March is Colorectal Cancer Awareness Month
If you see someone wearing a blue ribbon in March, it may be because the month and March 4 in particular is designated as Dress in Blue Day for Colorectal Cancer Awareness Month. The colon and rectum are the last portion of the intestines. Cancer of the colon is the 3rd most common cancer in the U.S, and is the 2nd leading cause of cancer death in the U.S. As with most cancers, there are many factors that can affect our risks. Thankfully, with early screening, colorectal cancer is one that can be more easily detected and treated.
Unfortunately, in the early days of the pandemic in 2020, screening decreased by 90% and diagnosis rates decreased by 32%, putting many at risk for a delayed diagnosis. It is estimated that 151,030 will be diagnosed and 52,580 deaths will be attributed to colorectal cancer in 2022. Even prior to that, rates had been increasing in those under age 50, although the median age of diagnosis for men is 66 and for women, 69. African Americans have the highest rates of incidence and mortality, and the total lifetime risk for Americans of developing colorectal cancer is 4% with a lifetime risk of dying of the disease is 1.7%.
Symptoms of colorectal cancer can include: blood in stools, change in consistency or shape of bowel movements, persistent abdominal pain and/or vomiting, unexplained weight loss and fatigue. Of course, even without symptoms, everyone should be screened starting at age 50 or sooner based on risk factors and recently updated recommendations from some organizations. The options for screening include some that visualize the colon and some that test the stool for blood or other markers.
Of those tests, the colonoscopy is the gold standard, and if normal, patients would not need further screening for 10 years. The colonoscopy consists of a camera being inserted through the rectum and advanced to visualize the entire colon. It can detect cancer and pre-cancerous polyps which can be removed during the procedure. If there are polyps removed, particularly adenomas which are pre-cancerous, the individual will need another colonoscopy sooner than 10 years. If another test is used, the screening interval is less and varies by type of test. The tests that detect blood in the stools should be done annually, and a newer test that detects DNA markers in the stool called Cologuard should be done every 3 years. Other options that are not as widely used include virtual colonoscopy which is expensive and not widely available. Barium enema and flexible sigmoidoscopy are other options, but do not give the ability to evaluate the entire colon and if done, should be repeated every 5 years. Of course, with any test other than colonoscopy, an abnormal result should prompt a colonoscopy.
Factors which increase an individual’s risk for colorectal cancer include: inflammatory bowel disease like Crohn’s disease or ulcerative colitis; a personal or family history of cancer or polyps, particularly adenomas; certain genetic syndromes; and as with many cancers there are many lifestyle issues which may contribute. Things which increase risk include lack of exercise, low intake of fruits, vegetables and whole grains, high intake of red meats and processed foods, being overweight, excess alcohol use, and smoking.
Please discuss your particular risk factors and screening recommendations with your physician or other provider.
Bridget Dewey, MD
Gateway Family Health Clinic