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What You Need to Know about Colorectal Cancer
September 11, 2020
The untimely passing of actor Chadwick Boseman, 43, has many people turning their attention to what caused his death: early onset colorectal cancer (CRC). It’s important to understand the disease, what causes it, and who may face an elevated risk of developing it.
Weill Cornell Medicine’s Felice Schnoll-Sussman, MD is director of The Jay Monahan Center for Gastrointestinal Health; an associate attending physician at the NewYork-Presbyterian Hospital/ Weill Cornell Medical Center; and professor of clinical medicine at the Weill Medical College of Cornell University, and Andrea Betesh MD, assistant professor of medicine, Division of Gastroenterology and Hepatology discuss what patients need to know about colorectal cancer.
How common is early onset colorectal cancer?
Dr. Schnoll-Sussman: Although the overall incidence of colorectal cancer in the United States has been declining over the past few decades, in patients younger than 50, it has been climbing by one to three per cent a year.
The patients act differently than the average-onset colorectal cancer patient: they often do not have the typical risk factors such as a poor diet or a sedentary lifestyle. Their tumors behave differently, too; they’re more likely to be located in the lower portion of the colon, especially the rectum--present already with metastatic disease and are biologically different with molecular differences.
It is said that Black communities experience a higher incidence of colorectal cancer. What are the statistics associated with this, and what role do genetics and family history play?
Dr. Schnoll-Sussman: African Americans have both the highest incidence of colorectal cancer and the shortest survival rate of any racial or ethnic group in the United States for most cancers. Nearly 20,000 new cases of colorectal cancer were expected in the United States among African Americans in 2019, with incidence rates 24 percent higher in black men and 19 percent higher in black women compared to other races, according to the American Cancer Society. Black colorectal cancer patients are also 15 to 20 percent more likely to die from the disease than patients of any other race.
These grim statistics may be due to multiple factors, including the fact that Blacks are more are more likely to have an aggressive subtype of colon cancer attributed to a genetic mutation, and have right-sided cancers that may lead to a later diagnosis and poorer prognosis.
Are there any unique risk factors associated with early onset CRC?
Dr. Betesh: The most well-established risk factor for early onset CRC is family history. If other members of your family had CRC, especially if they were diagnosed with CRC at a young age, you may have an increased risk of young onset CRC.
There are also some genetic syndromes (such as Lynch Syndrome and familial adenomatous polyposis) in which people are born with specific genetic mutations that increase their risk of developing CRC at a young age. We don’t fully understand why there has been an increase in young onset CRC, but there may be other risk factors for it--diet, obesity, smoking--however, this is still an area of active research.
What about lifestyle factors?
Dr. Betesh: Although there are early-onset patients who lead healthy lifestyles, there still are things we can do to decrease risk. Generally, what keeps the body healthy overall also is good for the colon: a healthy diet with lots of fiber in the form of fruits, vegetables, and whole grains; routine exercise; and maintaining a healthy body weight.
Smoking, drinking alcohol in excess, and eating a diet high in processed meats can boost the risk.
How do physicians screen for colorectal cancer? At what age should screenings begin, and should it be earlier or more often for some people?
Dr. Betesh: Colonoscopy is the best test for CRC. The physician uses this to closely examine the lining of the colon and look for pre-cancerous polyps while the patient is sedated. The physician can remove polyps during the procedure, decreasing the risk of developing CRC.
Stool tests also can screen for colon cancer. These tests don’t prevent CRC, but can help detect it early, before the onset of symptoms. Stool-based screening tests must be done more frequently (typically every one to three years), depending on the specific test. Early detection makes it easier to treat and potentially cure CRC.
For the general population, CRC screening should begin between age 45-50. For Black individuals, screening should start at age 45. If there’ s a family history of the disease, screening should begin earlier, generally at age 40, or 10 years prior to the age at which the relative was diagnosed with CRC.
If you are screened with a colonoscopy, you may be able to do this once every 10 years. Individuals with colon polyps or a family history of CRC may need to undergo screenings more frequently. Individuals with certain genetic syndromes that increase the risk for CRC also should begin screening at a younger age.
What are some of the symptoms that can be associated with colorectal cancer?
Dr. Betesh: Patients should look for changes in bowel habits, blood in the stool, or unintentional weight loss. If you experience any symptoms that you worry could be related to CRC, see your doctor right away. The earlier you seek medical care, the better.
Dr. Schnoll-Sussman: The most important thing to learn from this tragedy is that colorectal cancer is not a disease limited to older people. There is no age or gender or racial discrimination with this disease. Patients need to know their family history, be in tune with their bodies and speak with their physicians if they start experiencing any signs or symptoms consistent with colorectal cancer