Colorectal Cancer Awareness: Screening & Decreasing Risks

March is National Colorectal Cancer Awareness Month. To help raise awareness of this condition, we are sharing a guest blog by gastroenterologist Tamas Otrok, M.D. of Gastroenterology of the Rockies. Boulder Community Health is a proud partner of Gastroenterology of the Rockies.

The incidence of colorectal cancer (CRC) is progressively decreasing in the U.S. due to changes in some of the modifiable risk factors and, importantly, by increasing rates for CRC screening. However, it is still the third-most common cancer and the second-most common cause of cancer death in the U.S. among men and women combined.

What can you do to decrease your colorectal cancer risk?

Thankfully, there are things individuals can do to lower the risk of developing CRC. Understanding your family’s history history of cancer is important, as well as making sure your primary care provider knows this information before you turn 40. Leading a healthy lifestyle with proper diet, exercise and maintaining an ideal body weight, along with regular screenings, can contribute to the decrease of your CRC risk.

When should I start getting screened?

For those with an average risk, current guidelines recommend individuals start CRC screening by age 45 or 50 (we recommend checking with your insurance carrier) and continuing until age 75-85 (individualized on basis of risk and health status).

High-risk populations, such as individuals with a first-degree relative with CRC or large (larger than a dime) precancerous polyp, should discuss their family history with their provider and start CRC screening with colonoscopy every five years by age 40, or earlier if the family history of CRC is very strong.

Colonoscopy is Still the “Gold Standard”

Advertising for ColoGuard can lead some to think that it is an alternative or equivalent to colonoscopy. For CRC screening in average-risk individuals, colonoscopy every 10 years is still preferred to ColoGuard, which is done every three years. Colonoscopy is a cancer prevention test, ColoGuard is a cancer detection test.

It is also important to note that if any of the non-colonoscopy screening tests such as ColoGuard, FIT, or CT Colonography are positive, a diagnostic colonoscopy will need to be performed to identify polyps and cancers in the entire colon. A biopsy of lesions that are suspicious for CRC and removal of colonic polyps can prevent CRC from occurring.

Other reasons colonoscopy is still considered the best option:

• The option of a screening colonoscopy is free under many insurance plans while a colonoscopy done for a positive ColoGuard test is not.
• ColoGuard has a significant false-positive rate, leading to a diagnostic colonoscopy that is not a free benefit under most insurance plans.
• ColoGuard is not appropriate for patients with a personal history of precancerous colon polyps or significant family history of colon cancer.

Know Your Risk Factors

Understanding your risk factors can help you determine the level for which you may be susceptible to CRC. These include non-modifiable factors such as age, race and country of origin and modifiable factors such as lifestyle choices.

Non-modifiable risk factors include:

• Country of origin: Developed countries like the U.S. have a higher risk than developing countries like most of Africa.
• Race/ethnicity/income: CRC risk is higher in African Americans, Alaska Natives and American Indians than in Caucasians or Hispanics, as well as in low-income groups. These differences may be due, at least in part, to different risk factor profiles between the groups and differential access to screening and state of the art treatment.
• Age: CRC is uncommon before age 40, then the risk doubles every decade or until age 80. Therefore, recommendations are to start CRC screening by age 45 or 50 in otherwise average-risk people.
• Family history: This is a very important risk factor for CRC. Individuals with one or more first-degree relatives (parents, siblings or children) with CRC are at an increased risk for the disease and should discuss screening with their providers well before age 40. Screening should be started at age 40 or earlier in some of these individuals.

Modifiable risk factors include:

• Smoking: Cigarette smoking is a cause of CRC, as well as many other cancers.
• Alcohol: Excess alcohol (an average of >1 drink per day for women, >2 per day for men) can increase CRC risk.
• Obesity: Being overweight is associated with an increased CRC risk in both men and women.
• Exercise: Regular exercise (30-60 minutes of vigorous activity, 3-4 times per week) is strongly associated with protection from CRC.
• Diet: Diets high in red or processed meat, low in fruits and vegetables and low in high-fiber foods are associated with an increased CRC risk.

Each of these modifiable factors is associated with a modest (20-30%) effect on CRC risk but the single most important risk factor is a failure to be screened. Regular colorectal cancer screening can decrease risk by up to 70 percent.

Contact Gastroenterology of the Rockies to Schedule an Appointment

If you’d like to learn more about prevention and screening for CRC or wish to schedule an appointment with Gastroenterology of the Rockies, please call us at 303-604-5000.