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03/29/2018 12:01 AMColorectal cancer continues to be a major health issue for Americans. In fact, it remains the third most-commonly diagnosed cancer among men and woman. We’ve made progress in preventing, diagnosing, and treating this cancer over the past 30 years, yet in 2017, approximately 135,000 new colorectal cancers were identified with an estimated 50,000 deaths. Because colorectal cancer remains a major killer of Americans, the American Cancer Society (ACS) and The American College of Gastroenterology have organized an initiative to get 80 percent of Americans screened for colorectal cancer by the end of 2018.
Cancers have surpassed cardiovascular diseases as killers of Americans. The one cancer we’ve made tremendous progress in terms of decreasing incidence is colorectal cancer. Since 2000, the incidence rate of colorectal cancer in people older than 50 has dropped by 32 percent. This trend is thought to be largely a result of screening colonoscopies, which can prevent colorectal cancer by detecting and removing precancerous growths called polyps. Before we become too celebratory about the progress, there are sobering new observations. We’re now seeing a sharp rise in the development of colorectal cancer in Americans aged 40 and 50. It’s believed some of these early cancers are secondary to genetic predispositions (about 20 percent), but the majority remain unexplained and disconcerting. In this age group, often these cancers are found in advanced stages because colorectal cancers weren’t considered as a diagnosis. This group traditionally hasn’t been screened for colorectal cancer because the incidence was very low. At the very least, the public and physicians need to be aware of this trend. Perhaps we should consider screening strategies to include this age group.
Current methods for screening for colorectal cancer include various options including colonoscopy, FIT testing (tests for blood in the stool), CT colography (CAT scan of the colon), tests for genetic abnormalities in the stool (Cologuard), and flexible sigmoidoscopy. In my opinion, colonoscopy remains the gold standard for screening not only because of its high accuracy but because of its ability to remove the precancerous growths (polyps) before they can turn into cancer. Perhaps, in reality, the best test is the one that actually gets done.
ACS guidelines for screening colonoscopies begin at age 50 for normal-risk adults repeated every 10 years thereafter. If there’s a genetic predisposition to colorectal cancer or if precancerous polyps are found, the interval is shorter. There are important exceptions to this general screening guideline, particularly when there’s a family history of colon cancer. Here, screening starts at age 40 or 10 years younger than the youngest colorectal cancer family member. African Americans and Hispanics reportedly have a higher incidence of colorectal cancer, so some guidelines recommend to begin routine screening at age 45.
So what does our colorectal cancer report card look like? In my opinion, we get a grade of “C” with approximately 50 percent of eligible Americans being screened. Connecticut actually does reasonably well compared to the rest of the country, with an estimated screening rate of 70 percent. We actually rank fifth in the country for screening rates among the eligible population. We should be able to do better by educating Americans of the importance of colorectal cancer screening. If you haven’t yet been screened, don’t wait! Contact your family doctor, internist, gynecologist, or gastroenterologist and discuss screening. We can do better and hopefully reach ACS’s goal for colorectal screening of 80 percent by the end of 2018. Perhaps, in the near future we can set our sights on getting an “A” on our colorectal cancer screening report card!
Dr Myron Brand is a resident of Madison. He is a clinical professor of medicine at the Yale University School of Medicine, and partner in the practice of Connecticut Gastroenterology Consultants with offices in Guilford, New Haven, Hamden, an North Haven. He is the medical director of the Yale Shoreline Endoscopy Center in Guilford.