Fans and colleagues were stunned last summer when actor Chadwick Boseman died from colon cancer at age 43. For many, what was particularly shocking was his youth, considering most adults don’t even begin screening prior to age 50.
Like many gastroenterologists, I have observed an increase in colorectal cancer diagnoses among young people. I recently cared for one patient who was 27 at diagnosis and another who was only 34. Neither had a family history of the disease.
While it is extremely unusual for colorectal cancer to be diagnosed before age 40, these cases emphasize the importance of careful preventive care—including screening for colorectal cancer for on a regular basis—especially after age 45. These cases also illustrate why, even amid the COVID-19 pandemic, I encourage patients to make sure they remain up to date with colorectal cancer screening.
Since March is designated Colorectal Cancer Awareness Month, it’s the perfect time to learn about the importance of screening, our most effective tool to prevent colorectal cancer.
Understanding Colorectal Cancer
Colorectal cancer is the third leading cause of cancer deaths in the United States, behind lung cancer and breast cancer for women and prostate cancer for men. According to data from the American Cancer Society, the lifetime risk of developing colorectal cancer is approximately 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women. Estimates show there will be approximately 150,000 new cases of colorectal cancer in 2021.
Colorectal cancer is cancer of the large intestine or rectum. Most cancers begin as polyps, which are small growths inside the colon. Colorectal cancer usually grows slowly, meaning it may take years for a polyp to progress from being benign to malignant.
The causes of colorectal cancer are incompletely understood, but we do know that family history, underlying colon disease, obesity, smoking and unhealthy diets (which are low in fiber and high in fat) are associated with increased risk of colorectal cancer.
Colorectal cancer is usually more prevalent among people ages 50 and older, but we are seeing a rise in cases in younger people. As was made evident with Boseman’s death, there is growing recognition that colorectal cancer doesn’t exclusively impact older people—and that recognition is leading to changes in screening recommendations.
Screening Recommendations for Colorectal Cancer
In 2018, the American Cancer Society revised its recommendation that colorectal cancer screening for average-risk adults begin at 45 rather than 50. An average-risk adult is defined as someone who does not have a personal or family history of colorectal cancer, nor a personal history of inflammatory bowel disease nor polyps.
The U.S. Preventive Services Task Force is also drafting a recommendation for colorectal cancer screening to begin at 45, citing data that 10.5% of new colorectal cancer cases occur in people younger than 50.
Based on recommendations from the American College of Gastroenterology, screening at 45 has previously been advised for African-Americans because that population tends to present with colorectal cancer at younger ages and at more advanced stages.
Screening for colorectal cancer increases the likelihood of catching the cancer before it spreads to other parts of the body, which improves survival rates. The five-year survival rate for colorectal cancer is 90% if detected and treated before it has spread to other parts of the body. The rate drops to 14% if the cancer has spread at the time of diagnosis.
My team at the Mid-Atlantic Permanente Medical Group is proud that our patients have lower colorectal cancer mortality rates compared to national benchmarks. Those improved outcomes may be attributed to regular and consistent screening. Colorectal cancer screening rates for Kaiser Permanente members approaches 80% of our patients, much higher than national screening averages.
How to Get Checked
The two most common methods of colorectal cancer screening are stool-based testing and colonoscopy.
One easy way to screen for colorectal cancer is with a fecal immunochemical test, often referred to as FIT. This is a noninvasive way to check for colorectal cancer. From the comfort of home, the patient collects a stool sample with a swab and places the swab in a tube. The patient then mails the tube back to the lab in an envelope, where it is studied for signs of blood. If such signs are detected, the patient will need to undergo colonoscopy.
The fecal immunochemical test is completely risk-free, and is a great way to for patients to be screened during the COVID-19 pandemic, when access to medical centers may be limited or riskier for certain individuals. Whereas many cancer screening tests must be completed in a doctor’s office—such as a pap test for cervical cancer screening or a mammogram for breast cancer screening—the FIT is an easy way to be screened without a visit to a medical center. FIT is a convenient option for most patients at average risk for colorectal cancer, and should be performed annually.
Colonoscopy is another screening option. These tests are performed by gastroenterologists, and rely on a thin, lighted tube called a colonoscope to look for colon polyps. The gastroenterologist can remove any polyps identified, which can then be examined for cancer or precancerous changes.
Colonoscopies are performed at a medical facility and, though relatively rare, risks may include bleeding and bowel injury. The procedure takes about 20 minutes, in addition to recovery time. Preparation typically starts 1-2 days prior to the procedure, including a colon cleanse the day before the colonoscopy, and, in some cases, COVID testing prior to procedure.
During the cleanse, patients must follow a clear liquid diet and drink a liquid laxative prep. These steps clear out the colon so the gastroenterologist may carefully examine its lining. Once the preparation process is complete, the patient will receive sedation to undergo the procedure. The colonoscopy typically requires a day off work, and the availability of an adult to drive the patient home after the procedure.
In most cases, colonoscopies are recommended every 10 years, but more frequent testing may be recommended if polyps are found.
An Asymptomatic Disease
Most people with colorectal cancer never have symptoms, which is why regular screening is so important. Those who do have symptoms may experience changes in bowel habits, such as blood in the stool or changes in the size of the stool. Other rare symptoms may include abdominal pain and unexplained weight loss.
It’s very important to note that most people who experience gastrointestinal symptoms don’t have colorectal cancer. Anyone with concerns should talk to their primary-care physicians.
As I constantly remind my patients, the most important thing you can do to prevent colorectal cancer is to get screened appropriately. A great way to recognize Colorectal Cancer Awareness Month is to schedule your screening today!
Dana Sloane, MD, is a board-certified gastroenterologist with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente South Baltimore County Medical Center.