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Colon cancer: Not just for older people

By on March 27, 2021 in Columnist with 0 Comments
Jim Brown

Editor’s note: March was the national Colorectal Cancer awareness month.

By Jim Brown, M.D.

I suspect most people if they think about colon cancer think it is something that primarily affects older people or seniors. 

Not too long ago, popular actor Chadwick Boseman’s fans were shocked to hear he had died of colon cancer at age 43. The Baltimore outfielder Trey Mancini was diagnosed with colon cancer just before his 28th birthday. 

I remember the day very well when I was doing a colonoscopy on a 28-year-old female because she had been seeing blood in her stool. I was shocked to find the source was from colon cancer. Fortunately at surgery, there was no evidence of the cancer’s spread, and she did well. 

Deaths from colon cancer overall have been declining; however deaths from colon cancer in younger people have been increasing. 

An oncology professor at Johns Hopkins said they are seeing colon cancer in more people in their 30s and 40s. Thirty percent of colorectal cancer diagnosed today is in people under the age of 55. 

The American Cancer Society now recommends people of average risk should start screening for colon cancer at the age of 45. 

They also recommend that people in good health with a normal life expectancy should continue screening to age 75.

 For those over 75 the decision to screen should be based on their life expectancy and their prior screening history or prior history of cancer or precancerous polyps.

Colon and rectal cancer caused more than 50,000 deaths in 2020. One in every 24 men and women has a risk of getting colon cancer. Colorectal cancer is the third leading cause of cancer death in women and the second leading cause of cancer death in men. 

The death rate from colorectal cancer has been dropping over the last few decades due to better screening and treatment. In 2021, more than 100,000 people will be diagnosed with colon cancer and 40,000 with rectal cancer, which includes 18,000 in people younger than age 50. 

Cancer that starts in the colon or rectum is often called colorectal cancer. The surgical approach is different depending on where the cancer started. 

Like most illnesses and cancers we humans get, there usually are some risk factors that play a role in getting colorectal cancer. One is a family history of this type of cancer. Trey Mancini, mentioned earlier, had a family history of colon cancer as his father had been diagnosed at age 58 with stage 2 colon cancer. 

There are several risk factors for developing colorectal cancer that are controllable. 

Factors include obesity, especially abdominal obesity around one’s waist, physical inactivity, type 2 diabetes, cigarette smoking, excessive alcohol drinking, a diet high in red, processed and charred meats and as well as having low vitamin D levels. 

You have heard it said, “We are what we eat.” Eating a diet with plenty of vegetables, fruits and whole grains and low in animal fat has been shown to lower one’s risk. 

Quitting smoking, exercising regularly and drinking less alcohol will help lower your risk. I know I sound like a broken record, but we all should strive to walk at least two miles daily, six days a week. It is our best and cheapest “medicine” to maintain our health. 

Everyone should be screened by age 45, especially those with any of these risk factors. 

If polyps are found that could be a precursor to colon cancer, they will be removed. If that is the case these patients generally are recommended to have a screening colonoscopy every five years.

I have been asked if there is any way to screen without going through a colonoscopy. Colonoscopy is still the “gold standard” for inspecting the colon, and if precancerous polyps are found or a suspicious lesion is biopsied, the diagnosis of cancer in an early stage can lead to a cure. 

Many say they don’t mind the procedure as much as they do the colon clean out that is necessary in order to do an adequate study of the entire colon. 

These colon clean outs have become less onerous than they once were in the earlier years of colonoscopy. 

There are some noninvasive methods to screen the colon that test for abnormalities that might suggest the possibility of colon cancer. If the result were positive, obviously a colonoscopy would then be indicated. 

One is called a fecal hemocult test that tests a stool sample for evidence of blood in the stool through a chemical reaction. Obviously, if blood is found, it needs to be investigated. 

Another test is called a FIT or “fecal immunochemical test” that uses antibodies to detect evidence of blood in the stool that might have come from a polyp or cancer. This requires a very small sample from one’s stool. 

Blood in the stool can come from several causes including taking too much aspirin or NSAIDS that might have irritated the stomach lining and other possibilities. 

The FIT-DNA test or Cologuard tests by detecting altered DNA in the stool. This test requires the collection of the entire bowel movement that is sent to the lab for testing. 

There is no single test that is best for every person. Each test has its pros and cons. 

Personally, after having had three precious normal colonoscopies and now being past age 75, I have opted for an annual FIT test. 

These are things that you need to discuss with your own physician.

Jim Brown, M.D., is a retired gastroenterologist who has practiced for 38 years in the Wenatchee area. He is a former CEO of the Wenatchee Valley Medical Center.

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