“It’s time for your colon cancer screening …” Let the sighs begin…many dread hearing their healthcare provider mention the BIG word…colonoscopy. However, whether you dread it or not, this can save your life.
What and when are colorectal screenings recommended? According to the 2018 American Cancer Society Guideline for Colorectal Cancer Screening, it is recommended that those at ‘average risk’ for colon cancer begin screening at the age of 45. This age has changed within the last year where it used to be 50. Unfortunately, we are beginning to see colon cancer developing earlier on in age. Otherwise, those in ‘good’ health and with a life expectancy of more than 10 years, should have their colorectal screening performed until the age of 75. There are exceptions to continuing colorectal screening. For instance, for ages 76 through 85, life expectancy, overall health, person’s preferences, and prior screening history, colorectal screening may be continued. Colorectal screening is no longer recommended for those over the age of 85.
For those who are at a ‘higher risk’ for colorectal cancer, screening is recommended to occur earlier than the age of 45. For instance, if you have a family history of colorectal cancer or polyps, an inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis), confirmed hereditary colorectal cancer syndrome, or have a history of abdominal radiation or pelvic radiation (to treat a prior cancer), you are considered to be at a ‘higher risk’ for colon cancer. For those who have tested positive for hereditary colorectal cancer, it is recommended that you begin colon cancer screening beginning at age 20-25 years, or 10 years earlier than the youngest age of colorectal cancer diagnosis in the family, whichever comes first; the 10-year earlier mark also includes those with a first-second degree relative who has had colorectal cancer.
There are several testing options for colorectal cancer screening—a colonoscopy being the most sensitive to detect colorectal cancer. We recommend a fecal occult blood test yearly where we can detect blood in your stool which could be a sign to colorectal cancer. Another test that has become more popular over the years is a multi-targeted stool DNA test to detect colon cellular changes that could be consistent with colorectal cancer—AKA, Cologuard (the little blue/white box that you may see advertised on television). This testing is recommended every three years. As already mentioned, the most sensitive test for colon cancer is a colonoscopy. Colonoscopies are performed by those certified in endoscopy services such as a primary care provide, and of course, a gastroenterologist. Depending on the results of the colonoscopy, with biopsy of colon tissue, most are recommended every 10 years until the age of 75. However, a recommendation may be made for a patient to return earlier such as five years to repeat the colonoscopy. A CT colonography (virtual colonoscopy) can be performed every five years which can detect polyps, or colorectal cancer. Lastly, a flexible sigmoidoscopy is recommended every five years if indicated which looks primarily at the lower portion of the colon.
What do you need to be aware of? Many are unsure if lower stomach issues are consistent with something serious, or not. According to the 2018 American Cancer Society Guideline for Colorectal Cancer Screening, it is important to be aware of the following signs, or symptoms, that could be related to colorectal cancer. If any of these signs, or symptoms, occur, speak with your healthcare provider as soon as possible for proper assessment and recommended screening: change in bowel patterns (pencil-shaped stools, stool consistency changes, etc.), new onset of constipation, or diarrhea, abdominal pain/discomfort that persists for more than two weeks, dark colored stools/bright blood noted in stool, or after a bowel movement, persistent nausea, new onset of fatigue, etc. Please do not hesitate to speak with your healthcare provider related to these possible signs, or symptoms, of colon cancer that may occur.
As a provider, I can’t begin to express the importance of having proper colon cancer screening performed. Personally, I have a significant family history of colorectal cancer and polyps placing me as a “high risk” person for colorectal cancer. Even as a young adult, aside from issues I myself was suffering from, I have already had my first colonoscopy.
What are you afraid of? I have spoken with many patients who are worried to be “put to sleep” for this type of procedure. This procedure generally does not last longer than five to ten minutes. If you cannot tolerate full sedation, twilight sedation may be given to make you unaware of what is taking place without you being completely asleep. You are being carefully monitored by trained healthcare professionals to ensure no issue arise during the procedure. The prep for the colonoscopy…another dreaded statement by many. The prep is straight forward and not a challenge… personally, I found the biggest challenge to being on a liquid diet for 24 hours prior to the procedure. That’s a challenge for someone who enjoys eating, can I get an amen? However, this 24-hour period is necessary and worth it by knowing “what is going on down there.”
What are ways to promote a healthy colon? The American Cancer Society reports that the links between diet, weight, exercise, and colorectal cancer risk are some of the strongest for any type of cancer. In fact, an estimated 50-75% of colorectal cancer can be prevented through lifestyle changes like healthy eating, according to the Colon Cancer Foundation. According to Rush University Medical Center, there are five suggestions on helping prevent colon cancer.
· Limit red meat consumption and steer clear of processed meats as much as possible
· Hold the excess sugar
· Up your fiber intake
· Drink your milk
· Choose grains wisely
In addition, the American Cancer Society recommends the following:
· Lose Weight: Being overweight, or obese, most definitely increases the risk of colorectal cancer in both men and women. Having more belly fat has also been linked to colorectal cancer. Staying at a healthy weight and avoiding excess weight gain around the midsection may help lower your risk.
· Increase Physical Activity: Increasing your level of activity can help lower your risk of colorectal cancer and polyps. Regular moderate activity (doing things that make you breathe as hard as you would during a brisk walk) lowers the risk. However, vigorous activity might have an even greater benefit. Increasing the intensity and amount of your physical activity may help reduce your risk. Speak with your healthcare professional prior to beginning a higher intensity activity/exercise regimen.
· Improve Diet: Overall, a diet that is high in vegetables, fruits, and whole grains (and low in red and processed meats as discussed) have been linked with lower colorectal cancer risk. Many studies have found a link between excess consumption of red meats (beef, pork, and lamb), or processed meats (such as hot dogs, sausage, and lunch meats), and an increased colorectal cancer risk. Limiting red and processed meats and eating more vegetables and fruits may help lower your risk.
· Decrease Alcohol Consumption: Several studies have found a higher risk of colorectal cancer with increased alcohol intake, more commonly among men. Avoiding excess alcohol may help reduce your risk.
If you have any questions, or concerns, about colorectal cancer screening, the above recommendations, or signs/symptoms of colorectal cancer, please do not hesitate to speak with your healthcare provider. It is our goal as healthcare providers to take the absolute best care of our patients and make sure you are getting the proper screening and treatment necessary to ensure your health as a whole.