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Colorectal cancer screening

March is colorectal cancer awareness month. Coincidentally, I didn’t exactly plan it this way, but I had my screening colonoscopy with local gastroenterologist, Dr. Todd Sheer earlier this month. If you are age 45 years or older or have a family history of colon cancer or certain colon cancer risk factors, colorectal cancer screening is an essential component of your preventive health plan.

Colorectal cancer is relatively common. In fact, it is the third leading cause of cancer death in men and the fourth leading cause of cancer death in women in the United States. When these numbers are combined, it is the second leading cause of cancer death. In 2024, it is anticipated that there will be over 150,000 new cases of colorectal cancer and over 50,000 associated deaths.

The good news is that colorectal cancer is preventable. In fact, for most people it is one of the most preventable cancers, due to the effectiveness of screening and the opportunity to intervene before cancer occurs.

The death rate for older persons has been dropping for many years. This is partly due to improved screening and partly due to improved cancer treatments. However, colorectal cancer death rates have risen slightly for persons under age 55 years. This has led to the recommendation to begin screening earlier, at age 45 years for persons with average risk.

To be clear, people at increased risk such as those with a family history of colon cancer in a first degree relative (parent, sibling, child) and those with certain predisposing conditions such as genetic syndromes or inflammatory bowel disease should generally be screened at an earlier age, in consultation with their medical provider.

Also, the risk of colorectal cancer can be reduced through healthy lifestyle habits such as regular physical activity, a diet rich in fruits and vegetables, maintaining a healthy weight, and avoiding use of tobacco products or excessive alcohol intake.

Beginning at age 45 years for average risk persons, there are a variety of screening options ranging from stool testing to X-rays or endoscopy. Stool testing has improved in recent years and can permit early detection of colon cancer. A CT scan of the colon is another option as it permits imaging of the entire colon. However, according to many experts, endoscopy remains the gold standard for colorectal cancer screening since it permits both visualization of the colon and offers the opportunity to remove precancerous polyps before they have a chance to become cancerous.

I opted for a screening colonoscopy and was glad that I did. My gastroenterologist detected a precancerous polyp and removed it and cleared me for 7-10 years before my next screening is due.

Dr. Matthew A. Clark, a board-certified physician in internal medicine and pediatrics, works for the Indian Health Service.