Colon Cancer: What you need to know
By Dr. Laura Patwa
27, 38, 42, 47, 50, 56, 62, 67, 74, 85, and 92 are not Lotto numbers. These numbers represent the age some of my patients were when they learned about colorectal cancer. About 150,000 new cases are diagnosed in the United States yearly. It is the 3rd leading cause of cancer behind breast/lung cancers for women and prostate/lung cancers for men. With over 52,000 estimated deaths yearly, it is the 2nd leading cause of cancer deaths behind lung cancer.
When found early, the 5-year survival rate is about 90% — but unfortunately, only 4 out of 10 cases are found early. Once spread outside the colon or rectum, survival drops to 70% in 5 years (when spread to lymph nodes) and just 14% (when it reaches distant sites like the liver and lung).
Colonoscopy screening can detect a polyp -an abnormal growth of tissue- at an early stage before it becomes cancer. The rate of people who get screened is currently only around 67%, meaning 1 in 3 people who qualify will never undergo it.
In May 2021, the United States Preventive Services Task Force (USPSTF) updated the colorectal cancer screening recommendations for those of any race who are at average risk to begin at age 45. First-line testing options include a colonoscopy and Fecal Immunochemical Testing (FIT). Second-line testing consists of a multi-targeted stool DNA test (such as Cologuard or virtual colonography). While there are differences between each, the most important thing is to get screened. If a test (other than a colonoscopy) is abnormal, a colonoscopy should then be done to investigate further.
It is also important to know that colonoscopy is the only test recommended for patients:
- Who have symptoms (including but not limited to rectal bleeding, abdominal pain, or a change in bowel habits),
- Who are considered high-risk due to a personal history of colorectal cancer or polyps,
- Who have been diagnosed with inflammatory bowel disease (such as ulcerative colitis or Crohn’s),
- With hereditary colorectal cancer syndrome,
- With a family history of colorectal cancer,
- Who have had abdominal/pelvic radiation to treat another cancer.
Racial and ethnic disparities in screening are particularly striking for colorectal cancer and account for 19% of the discrepancy between death rates for black and white patients. There are a daunting number of contributors to this; studies largely found that a lack of knowledge of risk (unknown family history), low perception of benefits, perceived invasiveness of colonoscopy, fear of pain, financial concerns, or lack of insurance/access to care, not receiving a recommendation to undergo screening from a healthcare provider, and a general distrust in the healthcare system are all significant deterrents. Additionally, as a Gastroenterologist, patients share concerns with me, such as a fear of anesthesia or procedure complications, the bowel preparation, or “that is an exit only…,” “I am healthy/have no symptoms; therefore I do not need this…,” among many others.
27, 38, 42, 47, 50, 56, 62, 67, 74, 85, and 92 are real patients who are mothers, fathers, grandparents, aunts, uncles, brothers, or sisters to someone. With a cancer diagnosis, life is suddenly shattered, and uncertainty and fear permeate. BUT… colorectal cancer is preventable!
As someone who does this every day, what I wish I could tell everyone is:
1. 45 is the age that EVERYONE of average risk should get screened (regardless of the type of testing).
2. Understand your family history.
3. Advocate for yourself, and discuss unusual symptoms and barriers to testing with your healthcare provider to personalize the proper test for you and overcome those barriers.
4. If you don’t feel heard, find another provider to advocate for your healthcare.
