March is National Colorectal Cancer (CRC) Awareness month. CRC is the third most common cancer diagnosis and the second most common cause of cancer-related death in the U.S. But good news, the 5-year survival rate for CRC is 90% if the disease is diagnosed at an early-stage! The best way to do that is through colorectal cancer screening.
Unfortunately, cancer screenings in general have seen a huge backlog due to the COVID-19 pandemic. Colorectal cancer screening rates in particular have dropped because people are wary about going in-person to a clinic to get a colonoscopy done. While colonoscopy remains the gold standard for colorectal cancer screening in the U.S., convenient at-home screening tools (stool-based testing) are available for those at an ‘average-risk’ (see below).
Why Is On-Time Screening Important?
The National Colorectal Cancer Roundtable (NCCRT) has set a target of 80% CRC screening rates across the nation. While met by certain communities, many lag behind; especially rural, low-income, and certain racial and ethnic communities. COVID-19 has complicated the situation and made it worse. An evaluation of health records from 60 health care organizations between mid-March and mid-June of 2020 identified a 64% drop in colorectal cancer screening.
The Impact of Delay
Individuals might delay getting their screening colonoscopy by 6 or 12 months. If they have undiagnosed cancer, it has more time to advance to a late stage. Late-stage CRC is much harder to treat. The National Cancer Institute has projected 4,500 additional deaths over the next ten years from CRC as a result of pandemic-related delayed diagnoses.
The National Cancer Institute @theNCI has projected 4,500 additional deaths over the next ten years from #ColorectalCancer as a result of pandemic-related delayed-diagnoses. Click To TweetLet’s Learn Some Basics
Signs and Symptoms
One or more of these symptoms could indicate CRC:
- Changes in your bowel movement
- Rectal bleeding
- Blood in stool
- Cramping/belly pain
- Fatigue
- Unintended weight loss
CRC Risk Factors
There are modifiable and unmodifiable risk factors for CRC.
Modifiable risk factors are within your control and include:
- Obesity or being overweight
- Lack of exercise or physical activity
- Diets rich in red and processed meats
- Eating meat cooked at very high temperature (frying, broiling, or grilling)
- Limited intake of fruits, vegetables, and whole grains
- Smoking
- Excess consumption of alcohol
Unmodifiable risk factors are ones you cannot change. They include:
- Older age: while it’s more common after 50 years, CRC rates (particularly rectal cancer) have been increasing in younger populations
- Personal history of colorectal polyps (growths in the inner lining of the colon or rectum), colorectal cancer, or inflammatory bowel disease: this puts you at a high-risk, meaning you should start screening at an earlier age.
- A family history of colorectal polyps or cancer: having a first-degree relative (parent, sibling, or child) with a history of CRC greatly increases your risk for the disease. The risk is even greater if the relative was diagnosed before he or she turned 50 years. This puts you at a high-risk, meaning you should start screening at an earlier age.
- Having an inherited syndrome such as Lynch syndrome and familial adenomatous polyposis (FAP)
- Ethnic background: African Americans and Ashkenazi Jewish ancestry
Speak to your doctor to understand your risk for developing CRC!
Understanding Family Health History
As mentioned under risk factors, having a first-degree relative with CRC increases your risk of the disease, especially if they were diagnosed before 50. Having multiple members in the family with CRC means your doctor may have to be more vigilant with managing your health. Make sure you discuss this with your physician. The Centers for Disease Control and Prevention provides detailed guidance on how to collect your family health history. The Surgeon General’s Family Health History tool can also help.
What’s the Right Age to Start Screening?
- U.S. Preventive Services Task Force currently recommends 50 years for average-risk adults
- However, this could soon change to 45 years
- American Cancer Society recommends 45 years for average-risk adults and earlier for high-risk adults
- For high-risk adults, the U.S. Multi-Society Task Force for Colorectal Cancer recommends screening should start at 40 years or 10 years before the age when the youngest relative was diagnosed with CRC, whichever is earlier
- So, if a close relative was diagnosed at 45 years, your screening should start at 35 years
Which Screening Option Is Right for Me?
Stool-based and visual tests are the two options. You can read the details on these testing options here.
Stool-based tests: These require the person to collect and mail-in a stool sample using an at-home kit.
- Guaiac-based fecal occult blood test (gFOBT) detects blood in the stool and is an annual test
- Fecal immunochemical test (FIT) also detects blood in the stool and is an annual test
- FIT-DNA test combines a FIT test and also detects alterations in the DNA. It’s done every three years.
Visual tests: The doctor conducts a physical exam of the colon and rectum using a guided scope. This requires some extra preparation for the individual ahead of the actual exam.
- Colonoscopy
- Sigmoidal colonoscopy
- CT colonoscopy
Ensuring Earlier Diagnosis and On-Time Treatment for Young Adults With CRC
While a majority of CRC patients are older, the last decade has seen an alarming increase in younger patients developing this cancer (18-50 years). By 2030, 10% of colon cancers and 20% of rectal cancers are projected to be in those younger than 50 years. However, symptom recognition and diagnosis by clinical care providers remains a struggle, particularly among younger adults who present with these symptoms. The result is a time lag of weeks to several months—not to mention visits to multiple specialists and misdiagnoses—before an accurate diagnosis is made and treatment initiated. The delay in treatment initiation could lead to a more advanced disease that is harder to treat and could impact both the patient’s quality of life and survival.
The American Gastroenterological Association has updated its Clinical Practice Guidelines for young adult CRC to prepare clinicians to recognize the clinical symptoms being presented, understand the person’s risk factors, and improve patient management. Additionally, organizations such as the Colon Cancer Foundation and the Colon Cancer Coalition are working to raise awareness among both clinicians and the general population to move the needle in this space.
What About Instances of CRC Among People of Color?
African Americans are disproportionately affected by colorectal cancer—they have a 20% higher risk of developing the disease and 40% higher risk of dying from it, compared to other races.
The death of the Black Panther star Chadwick Boseman from colorectal cancer at the age of 43 was shocking to his fans and the population in general. But it also shone a bright light on how the disease can affect anyone, not just older white men, which is a common misconception about colorectal cancer.
Bottomline, be aware of any signs or symptoms, find out if there is history of CRC or colorectal polyps in your family, and make sure you speak to your doctor about it during your next visit!
*The information in this article does not substitute medical advice. Please speak to your doctor or nurse about specific health issues.
Surabhi Dangi-Garimella, Ph.D. is a biologist with academic research experience, who brought her skills and knowledge to the health care communications world. She provides writing and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.
From the editor:
Learn more about what is happening in the realm of colon cancer by listening to Season 2: Episode 9 of the Patients Rising Podcast.
The Colorectal Cancer Alliance is a deep and inclusive resource for information about colorectal cancer screening, and living with the disease from the perspective of families & caregivers, providers, surivors, fundraisers, donors and advocates.