03/10/2023
With it being Colon Cancer Awareness Month, we wanted to re-share a write up from our very own Dr. Nathan Holman that we posted last year. We hope you may learn something new regarding colon cancer prevention and continue to help us spread the word that 45 is the new 50!
"Cancer kills around 600,000 people annually in the United States. Of all malignancies, colon cancer is the third most common cancer diagnosed among both men and women. The American Cancer Society currently estimates that there will be roughly 153,000 new cases of colore**al cancer diagnosed in 2023. Colon cancer prevention has faced new challenges in recent years, with the Covid-19 pandemic having brought about a substantial decline in routine screenings. There has also been increasing evidence that colon cancer is on the rise among the younger population, leading to updated colon cancer screening guidelines in 2021. With March being Colon Cancer Awareness Month, it is important to discuss these recent challenges as well as changes surrounding colon cancer prevention. It is also essential to highlight the excellent methods available for reducing one’s chance of succumbing to a largely preventable disease.
Colon cancer screening has been shown to reduce the risk of developing colon cancer by up to 90 percent in some studies. In spite of a clear benefit, the CDC reports that only around 70 percent of eligible adults are up to date with their screening. At the start of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services recommended all non-urgent procedures be delayed, resulting in a 90 percent decline in colonoscopy screening. This, in turn, resulted in a 32 percent decline in new colon cancer diagnoses. Throughout 2020, the overall number of colonoscopies performed declined by around 25 percent in comparison to 2019. While this number did improve in 2021, overall colon cancer screening was still roughly 3.4 percent down from the years leading up to the pandemic. Epidemiologic models predict that by the year 2040 there will be an extra 4000 to 7000 colore**al cancer deaths related to delays in screening during the pandemic.
Another challenge facing colon cancer prevention as of late has been the alarming increase in colon cancer incidence among younger people. Recent studies show an uptick in colon cancer incidence of 2% per year among patients under 50. The American Cancer Society has reported that people born in 1990 have double the risk of colon cancer and quadruple the risk of re**al cancer compared to those born in 1950. Research is still ongoing as to why this may be, though there is some evidence that suggests environmental factors such as obesity, poor diet, and sedentary behavior play a role. In response to this data, multiple societies, including the American Cancer Society as well as U.S. Preventive Services Task Force, are now recommending colon cancer screening start at 45 instead of 50. This is quite a monumental change and bears repeating: 45 IS THE NEW 50. Help us spread the word!
With these challenges in mind, it is clear that colon cancer screening will require a stronger emphasis moving forward. There are a variety of screening tests that can be done, though current data suggests that a high-quality colonoscopy is the best available method. This test is associated with the highest number of colon cancer cases avoided, assuming one gets testing at regular 10-year intervals. The high quality of this exam is owed to the fact that a colonoscopy has the ability to view the entire colon while also allowing for detection and removal of precancerous polyps. The American Society for Gastrointestinal Endoscopy (ASGE) has stated that it is also the only test that is suitable for individuals who have risk factors such as family history of colon cancer. There are also stool based testing options, though these require more frequent checks than a high-quality colonoscopy. A FIT test (f***l immunochemical test) detects microscopic amounts of blood in the stool should be undertaken annually. The Cologuard test is another stool-based test which detects both microscopic blood as well as DNA cancer markers, and it must be done every 3 years. While both can offer some protection as they can detect anywhere from 79-92 percent of cancers, they are only able to detect a fraction of precancerous polyps when compared with colonoscopy.
As the U.S. Preventive Service Task Force has noted, “the best screening test is the one that gets done.” This is certainly true, as any test is better than no test, though it is worth keeping in mind that the colonoscopy is currently our best tool to detect and prevent colon cancer. Talk to your doctors about getting screened, and help save lives by spreading the news that when it comes to colon cancer screening, 45 IS THE NEW 50! " - Dr. Nathan Holman
