Colorectal cancer is unique in that, unlike many other cancers, we know how it progresses from healthy to cancerous. We also know how to prevent it and catch it in its early stages, making it one of the only truly preventable cancers. Unfortunately, even with this knowledge, about 140,000 people are diagnosed with colorectal cancer in the United States every year. Even worse, colorectal cancer is the second leading cause of cancer-related death in the United States behind lung cancer.
What exactly do we know about this disease, and, using what we know, what can we do about it? In this article we will dive back in to the basics of colorectal cancer and what the Colorado Cancer Prevention Program, supported by the University of Colorado Cancer Center, is doing to eradicate this disease.
What We Know: Risk Factors, Signs and Symptoms
The risk factors, signs, and symptoms of colorectal cancer in the average risk population are fairly established in the medical community.
Generally, signs of colorectal cancer include unexplained weight loss, blood in your stool, change in bowel habits, abdominal discomfort, or no symptoms at all. While these topics may be uncomfortable to talk with your doctor about, if you are experiencing symptoms, it is important to be evaluated (no matter your age!).
It is also important to be aware of your risk. If you are 50 years old or older with no personal or family history of cancer, you are considered average risk of developing colorectal cancer. A family or personal history of colorectal cancer can increase your risk of colorectal cancer, as well as specific familial or genetic syndromes, in which case you might need to begin screening before age 50.
“The strongest risk factors for colorectal cancer are things we can’t do anything about,” explains Dennis Ahnen, MD, gastroenterologist and CU Cancer Center member. “This includes things like where you are born, age, your race and your socioeconomic status.”
Other well-known risk factors include smoking, excess alcohol, obesity, lack of physical activity, and diets that are high in red/processed meat. It is important to note that these are modest risk factors and do not necessarily directly lead to colon cancer.
“The biggest risk factor for the development of colorectal cancer in the United States is failure to get screened,” says Ahnen.
What We Know: Screening Saves Lives
According to the organization Fight Colorectal Cancer,60 percent of colon cancer deaths in the average risk population could be prevented through screening.
“We recommend that all individuals 50 and older get screened for colorectal cancer regardless of whether they have a family history or symptoms,” says Swati Patel, MD, CU Cancer Center investigator, and assistant professor of gastroenterology at CU School of Medicine.
Screening options typically come in two categories: stool testing and structural testing.
“Stool testing is meant to detect things that a colon or rectal (colorectal) tumor may shed into the stool, such as microscopic blood,” says Patel. “The benefits of this test are that it can be done in the privacy of your own home and it does not require changes in diet or bowel prep.”
A positive test result from a stool sample does not necessarily mean that you have colorectal cancer. However, a positive stool sample test is an indication that more testing is needed, specifically experts recommend that a positive stool sample test is followed by colonoscopy to make sure that the blood is not coming from a precancerous polyp or cancer tumor.
The more common screening procedure is the colonoscopy, in which a doctor can directly visualize the rectum and the colon through a flexible probe that is inserted in to the rectum and advanced. The patient is sedated during this process and does not feel anything. Colonoscopies allow doctors to see precancerous polyps and remove them, thus preventing the cancer altogether.
“Patients often ask me what is the best screening test for colorectal cancer,” says Patel. “My response to them is the test that will get done.”
In Colorado, less than 70 percent of Coloradans are screened for colorectal cancer. This is lower than the national average.
What We Know: Patient Navigation Increases Screening Rates
People in underserved or underinsured populations are less likely to be screened than the general population, due in part to limited access and informational resources. Unfortunately, lack of screening often leads to diagnosis once cancer has reached a more advanced state in these populations.
“What studies have shown is that people who don’t have access to screening are at the highest risk,” says Andrea (Andi) Dwyer, director of the Colorado Cancer Screening Program (CCSP) at CU Cancer Center, and program director at the Colorado School of Public Health. “The CU Cancer Center and a number of agencies through Colorado have put a lot of time into the workforce development of patient navigation. These navigators have the ability to really interact with patients to overcome barriers such as language or getting to a location to be screened, integrating evidence-based practices to increase colorectal cancer screening.”
A studyfound that people living in rural parts of the state have the lowest screening rates in Colorado.
“Making sure patients get to their appointments and understand the importance of getting screened is critical. Navigation increases access by decreasing barriers,” says Dwyer. “Screening is the best opportunity to decrease the burden of mortality in colorectal cancer.”
The CCSP is a statewide program that partners with safety net hospitals and clinics to offer no-cost patient navigation services for cancer screening to medically underserved populations in Colorado and is funded by the Cancer Cardiovascular and Pulmonary Disease Grants Program.