Dr. Brian Clark, Gastroenterologist poses for a photo inside on of the colonoscopy procedure rooms at MelroseWakefield Hospital. Wicked Local Staff Photo / David Sokol
By Brian Clark, MD
March is National Colorectal Cancer Awareness Month. Colon cancer is still the second leading cause of cancer deaths among cancers that affect both men and women, with over 50,000 deaths related to the disease each year in the United States alone. Many of these cases could have been prevented with the help of our most valuable tool in the fight and prevention of colon cancer – colonoscopy. By increasing the number of people who come in for colonoscopies, we can reduce the number of people who die from colon cancer – it’s that simple.
What is colon cancer?
Colorectal or colon cancer refers to the group of cancers that affect the rectum and colon (or large intestine). About one in 20 people will develop colon cancer at some point during their lives, making this one of the most common cancers in the U.S. These diseases usually are caused by the growth of polyps – small masses of cells – in the rectum or colon. Though these growths start as benign (noncancerous), they can develop into cancerous tumors over time.
Who should have a colonoscopy, and when?
Because people age 50 and older make up the vast majority of colon cancer cases, they remain our biggest focus in screening. The Centers for Disease Control guidelines state that ALL people age 50 and older should be screened for colon cancer. But the recent rise in colon cancer cases among younger people is worrisome, and speaks to the importance of earlier colonoscopy screening for those who have a higher risk of developing colon cancer – and knowing what symptoms should send you to the doctor’s office. In fact, the American Cancer Society recently lowered their recommended age to start screening to age 45. By undergoing colonoscopy on time, we have a window of opportunity to catch developing polyps and remove them, which makes colon cancer one of the most preventable types of cancer. Colonoscopy is the most effective form of preventing colon cancer because if we find a polyp during the colonoscopy, we can remove it on the spot.
Colon cancer symptoms and risk factors
Colon cancer usually develops without any symptoms at all, until the disease has progressed to later stages. Even then, the symptoms of colon cancer can be vague and similar to symptoms of common gastrointestinal issues such as hemorrhoids, ulcers, or colitis (inflamed colon).
That said, colon cancer symptoms can include:
• Abdominal pain
• Bleeding from the rectum
• Changes in bowel habits (constipation, diarrhea or thinner stool)
• Decreased appetite
• Persistent tiredness or fatigue
• Unexplained weight loss
If you notice these symptoms, visit your doctor to see if you need a colon evaluation. It’s especially important to be aware of colon cancer symptoms if you know you’re at high risk for the disease. Several factors can raise your risk, including:
- Alcohol: Heavy alcohol use – more than two drinks per day for men and more than one for women.
- Diet: Those who eat a lot of red meat and processed meat have higher risk, especially if they eat few vegetables, fruits, and whole grain fibers.
- Family history: People with an immediate family member who has had colon cancer or polyps are two to three times more likely to develop it themselves.
- Inflammatory bowel disease: Patients with ulcerative colitis or Crohn’s disease should be followed by a gastroenterologist given their increased risk.
- Obesity: People who are obese are about 30 percent more likely to develop colon cancer than those who aren’t obese.
- Race: According to the American College of Gastroenterology (ACG) African Americans should begin screening at age 45 given their increased risk of early colon cancer.
- Tobacco: Smokers are at risk for many cancers, including colon cancer.
Younger people are now more at risk for colon cancer
In an alarming trend, millennials are now about twice as likely to develop colon cancer and four times as likely to develop rectal cancer compared to people born in 1950. From the mid-1980s through 2013 colon cancer rates found in those ages 20-29 rose up to 2.4 percent per year.
This trend has raised a lot of questions about who should be screened for colorectal cancer and when. The number of people younger than 50 who develop these cancers is still relatively low compared to those older than 50, who make up 90 percent of new colon cancer cases. However, the American Cancer Society now advises ALL adults to undergo screening for colon cancer beginning at age 45.
It’s not yet clear why more people younger than 50 are getting colon cancer. That makes prevention and early screening all the more important.
Avoiding colon cancer
Maintaining a healthy lifestyle will reduce your risk for colon cancer. That includes avoiding tobacco, keeping a healthy weight, being physically active, and eating a high fiber diet while avoiding too many red or processed meats. However the most effective prevention remains undergoing age-appropriate cancer screening!
Other than keeping those healthy habits, here are my takeaway recommendations:
- If you’re 45 or older: Schedule a colonoscopy or talk to your doctor about what screening test is right for you.
- If you’re younger than 45, but have any risk factors for colon cancer: Talk with your doctor or see a specialist (gastroenterologist) to discuss when you should start screening.
- If you have any concerning symptoms: Don’t wait to see your doctor or a gastroenterologist. Even younger adults can get colon cancer!
Brian Clark, MD, is a board-certified gastroenterologist at Tufts Medical Center Community Care in Stoneham He earned his medical degree from Boston University and completed his residency and post-doctoral fellowship in digestive diseases at Yale University. Dr. Clark is medical director of endoscopy and sees patients at MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford and at his office in Stoneham. To schedule a colonoscopy or learn more about colon cancer screening, please call 781-213-5212.