Colorectal cancer (CRC), or cancer of the colon or rectum, is the second leading cause of cancer death in the United States. The American Cancer Society (ACS) estimates that almost 153,000 Americans will be diagnosed with CRC in 2024, and about 53,000 people will lose their lives to this preventable disease. In North Carolina alone, nearly 3,500 people will be diagnosed.
CRC is a terrible disease, but there is a silver lining. Unlike other lethal cancers originating in the lung, breast, and pancreas, CRC is the only cancer which can be prevented at the same time screening is performed.
About 95% of colon cancers begin as benign but precancerous growths in the colon called polyps. Over time, mutations in their DNA can occur, causing them to grow, spread deeper into the colon wall, and transform into malignant tumors which can spread to lymph nodes around the colon and even distant sites throughout the body. Fortunately, this process takes many years, allowing ample opportunity to detect and remove these polyps before becoming cancerous.
Colonoscopy has become a common cancer screening procedure over the last several decades. Because of the increasing use of colonoscopy for CRC screening, decreased smoking, and improved treatments, the good news is that death rates from CRC have decreased in women by 60% since 1969 and by 55% in men since 1980.
While CRC deaths have dropped, the unfortunate fact is that only 72% of Americans are up to date with colon cancer screening. North Carolinians fare slightly better than the national average, as 75% of NC residents have been screened for CRC. Certain subgroups of people, including Asians, Hispanic/Latinos, and Native Americans, have screening rates well below average.
In recent years, there has been an alarming rise in CRC among young people. Overall, the lifetime risk of Americans developing CRC is about 1 in 23, but the rate of CRC is rising precipitously in those under 55 years of age. Since the mid-1990s, the incidence of CRC in people under 55 has risen by 1 to 2% per year. Since the mid-2000s, the death rate from CRC in people under 50 years of age has increased by 1% annually. Today, CRC is the leading cause of cancer death in men and the second leading cause of cancer death in women under age 50. Unfortunately, due to delayed detection, younger people often have more advanced disease and are less likely to respond to treatment.
While many theories exist about the cause of this disturbing trend, it is likely a combination of factors. A sedentary lifestyle and being overweight or obese may be important. Smoking and excessive alcohol use may factor in. Eating a diet low in fiber and high in fats, meats, and ultra-processed foods may contribute. Genetics also plays a role in certain cancers, as a family history of CRC and genetic syndromes (such as Lynch syndrome) increase risk.
Like any other disease, detecting CRC early improves survival. The ACS recommends everyone aged 45 and older be screened for CRC. People with risk factors, such as family history, may need to be screened sooner. Discuss your medical and family history with your primary care provider to determine when to begin colon cancer screening.
The US Preventive Services Task Force, a national group of experts in disease prevention, has approved several types of screening tests. It is important to understand the differences between them to know which type of screening is most appropriate for you. Colonoscopy remains the gold standard of screening and is the only test that can screen for and prevent colon cancer simultaneously.
Colon cancer develops silently, so an absence of symptoms should never discourage screening. It is common, deadly, and becoming more prevalent among younger people. BUT IT IS PREVENTABLE! Disgust for the bowel preparation, a busy schedule, or any other excuse is no reason to be at risk because undergoing CRC screening just may save your life.
Dr. Ravikant V. Varanasi, MD, AGAF practices at the Pinehurst Medical Clinic.
