For decades, the colonoscopy was a right of passage, a sign that you had officially entered middle age. The official guideline was to schedule your first test at age 50. This critical screening has been a lifesaver because colon cancer is usually slow growing in the early stages. Any colon polyps found during the examination are removed and tested to make sure they are not cancerous. Colon polyps, small, usually benign growths that grow on the lining of the large intestine, are relatively common. 40% of adults over the age of 50 have them. However, over time, benign polyps can become malignant, so removing them is an excellent preventive measure.
According to the American Cancer Society, making colonoscopies a regular part of preventive medicine has resulted in a welcome reduction in cancer deaths in people aged 50 and older. Between 2000 and 2012, diagnoses of colon or rectal cancer in this age group went down by 32%. Death rates declined by 52% from 1970 to 2015. Experts see a direct link to the increase in colonoscopies.
Unfortunately, the news is not so good for people under 50, whose colon cancer rates are trending in the opposite direction. According to a study in The Journal of Medical Screening, each year from the mid-1990s through 2013 the incidence of colon cancer in people in their forties has increased by another 1.3 percent. As a result, the US Preventive Services Task Force and the American Cancer Society have changed their guidelines, lowering the recommended age for a first colonoscopy to 45.
Currently there is no consensus regarding what’s behind rising colon cancer rates in young adults but several factors could be involved. Excess weight, smoking, heavy alcohol use, a diet low in fiber and high in fat and processed food, a sedentary lifestyle, and environmental factors may all play a part. Scientists are also studying the gut microbiome – bacteria that live in the gut. Certain types of bacteria contribute to good health and digestion, but others may help promote the growth of colorectal cancer, and even impact how certain cancer treatments work. Diseases such as Crohn’s, IBS, and diabetes, which can cause inflammation in the gut, may also be risk factors. Lastly, the environmental chemicals we eat, drink, or breathe may contribute to the development of cancer.
Symptoms of Colon Cancer
Unfortunately, early-stage colon cancer does not usually have symptoms. Consult your doctor if you experience any of the following:
- Changes in bowel habits that last longer than a few days (constipation diarrhea, stool appearance)
- Rectal bleeding (bright red blood) or blood in stool
- Persistent abdominal pain, gas, or cramping
- Unintentional weight loss
- Fatigue and weakness
- Persistent urge to have a bowel movement, even after using the bathroom
Following the Guidelines
The American Cancer Society recommends a first colorectal cancer screening at age 45 for people of average risk, with continued screenings as recommended by your doctor through age 75. For those above 75, the decision to be screened should be based on life expectancy, overall health, previous screening results, and personal choice. People over 85 no longer need to get screened.
More frequent screenings, as recommended by your physicians, are prescribed if you have:
- A personal history of colorectal cancer or certain types of polyps
- A family history of colorectal cancer
- A personal history of inflammatory bowel disease (ulcerative colitis or Crohn's disease)
- A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary non-polyposis colon cancer or HNPCC)
- A personal history of radiation to the belly or pelvic area to treat a prior cancer
Reducing Your Risk
The most important thing you can do to protect yourself from colon cancer is to get regular colonoscopies. Remember, removing polyps can literally "nip colon cancer in the bud." As for the lifestyle measures, just follow the principles of healthy living to reduce your risk for a variety of cancers and other conditions:
- Maintain a healthy body weight
- Get regular exercise
- Eat a variety of fruits and vegetables, especially raw, reduce your consumption of animal fats, cook with oils low in saturated fats, lower your sugar and salt intake, and avoid processed foods
- Stop smoking
- Limit your alcohol consumption – the recommended maximum is no more than one drink a day for women and two for men
If you are due (or past due!) for a colonoscopy, schedule an appointment with a gastroenterologist today. For help finding a doctor, click here.
This article appeared in the March 2024 edition of the HealthPerks newsletter.
