Last month was Colorectal Cancer Awareness month. Why should this matter, among the plethora of awareness initiatives and campaigns which compete for our attention? Because colorectal cancer can be prevented with screening. Most cancers begin in polyps, which are usually benign at first and grow slowly until they become a malignancy; screening for polyps and removing them interrupts this progression. The incidence of colorectal cancer in the United States is decreasing, a trend which is largely attributable to increased awareness and screening.
Despite this encouraging fact, colorectal cancer is far from beaten, and as the third most common cancer and second leading cause of cancer deaths, it remains a significant threat. I am frequently reminded of the importance of screening in my own practice, where some patients question the benefit of undergoing colonoscopy while they are feeling well. The fact is, most polyps grow silently, and patients are not aware of their presence until they undergo a colonoscopy. The new onset of abdominal pain, bleeding in or on stool, and change in bowel habits, while not necessarily indicative of cancer, are important and warrant reporting to your physician. Clinical practice guidelines recommend screening starting at the age of 50 in average-risk individuals. Some patients have conditions which put them at higher risk such as a strong family history, some inherited forms of colorectal cancer, and inflammatory bowel disease (ulcerative colitis); screening is generally started before age 50 in such situations. Smoking and obesity have also been linked to a higher risk of colorectal cancer.
Colonoscopy is a preferred screening option according to the American College of Gastroenterology guidelines, as it allows detection and removal and polyps during the same procedure. Other screening options such as testing for blood in stool are available and have been shown to be effective to detect cancer at an early stage. An open dialogue with your physician, with careful assessment of risk factors, can help you determine which screening test is best for you. Above all, remember that colorectal cancer can be beaten with prevention and early detection; screening could save your life, and the lives of friends and loved ones.
Charles Kahi, MD, MSCR, FACG
Indiana Chapter Governor, American College of Gastroenterology