If you could actually PREVENT cancer, wouldn’t you do so?
Colorectal cancer is the only cancer that people can actually PREVENT, in many cases, with a screening test. In fact it’s estimated that as many as six out of ten deaths from colorectal cancer would be prevented if people would just have screenings as recommended. And, it’s a fairly common cancer in that about one out of every 15 people, or about 6% of the population, will get colorectal cancer.
Reducing the number of deaths from colorectal cancer depends on detecting and removing polyps, as well as in detecting and treating cancer found in its earliest stages. Here are some compelling facts:
- Colorectal cancer can be prevented by removing precancerous polyps (abnormal growths), which can be present in the colon for as many as 10 years before invasive cancer develops
- When polyps first become cancerous, there are few – if any – early warning signs until it is almost too late
- When colorectal cancer is found early and treated, the five-year relative survival rate is 90%
- Screening rates are too low. Less than 40% of colorectal cancers are found early, according to the Centers for Disease Control and Prevention
- One U.S. clinical trial reported a 33% reduction in colorectal cancer deaths and a 20% reduction in colorectal cancer incidence among people offered an annual fecal occult blood test (FOBT)
- Taking an at-home (or doctor’s office) fecal occult blood test is good to do once a year, but it’s not enough. Only a colonoscopy allows physicians to find and remove polyps before they can become cancer. To learn more about scheduling a colonoscopy at our hospital call 256.301.3431 or for click here for our physician directory.
When should you be screened for colorectal cancer?
For people at average risk:
The American Cancer Society believes that preventing colorectal cancer (and not just finding it early) should be a major reason for getting tested. Finding and removing polyps keeps some people from getting colorectal cancer. Tests that have the best chance of finding both polyps and cancer are preferred if these tests are available to you and you are willing to have them.
Beginning at age 50, both men and women at average risk for developing colorectal cancer should use one of the screening tests below:
Tests that find polyps and cancer
- Colonoscopy every ten years
- Flexible sigmoidoscopy every five years*
- Double-contrast barium enema every five years*
- CT colonography (virtual colonoscopy) every five years*
Tests that mainly find cancer
- Fecal occult blood test (FOBT) every year*,**
- Fecal immunochemical test (FIT) every year*,**
- Stool DNA test (sDNA), interval uncertain*
*Colonoscopy should be done if test results are positive.
**For FOBT or FIT used as a screening test, the take-home multiple sample method should be used. An FOBT or FIT done during a digital rectal exam in the doctor’s office is not adequate for screening.
In a digital rectal examination (DRE), a doctor examines your rectum with a lubricated, gloved finger. Although a DRE is often included as part of a routine physical exam, it is not recommended as a stand-alone test for colorectal cancer. This simple test, which is not usually painful, can detect masses in the anal canal or lower rectum. By itself, however, it is not a good test for detecting colorectal cancer due to its limited reach.
Doctors often find a small amount of stool in the rectum when doing a DRE. However, simply checking stool obtained in this fashion for bleeding with an FOBT or FIT is not an acceptable method of screening for colorectal cancer. Research has shown that this type of stool exam will miss more than 90% of colon abnormalities, including most cancers.
People at increased or high risk
If you are at an increased risk or high risk of colorectal cancer, you should begin colorectal cancer screening before age 50 and/or be screened more often. The following conditions place you at higher than average risk:
- A personal history of colorectal cancer or adenomatous polyps
- A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
- A strong family history of colorectal cancer or polyps
- A known family history of a hereditary colorectal cancer syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC)
Based on your situation, your doctor can suggest the best screening option for you, as well as any changes in the schedule based on your individual risk.
Insurance coverage for colorectal cancer screening
Despite the availability of effective colorectal cancer screening tests, not enough people have them. Some factors affecting their use could include lack of public and health professional awareness of screening tools, financial barriers, and inadequate health insurance coverage and/or benefits.
Laws regarding insurance coverage for colorectal cancer screening tests vary by state. The same is true of state Medicaid programs. For people with Medicare, coverage begins at age 50 for the most common colorectal cancer screening tests. Although private insurance coverage can vary, many insurance companies follow Medicare payment rules for screening. For more information on insurance coverage or the cost of a colonoscopy, feel free to contact our business office.
Risk factors for colorectal cancer
A risk factor is anything that affects your chance of getting a disease. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for cancers of the lungs, larynx (voice box), mouth, throat, esophagus, kidneys, bladder, colon, and several other organs.
But risk factors don’t tell us everything. Having a risk factor, or even several risk factors, does not mean that you will get the disease. And some people who get the disease may not have any known risk factors. Even if a person with colorectal cancer has a risk factor, it is often very hard to know how much that risk factor may have contributed to the cancer.
Researchers have found several risk factors that may increase a person’s chance of developing colorectal polyps or colorectal cancer. Here’s an overview from the American Cancer Society.
Risk factors you cannot change
Younger adults can develop colorectal cancer, but the chances increase markedly after age 50. More than nine out of ten people diagnosed with colorectal cancer are older than 50.
Personal history of colorectal polyps or colorectal cancer
If you have a history of adenomatous polyps (adenomas), you are at increased risk of developing colorectal cancer. This is especially true if the polyps are large or if there are many of them. If you have had colorectal cancer, even though it has been completely removed, you are more likely to develop new cancers in other areas of the colon and rectum. The chances of this happening are greater if you had your first colorectal cancer when you were younger.
Personal history of inflammatory bowel disease
Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, is a condition in which the colon is inflamed over a long period of time. People who have had IBD for many years often develop dysplasia. Dysplasia is a term used to describe cells in the lining of the colon or rectum that look abnormal (but not like true cancer cells) when seen under a microscope. These cells can change into cancer over time. If you have IBD, your risk of developing colorectal cancer is increased, and you may need to be screened for colorectal cancer more frequently.
Inflammatory bowel disease is different from irritable bowel syndrome (IBS), which does not carry an increased risk for colorectal cancer.
Family history of colorectal cancer
Most colorectal cancers occur in people without a family history of colorectal cancer. Still, as many as one in five people who develop colorectal cancer have other family members who have been affected by this disease.
Those with a history of colorectal cancer or adenomatous polyps in one or more first-degree relatives (parents, siblings, or children) are at increased risk. The risk is about doubled in those with a single affected first-degree relative. It is even higher if the first-degree relative is diagnosed at a young age, or if more than one first-degree relative is affected.
The reasons for the increased risk are not clear in all cases. Cancers can “run in the family” because of inherited genes, shared environmental factors, or some combination of these.
People with a family history of adenomatous polyps or colorectal cancer should talk with their doctor about screening before age 50. If you have had adenomatous polyps or colorectal cancer, it’s important to tell your close relatives so that they can pass along that information to their doctors and start screening at the right age.
About 5% to 10% of people who develop colorectal cancer have inherited gene defects (mutations) that cause the disease. Often, these defects lead to cancer that occurs at a younger age than is common. Identifying families with these inherited syndromes is important because it allows doctors to recommend specific steps, such as screening and other preventive measures, at an early age.
Several types of cancer can be linked with these syndromes, so it’s important to check your family medical history not just for colon cancer and polyps, but also for any other type of cancer. While cancer in close (first-degree) relatives is most concerning, any history of cancer in more distant relatives is also important. This includes aunts, uncles, grandparents, nieces, nephews, and cousins. People with a family history of cancer or colorectal polyps should discuss this history with their doctor. They may benefit from genetic counseling to review their family medical tree to see how likely it is that they have a family cancer syndrome and a discussion about whether or not gene testing is right for them. People who have an abnormal gene can take steps to prevent colon cancer, such as getting screened and treated at an early age.
The two most common inherited syndromes linked with colorectal cancers are familial adenomatous polyposis (FAP) and hereditary non-polyposis colorectal cancer (HNPCC). To read more about these syndromes as well as other inherited conditions that increase the risk of colorectal cancer, visit the American Cancer Society’s website at this link.
Racial and ethnic background
African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. The reasons for this are not yet understood.
Jews of Eastern European descent (Ashkenazi Jews) have one of the highest colorectal cancer risks of any ethnic group in the world. Several gene mutations leading to an increased risk of colorectal cancer have been found in this group. The most common of these DNA changes, called the I1307K APC mutation, is present in about 6% of American Jews.
Risk Factors You Can Change (or Lifestyle-related factors)
Several lifestyle-related factors have been linked to colorectal cancer. In fact, the links between diet, weight, and exercise and colorectal cancer risk are some of the strongest for any type of cancer.
Certain types of diets
A diet that is high in red meats (beef, pork, lamb) and processed meats (hot dogs and some luncheon meats) can increase colorectal cancer risk. Cooking meat at very high temperatures (frying, broiling, or grilling) creates chemicals that might increase cancer risk, although it’s not clear how much this might contribute to an increase in colorectal cancer risk. Diets high in vegetables and fruits have been linked with a decreased risk of colorectal cancer, but diets high in fiber do not seem to help. Whether other dietary components (like certain types of fats) affect colorectal cancer risk is not clear.
If you are not physically active, you have a greater chance of developing colorectal cancer. Increasing activity may help reduce your risk.
If you are very overweight, your risk of developing and dying from colorectal cancer is increased. Obesity raises the risk of colon cancer in both men and women, but the link seems to be stronger in men.
Long-term smokers are more likely than non-smokers to develop and die from colorectal cancer. Smoking is a well-known cause of lung cancer, but some of the cancer-causing substances are swallowed and can cause digestive system cancers, such as colorectal cancer.
Heavy alcohol use
Colorectal cancer has been linked to the heavy use of alcohol. At least some of this may be due to the fact that heavy alcohol users tend to have low levels of folic acid in the body. Still, it would be wise to limit alcohol use to no more than two drinks a day for men and one drink a day for women.
Type 2 diabetes
People with type 2 (usually non-insulin dependent) diabetes have an increased risk of developing colorectal cancer. Both type 2 diabetes and colorectal cancer share some of the same risk factors (such as excess weight). But even after taking these into account, people with type 2 diabetes still have an increased risk. They also tend to have a less favorable prognosis (outlook) after diagnosis.