COLORECTAL CANCER – A CASE TO BE MADE FOR SCREENING AND COLONOSCOPY.
Written By: Chukwunonso Chime, MD Gastroenterologist
It is another year, another month of March and another National Colon Cancer Awareness Month, the month to draw attention to colorectal cancer and its impact on the American society. In the 365 days since my last article on colorectal cancer titled – Forty-five is the new fifty, it is estimated that one Hundred and fifty thousand (150,000) people in the United States would have been diagnosed with colon cancer of which 52,580 of them would have died.
In the United States, colorectal cancer is the third most diagnosed cancer in men and women combined and the second leading cause of cancer death in men and women. 2023 estimates are that there will be 106,970 new cases of colon cancer and 46,050 cases of rectal cancer of which close to a third of these cases, 52,550 are expected to die. This means that the number of deaths last year and this year from colon and rectal cancer remains unchanged and this continues to be a challenge with many factors contributing to this, especially cases where screening or surveillance has been deferred or delayed.
Although the median age of diagnosis for colorectal cancer among US population is about 66 years, the year of onset has gradually trended toward the younger age group. The rates of colorectal cancer appear to be dropping for the older age group and this correlates with screening in this age group, hence why the United States Preventive Services Task Force updated their guidelines in May 2021 to recommend colorectal cancer screening from age 45 years for average risk general population.
When it comes to colon and rectal cancer, by the time a patient has become symptomatic and presenting with blood in stool, weight loss or abdominal pain, in most cases, the colon cancer is already too advanced to make any meaningful changes to the chances of death. Colorectal cancer is staged from 1 to 4 in order of decreasing chance of cure and increased risk of death and chronic debilitating illness. The earlier colorectal cancer is detected, the more the likelihood of cure. According to the Surveillance, Epidemiology, and End Results (SEER) database, between 2011 and 2017, 5-year survival rates for stage 1 or localized colon cancer was 91% compared to 14% for stage 4 or distant spread. The rates were similar for rectal cancer too.
Some would wonder what would put them at risk of having a colon polyp or colorectal cancer and if any of that can be avoided. The two definite risk factors are aging and family history and as these risk factors cannot be modified, each year we age above the age of 45 years, we carry the risk that there could be a polyp growing in the colon that could eventually become cancer. There are modifiable environmental factors at play that have not been proven conclusively but could be contributory including smoking and obesity. Increasing incidence in younger age group could be related to a western diet but no diets have been proven to reduce the risk of colorectal cancer. Aspirin has a promising role for chemoprevention of colorectal cancer but has to be individualized and taken for at least 10 years to be beneficial.
Our community is not spared of this national data, there have been cases of late-stage colorectal cancer diagnosed in patients that did not take the opportunity towards preventing this deadly illness. Fortunately, there are tools that have been developed over time to help with early colorectal cancer detection with the goal of finding these cancers at an early stage when the chance for cure is greatest and these include colonoscopy every 10 years or yearly FIT, the American College of Gastroenterology also suggests consideration for flexible sigmoidoscopy every 5-10 years, multitarget stool DNA test (Cologuard) every 3 years, CT Colonography or Colon Capsule every 5 years.
Of all the methods listed above for colon cancer screening, colonoscopy remains the best tool as it has the advantage of not only detecting early cancer but can also identify polyps that can easily be removed before they have the chance to become cancer and I will talk about it in a little more detail. In a nutshell, colonoscopy is a procedure where a thin camera is passed into the large intestine and advanced to the location of the appendix and during the withdrawal, colon polyps are identified and removed when present. This procedure in the vast majority of cases in our hospital is done with the patient completely sedated, in order words, the patient does not feel any discomfort during the procedure. I must admit that the part most patients are not looking forward to when it comes to colonoscopy is the bowel prep, but I have good news, this has improved over time and majority of our patients would get a mixture of MiraLAX and Gatorade/any other solution of their choice… not alcohol that is. The entire procedure lasts about 20 minutes and complication rates are very low.
In summary, to make a difference in our community and nation at large, we should encourage ourselves, our friends and loved ones to start colon cancer screening, preferably with a colonoscopy at age 45 years and continue for the most part until the age of 75, possibly until 85 years based on health status and prior history of polyps. For those whose parents, siblings or kids had either colorectal cancer or concerning polyps, screening should start at age 40 years or 10 years younger that the age the cancer or polyp was diagnosed.
Please contact Western Wisconsin Health at 715-684-1111 to set up your colorectal screening to determine if you will need a colonoscopy with Dr. Chime or Dr. Dahlberg.
Western Wisconsin Health, Building a healthier tomorrow, together.
- Colorectal cancer alliance
- Centers for Disease Control and Prevention
- SEER database
- American College of Gastroenterology Guidelines
- United States Preventive Services Task Force