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Colorectal Cancer: The Facts

March is National Colorectal Cancer Awareness Month, and if you’re over 50, you are at greater risk for the disease. The American Cancer Society estimates that 140,000 new cases of colorectal cancer will be diagnosed this year.

It’s the second leading cause of cancer-related deaths in the United States, according to the CDC, and the third most common cancer in men and in women. But the news is not all bad.

“Colorectal cancer deaths are actually going down, because we are screening more patients, and we are getting better at treating the disease,” says Robert Yacavone, MD, Director of the Endoscopy Unit at Tufts Medical Center.

Catching colorectal cancer early

The gold-standard for screening, according to Dr. Yacavone, is still a colonoscopy.

“There are several colon cancer screening tests available, but colonoscopy is the preferred test because it’s the most effective at both prevention and detection,” Dr. Yacavone says. “Our ultimate goal is to detect any polyps, remove them, and prevent cancer from developing.”

Most colorectal cancers begin as a polyp, or growth, on the inner lining of the colon or rectum. Some types of polyps can change into cancer over the course of several years, but not all polyps become cancer. During a colonoscopy, the physician looks for any polyps and removes them.

Regular screenings are crucial because colorectal cancer often doesn’t cause symptoms until it is in the advanced stages. But research shows that patients have a much better outcome if the cancer is detected early.

“If the cancer is discovered at Stage One, we can surgically remove it and there’s a 90 percent survival rate,” Dr. Yacavone says.

In general, experts recommend that patients begin screening for colorectal cancer at age 50; patients at high risk (those with a family history of colorectal cancer or a history of polyps) should discuss the possibility of earlier, more frequent screenings with their doctor. African-American men and women may also be at increased risk, and should consider screenings beginning at age 45.

“Right now, only about 60 percent of people for whom screening would be appropriate are getting screened,” says Dr. Yacavone. “At Tufts MC, we want to improve that number—we have taken a pledge, along with hundreds of other hospitals, to raise that number to 80 percent.”

Besides colonoscopy, new screening methods include a stool DNA test, called Cologuard. This at-home test, while less invasive, does have a relatively high rate of false-positives; according to the Cologuard website, 13 percent of people without cancer or pre-cancer tested positive. Dr. Yacavone also points out that these tests detect the presence of cancer, but they are not a prevention strategy for detecting precancerous polyps.

Know your risk

In addition to regular screenings, it’s important to know your risk for developing colorectal cancer, and to reduce risk factors when you can. Risk factors include:

  • Being overweight or obese
  • Physical inactivity
  • Smoking
  • Heavy alcohol use
  • Age (over 50)
  • A personal history of colorectal polyps or colorectal cancer
  • A personal history of inflammatory bowel disease (IBD)
  • A family history of colorectal cancer or adenomatous polyps

Watch for symptoms

It’s also important to know the symptoms of colorectal cancer; these may include rectal bleeding, blood in the stool, a change in bowel habits or stool shape (e.g., narrower than usual), the feeling that the bowel is not completely empty, cramping pain in the lower abdomen, decreased appetite, or weight loss. If you are experiencing these symptoms, talk to your primary care physician.

The best advice - if you’re over 50, schedule a colonoscopy. Patients of average risk with normal results only need to repeat the test every 10 years.

“The screening doesn’t take long. Most people go through it and don’t remember even having the procedure,” says Dr. Yacavone. “And it can save your life.”