New Guidelines Recommend Earlier Colorectal Screenings

For years, doctors recommended patients begin colorectal screenings at age 50. However, in 2018, the American Cancer Society (ACS) updated their colorectal screening recommendations to begin at 45. And now, the U.S. Preventive Services Task Force (USPSTF), followed by doctors, insurance companies and policymakers, has followed suit. 

What are Colorectal Cancer Screenings?

Colorectal cancer screenings can include:

• Stool test. Guaiac-based fecal occult blood test (gFOBT), fecal immunochemical test (FIT) and FIT-DNA tests can detect small traces of blood and/or cancer cells. These screenings are conducted every one to three years depending on the test. 
• Sigmoidoscopy. Flexible sigmoidoscopy is a short, thin, flexible lit tube that’s inserted in the rectum and lower third of the colon to check for polyps and cancer. This test is ordered every five years. You also have the option of getting it done every 10 years if you get an annual FIT.
• Colonoscopy. This is a longer version of a flexible sigmoidoscopy. The difference is that it can identify and remove polyps and cancer from the rectum and entire colon. During the test, the doctor can find and remove most polyps and some cancers. Colonoscopies also are used as follow-up to screenings that had suspicious findings. Generally, colonoscopies are ordered every 10 years. 
• CT colonography.  Also called a virtual colonoscopy, this test relies on X-rays and computers to produce images of the whole colon and display them on a screen for a doctor to review. They’re usually ordered every five years.

Colorectal cancer is the third deadliest cancer in the U.S. and on track to claim nearly 53,000 American lives this year – 11 percent of these cases are among Americans younger than 50. Historically, most colorectal cases were diagnosed between the ages of 65 and 74. However, over time, more and more Americans younger than 50 have been diagnosed with the condition. In fact, the number of new colorectal cancer cases among adults aged 40 to 49 rose by 15 percent over the last 15 years, according to the U.S. Department of Health and Human Services. 

“Hopefully, these guidelines will help doctors catch more cancers at earlier stages,” says Bernard Kaminetsky, MD, medical director, MDVIP. 

What is Colorectal Cancer

The American Cancer Society describes colorectal cancer as a cancer starting in the colon or rectum. Even though these cancers are different, they’re often grouped together because they have many common features.

Most of these cancers begin as a polyp – a growth on the inner lining of the colon or rectum. Polyps are usually detected through screenings. Just like growths that can develop in other parts of the body, some polyps are benign and remain benign, while others turn cancerous. The likelihood of a polyp becoming cancer often depends on the size of the polyp, the number of polyps found during a screening, if dysplasia (precancerous cells) are found in the area of a polyp even after removal and the type of polyp found. Here’s an overview of common types of colorectal polyps. 

• Adenomatous polyps: come in three types – tubular, villous and tubulovillous and they’re all considered precancerous. 
• Hyperplastic polyps and inflammatory polyps: are common and usually not precancerous. Additional screenings may be necessary if this type of polyp is found and it’s larger than 1 cm. 
• Sessile serrated polyps (SSP) and traditional serrated adenomas (TSA): are precancerous.

Colorectal Cancer Risk Factors

There’s a long list of colorectal cancer risk factors. Some factors are lifestyle based and controllable, while other risk factors are uncontrollable. 

Lifestyle Based (Controllable) Factors

• Being overweight or obese. Leptin is a hormone created by fat tissue in the small intestine. Extra body weight can raise leptin levels. Some studies found that leptin may increase the growth of colon cancer cells.
• Being sedentary. A lack of physical activity raises the risk for obesity. 
• Eating a lot of red meat (beef, pork, lamb or pork) and/or processed meat (hotdogs and deli meats). These meats contain heterocyclic amines (HCAs) and N-nitroso compounds (NOCs) – two chemicals that are thought to be carcinogenic.   
• Smoking. The chemicals in cigarettes raise the risk for many types of cancer, including colorectal.
• Drinking alcohol. Studies suggest alcohol can damage cells, raising the risk for cancer, including colorectal cancer.  

Uncontrollable Factors

• Aging. The risk for colorectal cancer rises with age. 
• Having a personal health history of colorectal health issues such as polyps, cancer and inflammatory bowel disease. Genetically inherited mutations and syndromes (e.g., Lynch, Peutz-Jeghers , MUTYH-associated polyposis) can raise the risk for colorectal cancer. 
• Having a family history of colorectal polyps or cancer. 
• Having a racial or ethnic background of African American or Eastern European, as there is a higher incidence of colorectal disease cases among these backgrounds. 

When to See Your Doctor

The American Cancer Society recommends you speak to your doctor if you notice:

• Persistent change in bowel habits
• Rectal bleeding or blood in stool
• Persistent abdominal discomfort, such as cramps, gas or pain
• Feeling as though you can’t completely empty your bowel 
• Persistent weakness or fatigue
• Unexplained weight loss

“Regardless of your risk factors, there are some steps you can take to lower your risk for colorectal cancer,” says Kaminetsky. “I think the first step is to clean up your diet. Highly processed foods contain a lot of chemicals. Whole or low-processed foods are richer in nutrients and fiber and generally are much healthier.”

Colorectal Cancer Prevention

It’s important to work with your doctor to help you lower your risk for colorectal cancer. Here are a few tips:

• Get regular physical activity and/or exercise
• Eat a healthy diet
• Weight management
• Polyp removal

Some studies have found that aspirin therapy may help lower your risk for colorectal cancer. Make sure you talk to your doctor before beginning an aspirin regimen, exercise program or new diet. Also talk to your doctor about the new USPTF colorectal cancer screening guidelines and see when you need to schedule a screening.

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