Colorectal Cancer: why screening at age 45 is important.
Colonoscopies can help eradicate cancer before symptoms even appear.
Dr. Thosani is an associate professor at McGovern Medical School at UTHealth Houston and a gastroenterologist affiliated with Memorial Hermann.
Of the cancers that affect both men and women, colorectal cancer is the nation’s second leading killer, according to the U.S. Centers for Disease Control and Prevention. And it has become increasingly prevalent among people younger than 50, the National Cancer Institute notes, even as the rate has declined among older adults. But there are ways to protect yourself, the most important of which is to get a screening colonoscopy. Gastroenterologist Nirav Thosani, MD, discusses how you can reduce your risk. Q. The recommended age for a first screening colonoscopy recently changed from 50 to 45. Why did that change, and why is it important for people to
get that screening?
Dr. Thosani: What we started noticing in the last decade or so is a gradual increase in the rate of colon cancer in people younger than 50, and more people dying from colon cancer younger than 50. Those findings led to the development of the current guidelines for people with no family history to start undergoing screenings at age 45. A screening colonoscopy is the most helpful of all the interventions available to prevent colon cancer, because not only does it find polyps, or precancerous lesions, in the colon and rectum, it allows us to remove them before they become cancerous. Q. How common is colon cancer, and who is most at risk?
Dr. Thosani: It’s currently one of the top five leading cancers in the U.S., so it’s very prevalent. People with a family history of colon cancer or polyps are at a higher risk. Smoking is another risk factor, and so is obesity. One thing people might not realize is that excessive consumption of red meat – eating more than three servings a week – is another big risk factor. Q. What are the warning signs of colon cancer?
Dr. Thosani: Most of the time, there are no early signs. That’s another reason getting screened is so important. If you wait until you notice symptoms, usually that means the cancer has spread quite a bit. In those cases, you might notice blood in your stool or a change in your stool consistency. In some cases, the stool can become very thin and pencil-shaped. Abdominal pain can be a symptom, too, but that’s a tricky one because it can be a symptom of a lot of other gastrointestinal conditions as well.
Q. How can we reduce our risk? Dr. Thosani: The most important preventive measures are diet and exercise. Eating a high-fiber diet and reducing your meat intake definitely helps. Avoiding obesity and staying fit helps. If you don’t smoke, or if you quit smoking, that will reduce your risk. Genetic risk based on your family history is not something you can change, but if you have a family member who has had colon cancer or high-risk polyps, you want to start screening earlier — you may need to start at 35 or even earlier. The frequency of colonoscopies will depend on how many polyps we find, as well as the size and pathology type of those polyps. Q. Are colonoscopies becoming more comfortable?
Dr. Thosani: There have been a number of advances that have made colonoscopies more comfortable and the prep more tolerable. We now have a pill-based colonoscopy prep for people who can’t tolerate drinking the liquid solution. We also have a lower-volume version of the bowel prep, which is one liter as opposed to four liters. And there have been modifications to what you can eat the day before the procedure. It used to be a clear liquid diet, but now you can have low-fiber and low-residue foods such as eggs, milk, yogurt, cheese, white bread and white rice, if needed. That has increased the rate of patient acceptance for the procedure. Q. Are there other advances on the horizon?
Dr. Thosani: The endoscopes used in colonoscopies have gotten more flexible and the optics are more high-definition, which helps us see better and find polyps more easily. The most exciting advance has been the development of artificial intelligence working alongside the physicians, which can help you find more polyps. At UTHealth Houston and Memorial Hermann, we have been doing active research on new AI technologies. One AI technology we were studying is now FDA approved, and we’re doing clinical trials with two others. One of those not only finds polyps but it can also measure the size of the polyp. That helps us ensure that we’ve removed polyps completely, and we think that will have a huge impact on future colonoscopies.
Learn more about preventing colorectal cancer and scheduling your colonoscopy at memorialhermann.org/colon