By Diana Weber, M.D., Medical Director, Blue Cross and Blue Shield of New Mexico
The American Cancer Society estimates there will be 890 new cases of colon and rectal cancer in New Mexico in 2022 and 330 New Mexicans will die of colorectal cancer this year. The incidence of these cancers is higher in males than females, but colorectal cancer is the third leading site of new cancers in both men and women. Colorectal cancer leads to more deaths than any other cancer except lung and prostate cancer in men, and lung and breast cancer in women. For reasons that are not clear, the incidence of colon and rectal cancer is increasing in younger individuals while decreasing slightly in adults 50 years of age and older. Similarly, while the colorectal cancer death rate has dropped overall, we are seeing a disturbing rise in mortality in adults younger than age 55.
What can I do to better protect myself from colon cancer?
Make sure you are getting your screening. One of the explanations for the decreased mortality from colorectal cancer in people over 50 is that increased screening has resulted in early detection when cancers are much easier to treat and treatment is more likely to be successful. Screening tests are important because symptoms of colorectal cancer (rectal bleeding, pain, blood in the stool, changes in bowel habits and weight loss) do not usually appear until the cancer is advanced. Not only can screening detect colon cancer in early stages, but if a polyp is found during a colonoscopy, it can be removed at the same time. Polyps are often precancerous lesions, so removing these small growths at the polyp stage prevents them from turning into cancer. If polyps are found, you will need to get more frequent colonoscopies to detect new polyps that might develop.
What are the screening recommendations for colon cancer?
Screening guidelines have changed recently. The American Cancer Society and the U.S. Preventive Services Task Force now recommend that people without risk factors start colorectal cancer screening at age 45 and have regular screening until age 75. After age 75, screening for colorectal cancer is dependent on the overall health of the individual. It is particularly important for African American individuals to begin screening at age 45 because they are more likely than others to get colorectal cancer at a younger age. There are different methods for screening for colorectal cancer, so it is important to speak with your clinician about the most appropriate screening test for you.
What are the risk factors for colorectal cancer?
There are some risk factors that you have no control over. For instance, cancer risk increases with age. Also, if you have a family history of colorectal cancer or you have had colorectal cancer in the past, your risk is increased. As stated above, a history of certain types of polyps increases your risk. Individuals with chronic inflammatory bowel disease (ulcerative colitis or Crohn’s disease) or type 2 diabetes are also at increased risk. Additionally, some inherited genetic abnormalities lead to higher incidences of colorectal cancer. If you have any of these risk factors, you should make sure your doctor knows this as you may need to be screened more frequently than the general population.
There are also risk factors you can control, and the presence of these factors leads to 55 percent of the cases of colorectal cancer in the U.S. If you are overweight and physically inactive, your risk of colorectal cancer is higher. Diets high in processed or red meat and low in fruits, vegetables and fiber increase your risk, as does heavy alcohol consumption. These are all lifestyle issues that you can modify to lower your risk of colorectal cancer.
How is colon cancer treated?
Over the past decades, treatment for colorectal cancer has improved, which is another reason for the decrease in the death rate from colorectal cancer. Surgery is used to treat almost all forms of colorectal cancer, though in some cases it might not be the first line of treatment. In many cases, surgery can be performed through very small incisions, sometimes with robotic assistance. Hospital stays after these operations are very short, and pain is much less than that of traditional open surgery. Chemotherapy is used to treat some types of colorectal cancer, and it may be administered before surgery. In some cases, radiation therapy is used. Newer therapies include immunotherapy and targeted therapy.
When colorectal cancer is detected early, survival is extremely high. This is another reason why physicians recommend a disciplined screening process. Like most cancers, the more advanced the tumor at diagnoses, the poorer the survival. But when colorectal cancers are localized to the intestine, the five-year survival rate is 90 percent or better.
So, in the spirit of National Colorectal Cancer Awareness Month, review your records to make sure you are up to date on your screening. Consult your clinician if you have any questions. And follow up on those new year’s resolutions to eat better, exercise more, and decrease your alcohol consumption. Not only will you feel better, but you will lower your risk of colorectal cancer.
For more information, you can go to the American Cancer Society website at cancer.org.