Colon cancer is the 4th most common type of cancer. It is the 2nd leading cause of cancer deaths in the United States. Increased awareness and improved screening methods have helped reduce overall death from colon cancer. Early detection can lead to removal of polyps before they have time to become cancer. A polyp is abnormal tissue that grows along the wall of the colon. They can go from benign tissue to a cancer, generally over a period of years.
African Americans have the highest rates of colon cancer and are diagnosed at younger ages. They often have more advanced disease when the diagnosis is made. Also, African Americans die more often from colon cancer than other racial groups. The causes of these inequalities are not clear. Some reasons are that African American patients are exposed to more risk factors and they may have more difficulty getting to a doctor. They may have a family history of colon cancer and not know it. Also, their healthcare provider may not be appropriately counsel them about risk factors, screening, or follow up tests for colon cancer.
Who is at risk?
There are several major risk factors for colon cancer. These include age greater than 50, African American race, smoking and family history of colon cancer or polyps. Other risk factors include heavy alcohol use, overweight or obesity, diets high in processed and/or red meat, diabetes, and inflammatory bowel diseases such as Crohn’s disease or ulcerative colitis. Quitting smoking, limiting alcohol and red meat, losing weight, and increasing dietary fiber (vegetables, fruits, and whole grains) can help reduce your risk of colon cancer and improve your overall health. Family history is an important risk factor. You may need to be screened earlier and more often if you have a family history of colon cancer.
What are the warning signs?
Often there are no warning signs of colon cancer until more advanced stages. This makes on time screening an important tool for early detection. Symptoms of colon cancer may include unintentional weight loss, abdominal pain, or changes in your bowel habits. Stool (poop) that becomes skinny, streaked with blood, black like tar, or pale gray may be a sign of a serious problem. If you experience any of these symptoms, you should talk to your doctor immediately.
Who should be screened?
Colon cancer screening is recommended for most people starting at age 50 until about age 75. You may need to be screened earlier than 50 if you have a family history of colon cancer, especially in close relatives such as parents or siblings. Patients over 75 may consider screening if they are healthy. They can discuss with their doctor if continued screening is right for them.
Many people have anxiety about colon cancer screening, especially colonoscopy. New studies show that many different tests are equally effective at detecting and reducing deaths from colon cancer. The main types of colon cancer screening tests are stool tests and procedures using a camera to see the inside of the colon.
The fecal immunochemical test (FIT) tests a stool sample for blood not visible to the naked eye. The FIT is recommended once a year alone, or may be combined with flexible sigmoidoscopy. The main advantages of FIT are that it is not invasive and does not require fasting or bowel preparation. However, if the FIT is positive for blood, a follow up colonoscopy will be required for further evaluation.
Flexible sigmoidoscopy and colonoscopy are procedures that use a thin flexible tube (a “scope”) with a light and camera. The scope is inserted through the anus to examine the colon and remove any polyps to be studied under a microscope to determine if it is cancer. The flexible sigmoidoscopy examines the last parts of the colon where the majority of colon cancers are found. Colonoscopy examines the entire colon. Patients are usually awake for a flexible sigmoidoscopy, and are asleep for a colonoscopy. For both of these tests, you will have to prepare ahead of time. You have to stop eating solid foods for 1-2 days before the tests and drink a liquid the night before. That will help to clean out your colon for the exam. Flexible sigmoidoscopy without FIT is recommended every 5 years. If combined with FIT it can be done every 10 years. Colonoscopy alone is recommended every 10 years. The main advantages of flexible sigmoidoscopy and colonoscopy are that they can find and remove most suspicious growths at the same time. In some cases surgery may be required.
The most important test is the one that you get done. So if you are 50 or older and have not been screened, or have family members who have been diagnosed with colon cancer, talk with your doctor to find out which colon cancer screening test is right for you!