Updated March 14, 2022.
Clinical Editor: Megan Dodson, PA-C
Colorectal cancer, cancer affecting the colon or rectum, is the third leading cause of cancer-related death in the United States, responsible for over 52,000 deaths in 2018 alone, many of which may have been prevented by routine screenings. Despite the severity of the disease however, routine preventive screenings for colorectal cancer have decreased dramatically during COVID-19. A study by Epic Health, for instance, found that colorectal cancer screenings dropped by 86 percent at the beginning of the pandemic, and remained 3.4 percent below pre-pandemic baseline two years later. Having an understanding of your risk level and a relationship with your primary care provider can help to make sure you are taking advantage of the screening options that are recommended for you. Below is a guide on how you can work with your primary care provider to determine the right time to start screening.
What are the signs of colorectal cancer?
One of the reasons why colorectal cancer is so fatal is because you could have no symptoms at all, which is why regular screening is pivotal in identifying colorectal cancer and preventing things from getting worse. That being said, if symptoms do present themselves, there are some key signs to be on the lookout for.
The hallmark signs of colorectal cancer are blood in your stool (which can be bright red or black) and/or changes in the size and shape of your stool. You can also experience abdominal pain, unexplained weight loss and changes in bowel movements.
If you have any of these symptoms, don’t panic! There are several other conditions that could cause similar symptoms, such as hemorrhoids, tears around your rectum after a hard bowel movement, and diverticulitis. On top of that, if you are younger than 40 and have no family history of colorectal cancer at a young age, your chances of colorectal cancer are quite low. If you are having symptoms, though, it is important to not ignore them and check in with your primary care provider to see what is going on.
Who is at higher risk?
Recent headlines have been highlighting the growing body of research showing an increased number of colorectal cancer cases among younger individuals (40s and early 50s), but the majority of cases typically occur among men and women in their 60s and 70s. Older age is a major risk factor for colorectal cancer, but there are other risk factors that may increase your chances of developing colorectal cancer.
- Family history
- Anyone with a first-degree relative (parents or siblings) diagnosed with colorectal cancer or certain kinds of polyps.
- Anyone with a family history of colorectal cancer in a first-degree relative younger than 50, or more than one first-degree relatives at any age are at significantly higher risk. This may affect the timing or frequency of recommended screenings for you.
- Race: Case rates and deaths from colorectal cancer impact communities of color differently, but more research is needed in identifying the underlying cause of these health disparities. For example, colorectal cancer disproportionately impacts the black community, with African Americans having both higher case rates and deaths compared to white communities. The cause of this is multifactorial, but this health disparity is one that needs to be considered in improving the detection and treatment of colorectal cancer in the black community.
- Nutrition: Diets high in red meat and processed meat have been found to be associated with higher rates of cancer.
- Obesity: Individuals who are overweight or obese are at higher risk of developing colorectal cancer
- Smoking: Tobacco smokers are more likely to develop and die from colorectal cancer than non-smokers
- Inflammatory bowel disease (IBD): Not to be confused with Irritable Bowel Syndrome (IBS), IBD can lead to chronic inflammation of the large intestine, which in turn increases the risk of colorectal cancer
- Type 2 Diabetes: People with type 2 diabetes have an increased risk of colon cancer.
When should I start screening?
At One Medical, we believe the decision to start screening for colorectal cancer should be tailored to you and your specific health needs. We encourage you to have a discussion with your primary care provider about when to start screening for colorectal cancer at age 45. If you have a family history of colon cancer or other risk factors for it, we recommend having this conversation even earlier.
The decision to screen for colorectal cancer in adults between the ages of 76 -85 should be an individual one, as the benefits of screening can be much smaller after 75 depending on an individual's current health and life expectancy. The decision to be screened should be based on a person’s overall health and prior screening history to determine whether the benefits outweigh the potential harm from invasive testing and follow up procedures. We are here to help guide you in your health and find the path that makes sense for you.
How do I screen?
There are several options for colon cancer screening, including a colonoscopy at least once every ten years or a stool test kit (also known as a FIT ) every year that can be done from the comfort and privacy of your own home. A FIT looks for tiny amounts of blood in your stool and may require follow-up testing if found. Colonoscopies are an invasive procedure where you will need to be referred to a gastroenterologist to perform the procedure. FIT tests on the other hand can be ordered by your primary care provider and picked up at any One Medical lab on the same day.
At One Medical, we recommend screening average risk individuals with a FIT test due to its convenience and accessibility at many of our offices, but a colonoscopy is an excellent choice as well. There are several other screening methods that may be better suited for you, such as FIT-DNA test (aka Cologuard) and sigmoidoscopies. Your primary care provider can help you determine the best colon cancer screening method for you based on your personal and family history.
The thought of colon cancer can be scary, but you are not alone. Your primary care provider is there to answer any questions you may have. At One Medical, we will work with you to find the best screening timeline and method based on your unique health needs and goals. Schedule a Live Well visit today to talk more about colon cancer screening and other health screening that will keep you happy and healthy for years to come.
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