Colon Cancer Is Skewing Younger
Traditionally seen as an older person’s disease, colon cancer is skewing younger. Today, more than 10% of cases occur in people under age 50. In response, the U.S. Preventative Services Task Force, experts in evidence-based medicine, now recommends that colon cancer screening start at age 45, instead of 50.
“The increasing numbers of young people with colon cancer is a troubling trend, but screening at younger ages should save lives,” says gastroenterologist Joel Gabre, MD, instructor of medicine at Columbia University Vagelos College of Physicians and Surgeons. Gabre also is a researcher on a multidisciplinary team at Columbia trying to figure out why colon cancer, also known as colorectal cancer, is more prevalent than ever.
Colon cancer is the third most deadly cancer in the United States, claiming nearly 53,000 lives in 2021. That number is expected to rise in the years ahead, in part because of missed screening appointments during the pandemic.
Age is not the only thing that makes a person susceptible. Unhealthy diets, lack of exercise, and obesity may also contribute. Overall, 1 in 20 Americans will develop colon cancer at some point during their lives.
Typically, colon cancer is asymptomatic, so “everyone should get screened,” says Gabre. Screenings are important to determine your risk and start treatment as soon as possible if a cancer is caught.
Colonoscopy is the best way to get a complete picture of your colon. “This is the best way to screen, because we not only find pre-cancerous polyps but also remove them,” says Gabre.
Colonoscopies take place in a hospital or outpatient surgical center. During the exam, a doctor inserts a thin, flexible tube (colonoscope) into the rectum to evaluate the entire colon, in search of precancerous polyps (fleshy growths). If present, polyps can be removed during the exam. If no polyps are found, people can wait 10 years for their next colonoscopy because it takes that long for new polyps to emerge and grow. Those determined to be at risk of colon cancer, because of the presence of polyps or because they have a family history, previous cancer, or inflammatory bowel disease, may need another colonoscopy sooner.
There's no denying, colonoscopy prep—fasting and drinking prescribed laxatives to clean out the colon for best viewing—can be unpleasant. But it’s not as bad as missing an early cancer that can be treated. “Without a good prep, it’s hard to detect polyps and cancers, so it’s important to follow the instructions, even if it’s uncomfortable," says Gabre. “Think about your life. Think about your family. You do not want to miss a colon cancer diagnosis.”
Other cancer screening options
For people who want to avoid anesthesia, Gabre says some gastroenterologists offer sigmoidoscopies. During a sigmoidoscopy, like a colonoscopy, a doctor inserts a thin, flexible tube into the rectum to view the colon. But the tube is shorter in a sigmoidoscopy, and the doctor can only evaluate one side of the colon.
The prep typically involves only an enema, and the procedure is done in a hospital or surgical center. “But the exam is not as comprehensive as a colonoscopy, and I generally don’t recommend them for screening if a patient can tolerate a colonoscopy and undergo anesthesia,” Gabre says.
At-home tests are exactly that. They look for blood or evidence of tumors in fecal samples. Samples are sent to a lab for analysis.
“At-home tests can be good for identifying cancer but not early pre-cancerous polyps,” Gabre says, “and a positive test will need to be followed up with a colonoscopy. Colonoscopy is the best screening method, but if colonoscopy is out of the question, home tests are better than no screening at all.”
Ask your primary care physician if you should get a colon cancer screening and what type. The physician can recommend a specialist to perform it.
Joel Gabre, MD, is an instructor of medicine at Columbia University Vagelos College of Physicians and Surgeons and a researcher with the Gastrointestinal Cancer Prevention and Genetics Program.