Colorectal Cancer Awareness: Screening Tests Key to Prevention, Early Detection

March is National Colorectal Cancer Prevention Month, a good time to spread awareness about the disease, which is the third most common cancer for both men and women, and the third leading cause of cancer-related deaths in the U.S.  

The American Cancer Society (ACS), predicts that more than 153,000 new cases of colorectal cancer will be diagnosed in 2023, and 52,550 people will die from the disease.

While colorectal cancer rates have dropped in recent decades – due to increased screening and better awareness about lifestyle-related risk factors – that downward trend has generally been seen in older adults.

For people under the age of 50, colorectal cancer rates have been on the rise since the mid-1990s, increasing by 1% to 2% each year, according to the ACS.

Which is why routine screening tests, such as colonoscopy are so important for the prevention and early detection of colorectal cancer.  

Through colonoscopy, colorectal polyps can be found and removed before developing into cancer.  Colonoscopy can also detect cancer at an earlier stage, when it is easier to treat.  

Robert Driscoll, MD, a surgeon at the Dana-Farber Brigham Cancer Center in clinical affiliation with South Shore Health, answers five common questions on colorectal cancer screening, prevention and treatment.

When it comes to colorectal cancer prevention, how important are routine screenings?

Increases in routine screening for colorectal cancer and greater awareness about modifiable risk factors have substantially lowered both colorectal cancer incidence and mortality in older adults.

That has not been the case for adults under 50 years old, for whom colorectal cancer rates have actually increased annually during the past three decades, making routine screening even more important.

What kind of screening is available for colorectal cancer and at what age should people start?

For patients at average risk for colorectal cancer, regular screening should begin at age 45. There are two types of screening available; stool-based, including fecal immunochemical test (FIT) or Cologuard, and structural or visual-based testing through colonoscopy.

Stool-based testing is done yearly unless there is a positive test. Those patients should then undergo visual testing/colonoscopy. Visual testing is performed at 3-to 5-year intervals, depending on the findings.

People at increased risk for colorectal cancer should be screened earlier than age 45. Screening for this is individualized both for frequency and type of testing.

What are some of the risk factors for colorectal cancer and are there lifestyle changes that can lower someone’s risk?

There are several risk factors associated with the development of colorectal cancer. The risk factors that are modifiable include obesity, physical inactivity, a diet high in red meat, smoking and alcohol use.

Unmodifiable risk factors include age, a history of inflammatory bowel disease, inherited syndromes -- such as Lynch Syndrome, a family history of colorectal cancer or adenomatous polyps, familial adenomatous polyposis, and Type 2 diabetes.

Certain ethnic groups also have a higher incidence of colorectal cancer – particularly African Americans and Eastern Jewish groups.

What are some of the symptoms of colorectal cancer that someone should be concerned about and discuss with their primary care provider or specialist?

Concerning symptoms of colorectal cancer include changes in bowel habits, feeling the need to have a bowel movement but not feeling relieved by having one, rectal bleeding, weakness, fatigue, unexpected weight loss, cramping or abdominal pain.

What kind of treatment options are available for someone diagnosed with colorectal cancer?

Treatment options for source control center largely on surgical resection. Some early cancers can be treated with a minimally invasive or endoscopic treatment, with resection of the malignant polyps or removal of the tumor.

Usually, however, surgical resection of the involved section of the bowel will be needed. For more advanced cancers and cancers in certain parts of the intestinal tract (rectum), a combined treatment with radiation, chemotherapy and resection is needed.

Robert P. Driscoll, MD, is a surgeon at Brigham and Women's Harbor Medical Associates in Braintree. Learn more about colorectal cancer care at Dana-Farber Brigham Cancer Center in clinical affiliation with South Shore Health.