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Colon Cancer: Risks, Prevention and Removing Precancerous Polyps

March 15, 2018

Excluding skin cancers, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. During “March is Colon Cancer Awareness Month,” Hartford Hospital gastroenterologist Dr. Eileen Plotkin answers your questions about the disease. 

Q. What should the general population know about colorectal cancer? 

A.  Colorectal cancer is a common and lethal disease. It is the third most commonly diagnosed cancer in men and women in the United States, and is the second leading cause of cancer related deaths in the country.

The risk of developing colon cancer increases as people get older, with more than 90% of cancers diagnosed in people over 50 years of age. People with a family history of colon cancer and African Americans are at increased risk for the disease. Men also have a slightly higher risk of developing colon cancer than women.

Approximately one in three people who develop colon cancer die of this disease. Fortunately, both the incidence of and mortality rates from colon cancer have been declining in the United States. Getting screened—and treated early if cancer is found— reduces the risk of dying from this disease.

Q.  Are there any effective strategies for the prevention of colon cancer?

A.  It is estimated that in 2015, about 133,000 people were diagnosed with colorectal cancer, and about 50,000 will die from it. Screening is the process of looking for cancer or pre-cancer in people who have no symptoms of the disease. Regular colorectal cancer screening is one of the most powerful ways to prevent colorectal cancer.

Q: What do the guidelines say about how to prevent colon cancer-related death?

A: The US Preventative Task Force has identified several effective ways to be screened for colon cancer including stool testing, flexible sigmoidoscopy combined with stool testing and colonoscopy. Of these three strategies, colonoscopy yields the most life years gained.  It is unfortunate that only a little more than half of people who are at risk for colorectal cancer undergo the testing they should.

Q.  Who in the general population benefits from the screening?

A.  To maximize the impact of screening, it is not just sufficient to recommend a procedure to patients. Screening must be targeted to appropriate patients, performed properly at appropriate intervals, and supported by patient education.

Since more than 90 percent of colorectal cancers occur in people aged 50 and older, those between 50 and 75 years of age would benefit the most from colorectal cancer screening. Adults ages 76 to 85 may also benefit, especially if they have never been screened before and are healthy enough to undergo treatment, if cancer is found. Those with family history of colon cancer, precancerous polyps or certain inherited syndromes should undergo screening before age 50 years and should consult their doctor.

Q.  People often worry about getting screened. What can you tell them about a colonoscopy to make them feel  more comfortable?

A. Although the procedure is often identified by the vigorous bowel preparation, colonoscopy has the benefit of reducing colon cancer related deaths by identifying and removing precancerous polyps.  Polyps are small growths that can over time become cancer. About 1 in 4 men and 1 in 3 women will have precancerous polyps found on colonoscopy. If you have family history of colon cancer or polyps the chance of finding polyps goes higher.  Colonoscopy is commonly done with sedation. The doctor looks at the entire length of the colon with a colonoscope, a thin, flexible tube with a small video camera on the end. The test is generally well tolerated and has very low risk of complications.  If you are over 50, please talk to your doctor or gastroenterologist about scheduling a colonoscopy. If you have family history of colon cancer or precancerous polyps or any concerning symptoms like rectal bleeding, unexplained weight loss, colonoscopy might be recommended at an earlier age, so speak to your doctor.

Q.  Any advice about diet and lifestyle changes to prevent colon cancer?

A.  At this time, the best advice about diet and activity to possibly reduce your risk of colorectal cancer is to:

• Avoid obesity and weight gain around the midsection.
• Increase the intensity and amount of your physical activity.
• Limit red and processed meats.
• Eat more vegetables and fruits.
• Get the recommended levels of calcium and vitamin D.
• Avoid excess alcohol.
• Quit smoking.

Learn more about colorectal cancer prevention here.