The cancer death easiest to avert

Screening could help hundreds of thousands stay cancer free

Linda Marie Farkas, M.D.

Colorectal cancer is the third leading cause of cancer deaths among women and the second leading cancer killer among men in the United States, but it may also be the easiest to prevent.

According to the American Cancer Society, more than 135,000 people in the U.S. will be diagnosed with colorectal cancer and more than 50,000 will die from it in 2017. The disease does not discriminate; it affects all populations.

Talking with your doctor about screening is potentially lifesaving and essential for everyone over age 50, as well as for younger individuals with family histories of colon disease, type 2 diabetes or ailments such as irritable bowel disease (IBD). Approximately 15 percent of persons with colon cancer are under 50. A study published this month by the American Cancer Society found that people born in 1990 have double the risk of colon cancer and quadruple the risk of rectal cancer as those born in 1950. Family history or race are also risk factors; African Americans and Jewish Americans of Eastern European descent, for example, have higher rates of the disease.

“This is one of our most preventable cancers,” says Linda Farkas, chief of the Division of Colorectal Surgery at UC Davis Medical Center. “Screening is extremely important – both for average-risk individuals at recommended ages, but also for groups whose personal histories (such as radiation or IBD) indicate colonoscopies younger and more frequently.”

Colorectal cancer risks and preventions

The following risk factors increase the risk of colorectal cancer:

  • Age; risk increases after age 50
  • Family history of colorectal cancer; risk is doubled when parent, sibling or child has had the disease
  • Personal history; previous colorectal cancer, high-risk polyps, ovarian cancer, inflammatory bowel disease
  • Inherited risk; certain gene changes linked to familial adenomatous polyposis (FAP) or hereditary nonpolyposis colon cancer
  • Alcohol; drinking three or more alcoholic beverages per day
  • Cigarette smoking
  • Obesity

The following protective factors decrease the risk of colorectal cancer:

  • Lifestyle that includes regular physical activity
  • Aspirin; risk is decreased 10-20 years after patients start taking it
  • Combination hormone replacement therapy in postmenopausal women
  • Removal of polyps that are larger than 1 centimeter

It is not clear if the following affect the risk of colorectal cancer:

  • Use of nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin
  • Calcium supplementation
  • Diet; it is not known if a diet low in fat and meat and high in fiber, fruits, and vegetables lowers the risk, but studies have shown that diets high in fat, protein, calories and meat increases the risk

The following factors do not affect the risk of colorectal cancer:

  • Hormone replacement therapy with estrogen only
  • Use of cholesterol-lowering statin drugs
Source: National Cancer Institute

“While the colonoscopy is the only modality that is diagnostic and therapeutic at the same time, there are other screening tests patients can choose,” Farkas says. “A health professional can help guide the option that is best. The goal is to detect and remove precancerous polyps, as well as cancerous polyps at the earliest possible stage.”

Survival rates overall for individuals with colorectal cancer have greatly increased over the last decade, suggesting that more awareness of and encouragement to get screened has been effective. Survival continues to increase for those who get screened on time and regularly, but not all groups have experienced the same decline in morbidity. African Americans, Native Americans and Alaskan Natives have increased risks of death from colon cancer.

Studies suggest that groups with the lowest survival rates may also have the lowest screening rates. Greater encouragement may be required for those who are particularly uncomfortable approaching the topic with a physician for personal, financial or cultural reasons.

Patients should feel empowered to request health care in the manner that makes them feel most at ease, including in the language they are most comfortable with. Women may also want to request a female provider as they might with a gynecologist.

“Many women I’ve seen have delayed diagnosis and treatment because they were too shy or uncomfortable to see a male physician,” Farkas says. “If my gender allows patients that would not normally seek care to seek care, then so be it!”

Related information

About colorectal cancer from the UC Davis Comprehensive Cancer Center
Colorectal cancer care from the UC Davis Department of Surgery
Reducing your cancer risk: Simple changes for a healthier life

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