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Is 50 the Magic Number for Colorectal Cancer?

March is Colorectal Cancer Awareness Month

The American Cancer Society estimates 95,520 people will be diagnosed with colon cancer this year, 39,910 will be diagnosed with rectal cancer, and 50,260 will die from this disease.

Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States. Alarmingly, a recent study performed by the Cleveland Clinic found that the rate of colon and rectal cancers is rising in adults under the age of 50—the recommended screening age. The reason for the rise in both incidence and death rates remains unclear.

The study’s lead author, Rebecca Siegel, an epidemiologist at the American Cancer Society, says the study “tells us that we need to get messages out for people when they turn 50, they need to call and schedule their colorectal cancer screening, because increasing death rates for people who should be screened is very concerning.” She went on to assure that, “It’s important to mention that still the risk for colorectal cancer is still low in people under 55. We don’t want to be alarmists. The risk is low.”

Surveillance, Epidemiology, and End Results (SEER) data shows this trend as well. It found that while new colorectal cancers in older adults (ages 50+) have fallen consistently since 1985, rates of colorectal cancer for people under age 50 have risen, particularly for rectal cancer. After 2001, there was an average annual increase of 2.1% in young onset colorectal cancer compared to a decrease of 2.5% yearly for those 50 and older. Rectal cancer cases increased even more rapidly in younger patients at an average annual change of 3.9%.

The message from both studies is clear: Doctors should make it clear to all patients that colorectal cancer screening is critical at the age of 50.

What is Colorectal Cancer?

Cancer that begins in the colon is called a colon cancer, while cancer in the rectum is known as a rectal cancer. Cancers affecting either of these organs may be referred to as a colorectal cancer. Colorectal cancers generally develop over time from adenomatous (pre-cancerous) polyps (growths) after a series of mutations (abnormalities) arise in cellular DNA.

The wall of the colon and rectum is made up of several layers. Colorectal cancer starts in the innermost layer (the mucosa) and can grow outward through some or all of the other layers. When cancer cells are in the wall, they can then grow into blood vessels or lymph vessels (tiny channels that carry away waste and fluid). From there, they can travel to nearby lymph nodes or to distant parts of the body. The stage of a colorectal cancer depends on how deeply it grows into the wall and if it’s spread outside the colon or rectum.

Know Your Risk Factors

What causes colon and rectal cancers? Several factors may place you at a higher risk for colorectal cancer. If you have any of the risk factors below, speak with your doctor about when you should undergo screening.

Factors you can’t control:

Age: Over 90% of those diagnosed with colorectal cancer are over age 50. As we age, we’re more likely to grow polyps which have the gene changes that turn normal tissue into cancer.

A history of polyps or cancer: If you have a personal cancer history of colon polyps or colon cancer, rectal cancer, ovarian cancer, endometrial cancer, or breast cancer you may be at an increased risk for colorectal cancer. Ask your doctor about genetic testing.

Inflammatory Bowel Disorders (IBD): If you’ve been diagnosed with an inflammatory bowel disorder such as ulcerative colitis or Crohn’s Disease, you’re at a higher risk for colorectal cancer.

A family history and genetics: If you or a family member has a history of colorectal cancer, or colon polyps, you may be at an increased risk for colorectal cancer. Generally, screening for family members is recommended to begin 10 years prior to the survivor’s age of diagnosis. For example, if your loved one was diagnosed at age 52, family member screening needs to begin at age 42.

Factors you can control:

Lifestyle: Low physical activity, obesity, smoking, and heavy alcohol use are all linked to a higher incidence of colorectal cancer.

Diet: A diet high in red meats (beef, pork, lamb, etc.), processed meats, and fats may all be linked to colorectal cancer.

Convincing evidence also suggests the following strategies can also decrease your risk:

  • Don’t smoke.
  • If you do smoke, stop.
  • Increase your physical activity (get at least 150 minutes of moderate intensity or 75 minutes of vigorous intensity activity each week).
  • Maintain a healthy body weight.
  • Avoid overall body fat, especially fat around your waist.
  • Reduce the amount of red meat and processed meats you eat.
  • Use alcohol in moderation.
  • Increase your intake of foods that contain dietary fiber.
  • Include garlic in your diet.
  • Drink more milk if you can tolerate it
  • Add foods with calcium.
  • Use alcohol in moderation.

The Cleveland Clinic offers a free online risk assessment you can complete in just 5 minutes or less.

Colorectal Cancer Screening

Colorectal cancer can often be prevented through regular screening, which can find polyps before they become cancerous. The American Society of Clinical Oncology (ASCO) recommends that you speak with your doctor about when screening should begin based on your age and family history of the disease. Although some should be screened earlier, those with an average risk should begin screening at age 50. African Americans should start receiving screening at age 45 because they are more often diagnosed at a younger age.

Because colorectal cancer usually does not show any symptoms until the disease is advanced, it’s important to talk to your doctor about the pros and cons of screening at various ages.

Prognosis: Hopeful

Many of those diagnosed with colorectal cancer live normal life spans. With prompt and appropriate treatment, the outlook for a person with the disease is hopeful. The treatments available today offer good outcomes, but you may require several treatments or a combination of treatments (surgery, chemotherapy, radiation) to have the best chance of avoiding a recurrence of the cancer. Always tell your doctor about any changes in your health to ensure he or she is able to decide if you need any additional screening tests or treatment.

For more information on screenings for colorectal cancer, call the CCHC Endoscopy Center in New Bern, at (252) 514-6644. A team of doctors and other health care providers are ready to discuss any concerns you may have.

(Sources: American Cancer Society; Cleveland Clinic; American Society of Clinical Oncology; Fight Colorectal Cancer Organization; National Cancer Institute; Mayo Clinic; Colorectal Cancer Alliance; and CNN Health.)