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45 is the New 50: Why colon cancer screenings should start sooner than you think

Category: Patient Stories
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Dr. Yoni Hillman, a physician at St. Luke’s Gastroenterology Associates.Published in Positively Superior magazine, December/January issue

Cancer is still one of the leading causes of death in our country despite significant improvements in our understanding and development of new treatments. In 2018, approximately 1.7 million new cases of cancer will be diagnosed in the United States and over 600,000 Americans will die from cancer.

The leading cause of cancer-related deaths in the United States is lung cancer. The second most common is colon cancer. During this year, there have been approximately 140,000 new cases of colon cancer and 55,000 deaths related to colon cancer.

In addition to these sobering statistics, there has also been a recent increase of colon cancer in younger Americans. At this point, the cause is unknown. However, this development has prompted the American Cancer Society to change its recommendation on when to begin routine colon cancer screening. Instead of age 50, all Americans who have an average risk for colon cancer should now begin screening at age 45.

Although these numbers and the development of colon cancer in younger individuals may seem alarming, there is reason for optimism. Colon cancer is one of the only cancers for which the incidence is declining. Since 1985, the incidence of colon cancer has declined by 44% and the mortality rate from colon cancer has decreased by 48%.

The prevailing theory for this dramatic decrease in colon cancer incidence is the development of colon cancer screening programs. Screening tests help to detect colon cancer at an early stage, making treatment more effective and drastically improving the survival rate. Many of the screening tests also identify the presence of wart-like growths called “polyps.” Typically, colon cancer begins with the formation of these polyps that can grow over many years into a cancer. Removing polyps while they are still small can prevent them from growing into cancer. In this way, a colonoscopy can be considered to be a cancer-prevention procedure.

Despite these dramatic and exciting developments, almost half of all Americans eligible for colon cancer screening do not undergo the appropriate testing. It is believed that if more Americans committed to regular colon cancer screening, the incidence and mortality rate from colon cancer would decline even further.

There are a few main reasons individuals do not participate in regular screenings. Some feel they are unlikely to develop colon cancer because they have no family history of the disease. Unfortunately, this group may not realize that approximately 66% of all patients diagnosed with colon cancer have no family history of the disease. Others may avoid testing because they find the topic taboo or feel uncomfortable with the idea of a colonoscopy in general. However, the benefits of regular colon cancer screenings are clear.

For average risk individuals, a colonoscopy should be performed every 10 years. During this procedure, polyps can be identified and removed at the same time.

An alternative to a colonoscopy is a fecal immunochemical test (FIT). This test can be completed in the privacy of your own home. If the test is negative, no colonoscopy is needed. However, if this test comes back positive, a colonoscopy will be required to investigate further. For this strategy to be effective, the test needs to be repeated every year.

Screening should continue through age 75, as long as a person remains in good overall health. After age 75, the decision to continue colon cancer screening is left to the discretion of the individual and his or her primary care provider. Patients in this age range should have a discussion regarding their overall state of health, as well as their health goals, and then weigh the risks and benefits of continued screening for colon cancer.

Staying healthy is important in colon cancer prevention as well. Exercising five times a week for 30 minutes a session and eating a balanced diet filled with fruits and vegetables are both key in maintaining overall health. In addition, smoking is a leading risk factor for all cancers, and should be avoided.

For select high risk individuals, colon cancer screening can begin even sooner than age 45. This includes individuals with a family history of colon cancer and those who have been diagnosed with inflammatory bowel disease. To inquire about your risk level or discuss colon cancer screening options for you, talk to your primary care provider.

To establish care with a St. Luke’s primary care provider, call 218.249.4000 or visit