March is National Colorectal Cancer Awareness month; a great time for women to review our colorectal health, including our colon cancer screening status. By 2030, colorectal cancer (CRC) will take more lives under the age of 50 than any other cancer. In fact, 1 in 25 women (4%) will be diagnosed with CRC in their lifetime. It is more common in Black Americans by about 20% and this population is also about 40% more likely to die from this cancer than other groups.
There are many risk factors to consider for colon cancer screening. The guidelines for CRC screening have recently changed. Screening for average risk individuals used to start at age 50, however that has now been lowered to age 45. Individuals with a family history of CRC or inflammatory bowel disease (ulcerative colitis and Crohn’s disease) need to be screened earlier than 45 however because they are at a higher risk of developing cancer; the exact age screening should start will be dependent on family history so it is recommended to consult with your primary care physician directly.
· Family history of CRC
· Increasing age
· Personal history of polyps or cancer
· Inflammatory bowel disease (IBD)
· Smoking and excessive alcohol use
· Diets higher in fat
There are several signs and symptoms to watch for that may make your physician want to screen sooner than 45 years old. If you are having any of these, please make sure you speak with your physician about your best next steps.
Signs and Symptoms:
· Blood in the stool or rectal bleeding
· Change in bowel habits and/or stools that are narrower than your baseline
· Unintentional weight loss
· Frequent abdominal pain, bloating, pain, fullness, or cramping
· Increased fatigue and weakness
Colonoscopy is still currently considered the gold standard for colon cancer screening as it offers direct visualization of the colon and the physician can remove polyps or other lesions if identified during the procedure to send for pathology; depending on the results of the colonoscopy and the pathology if lesions are removed, the physician will decide what the ideal follow-up time will be to continue to effectively screen for CRC. Unfortunately, for individuals who don’t have health coverage, colonoscopy cost can be prohibitive. For these individuals and others who choose to not screen with a colonoscopy, there is another more cost-effective and less invasive option called FIT stool testing, which is also considered a valid screening tool when repeated yearly. If a FIT stool test is ever abnormal, patients would need to then be assessed with a colonoscopy.
Bridget Gruender, MD, MS, DABOM, is a board certified family medicine physician, diplomat of the American Board of Obesity Medicine and physician/owner at Liberty Family Medicine.