflammatory bowel disease, genetics and history of metabolic conditions (diabetes, hypertension, hyperlipidemia, obesity). Other factors include diets that are high in fat, processed red and charred meats or diets low in fiber, fruits and vegetables. People who smoke tobacco and consume alcohol chronically are also at an increased risk.
A colonoscopy is the gold standard and diagnostic choice for CRC screening. There are alternatives to colonoscopy in detecting CRC such as Cologuard, FIT or imagining studies such as virtual colonoscopy. However, there are disadvantages such as higher false positive or false negative rates with the stool tests and virtual colonoscopy is not a great tool for smaller lesions greater than 1 cm which can be pre-cancerous. A colonoscopy is the only test out of the above where a biopsy can be taken for any abnormal tissue and polyps can be removed at time of procedure. An average risk patient can go 10 years between screenings with no abnormal findings unless symptoms occur. Other alternatives to a colonoscopy require more frequent screenings. If any of the alternative tests are positive, you must have a colonoscopy to exclude CRC.
Although screening for colon cancer starts at age 45 for average risk patients, there are special scenarios where the age is sooner. For example, in patients who have a first degree relative with colorectal cancer, (age 40 or 10 years younger than the age of the relative diagnosed with CRC) or if there are any of the following signs: rectal bleeding, changes in bowel habits, unintentional weight loss, abdominal pain, or unexplained iron deficiency.
Regardless of the option used for CRC screening, it is imperative that all patients be screened for colon cancer due to the increasing incidence and mortality rates. There are ways to reduce your risk of developing colorectal cancer such as regular screenings, maintaining a healthy diet, exercising, quitting smoking and more. To learn more about being proactive in your health, visit American Cancer Society (
www.cancer.org).