Colorectal Cancer Q&A: The Truth about Screening, Prevention, and More

Summary:

• A colonoscopy is the best way to screen for and prevent colorectal cancer (CRC) because it allows your doctor to find and remove precancerous growths called polyps before they have a chance to turn into cancer.
• The U.S. Preventive Services Task Force (USPSTF) recommends that most people have colonoscopy screenings starting at age 50. People who are at a higher risk for CRC due to family history or other factors should begin having screenings at a younger age based on their doctor’s recommendation.
• Cologuard, an at-home test, is not a preventive CRC screening tool because it detects cancer after you develop it.

If you’re like most people, you might feel uncomfortable talking about colorectal health — even with your doctor. But the truth is that your colon, also called the large intestine, is a critical part of your digestive system and so important to your overall health and well-being. One of the best ways to keep your colon healthy is to follow your doctor’s recommendations and have routine colonoscopy exams to screen for colorectal cancer (CRC).

Three Western Connecticut Medical Group (WCMG) gastroenterologists — Dr. Steven Brandwein, Dr. Joseph Fiorito, chief of gastroenterology at Danbury Hospital, and Dr. Steven Gorelick, senior medical director for medical subspecialty and oncology at Danbury Hospital— provided answers to common questions many people have about CRC, colonoscopy screenings, and at-home CRC tests.

Q — What is colorectal cancer, and is it preventable?

A — Dr. Brandwein: CRC starts in the colon or the rectum. CRC can also be named colon cancer or rectal cancer, depending on where it starts. CRC occurs when cells in your colon or rectum grow out of control. It begins as a growth in the lining of the colon or rectum called a polyp. If left untreated, some polyps can eventually turn into cancer.

Besides some types of skin cancer, CRC is the third most common cancer diagnosed in both men and women in the United States. It is also one of the most preventable cancers because of colonoscopy screenings.

Q — What is a colonoscopy?

A — Dr. Fiorito: A colonoscopy is an outpatient exam that allows your doctor to look at the inside lining of your colon and rectum to check for precancerous polyps and other irregularities. A colonoscopy is a preventive screening because your doctor can remove precancerous polyps during the exam before they have a chance to turn into cancer.

While you are under sedation, your doctor will guide a flexible tube called a colonoscope into your anus, through your rectum, and into your colon. The tube has a light and a video camera on the end, which transmits an image to a video monitor that your doctor will use to look at the inside of your colon.

Q — Who should have a colonoscopy?

A — Dr. Brandwein: According to the U.S. Preventive Services Task Force (USPSTF) — which is the governing body for setting CRC screening guidelines — people who are at average risk for CRC should begin having colonoscopies at age 50. People who have a family history of CRC or other risk factors should begin screenings earlier.

Risk factors are conditions or habits that make it more likely that you will get a disease like cancer. Some risk factors can be changed and others cannot. Speak with your healthcare provider if you have any of the following risk factors for CRC.

Risk factors you can’t change:

• Age: CRC is more common in people age 50 and older, but young adults can also get CRC. In fact, occurrence of young onset CRC is on the rise in the United States.
• Family History: First-degree relative (parent, sibling, or child) who had CRC or precancerous polyps
• Personal History: Inflammatory bowel disease, personal history of CRC or polyps, or genetic predisposition to CRC, such as Lynch syndrome
• African American: African Americans are more likely to develop CDC at a younger age and to be at a more advanced stage when diagnosed

Risk factors you can change:

• Eating an unhealthy diet high in fats, salt, sugar, and processed foods
• Moderate to heavy alcohol use: According to the Dietary Guidelines for Americans, moderate alcohol consumption is defined as having up to one drink per day for women and up to two drinks per day for men; heavy alcohol use is defined as consuming eight drinks or more per week for women, and 15 drinks or more per week for men
• Smoking tobacco
• Unhealthy weight (overweight or obese)

When should you start having colonoscopy screenings, and how often do you need them? Check out this Colorectal Cancer Screening Guide.

Q — There has been a lot of buzz about Cologuard. What is Cologuard, and is it beneficial?

A — Dr. Fiorito: Cologuard is an FDA-approved, at-home colon cancer test that is available by prescription only. Cologuard tests for blood or altered DNA in your stool that could be a sign of colon cancer. Cologuard detects colon cancer after you already have it. A colonoscopy, on the other hand, prevents colon cancer by detecting precancerous polyps, which can be removed during the exam.

A — Dr. Gorelick: We recommend colonoscopy screenings for all of our patients versus Cologuard. The Cologuard test is good for identifying advanced polyps and colon cancer, but it does not pick up polyps that can turn into cancer. This can create a situation where a patient thinks they have negative Cologuard test results, but they actually have a precancerous polyp. There are also issues with false positive tests and insurance coverage.

Q — Is there anything I can do to reduce my risk of developing colorectal cancer?

A — Dr. Gorelick: The best thing you can do to prevent CRC from developing is to follow your healthcare provider’s recommendations for preventive screenings and lifestyle modifications. Routine colonoscopies could save your life. Taking care of your overall health by eating a healthy diet, getting regular exercise, maintaining a healthy weight, limiting alcohol, and quitting smoking can also help to lower your risk for CRC.

Learn more about WCMG Danbury Gastroenterology Specialists, part of Nuvance Health, by visiting our website or calling (203) 739 7038.

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