Age-appropriate screening is one of the keys to Personal Health Mastery, since early diagnosis can be the best way to disease containment and, in some cases, cure.   As a part of the information we will provide here on DMMD, widely accepted recommendations for screening for common diseases will be emphasized for this reason.  Dr. Lotsu talks about colon cancer risks and screening.

Here’s to Mastering Your Health!

DO YOU KNOW YOUR RISK FOR DEVELOPING COLON CANCER?

by Dzifaa Lotsu, MD

Colorectal cancer is a disease that affects men and women worldwide. In comparison to other forms of cancer, colon cancer ranks 3rd for women and 4th for men overall.  It affects all races and ethnic groups.  However, if diagnosed early, there is an almost 95% survival rate across all ethnic groups. Therefore, it is imperative that one knows his/her colon cancer risk and what to do about it, as this disease is largely curable if caught early. Screening through stool testing (so-called fecal occult blood test), colonoscopy, or newer methods, like CT colonography, have been shown to save lives.  Below is a discussion of risk factors that you should understand for colorectal cancer and appropriate timing for screening.

1.Age: Colorectal cancer is rarely diagnosed before the age of 40 (unless there is a strong family history). Furthermore, less than 5% of colorectal cancer cases are diagnosed between the ages 40-50. However, approximately 90-95% of new cases are diagnosed over the age of 50. What you can do: Before you 50th birthday, you should have a discussion with your physician about a screening colonoscopy or flexible sigmoidoscopy.

2.Family history: There is a 1.5-2-fold increase in colorectal cancer risk, if you have a first-degree relative diagnosed before the age of 50. If you have at least one first degree relative diagnosed with colorectal cancer before age 60, then you should have your screening for colorectal cancer at age 40, or at least 10 years before the age of that family member’s diagnosis.  For example, if you father was diagnosed with colon cancer at age 55, then you should have a screening colonoscopy by age 45.

3.Personal History: If you have a history of colon cancer, there is a 6-fold increase in the chance you will have other tumors/cancers. Because of this, you will need to have your colonoscopy frequently (ie. at least every 1-2 years).

4.Inflammatory Bowel Disease (IBD): There is a significant increase in risk of colon cancer in persons diagnosed with Ulcerative Colitis (UC) and Crohn’s disease (CD). Particularly in chronic UC when persons are diagnosed with what is called pancolitis (inflammation throughout the colon), the risk for colorectal cancer increases dramatically. These individuals should have a screening colonoscopy every 1-2 years.  The same is not true for Irritable Bowel Disease (IBS), which is commonly confused with IBD.  There is no increased risk of cancer with IBS.

5.Genetics: Familial Adenomatous Polyposis (FAP) &Hereditary Non-Polyposis Colorectal (HNPCC aka Lynch syndrome).  If you’ve never heard of these, then that’s probably a good sign.  These two syndromes involve a genetic predisposition to developing colorectal cancer as early as age 20. These syndromes require genetic counseling and testing. They are extremely rare but please discuss the options for genetic testing if you know a relative diagnosed with colorectal cancer before age 50.

6.Risk factors you can control: All of these below increase one’s risk for colorectal cancer.  Fortunately, these are all modifiable with lifestyle changes and medications.  Commit to them today!

A.Smoking- stop smoking

B.Obesity- commit to healthy dieting and daily aerobic exercise

C.Diabetes- consistent carbohydrate dieting, exercise and medications where appropriate

D.Coronary Artery Disease- diet, exercise and medications where appropriate

E.Alcohol- if your risk is elevated avoid over-consumption

7.Protective Factors:

A.Diet: A diet high in fruits and vegetables is protective against developing colorectal cancer. Some researchers believe that limiting your consumption of red meat decreases your risk as well.

•Consume more Calcium, Magnesium, and folic acid. These nutrients have been associated with lower colorectal cancer risk.

B.Exercise: Regular exercise boosts your immune system, which is a major defense mechanism against cancers of all kinds but certainly colorectal cancer.

C.Fiber: Some researchers believe that a diet high in fiber decreases your risk of developing colorectal cancer.

D.Medications: There is evidence that medication such as aspirin and a cholesterol lowering class of drugs, called statins, decrease colorectal cancer risk.  Please discuss with your physician to determine if these medications are appropriate for you.

Dzifaa Lotsu, MD, Internal Medicine, Northwestern University, and Gastroenterology Fellowship at Vanderbilt University, Nashville Tennessee.