The colonoscopy: It is one of those unwelcome rites of passage when turning 50, like all of the greeting cards announcing the supposed end of our prime. Let’s face it: the prep is unpleasant, the procedure can be uncomfortable and a colonoscopy can put you out of commission for the better part of a day.
But colorectal cancer is a deadly disease that can be caught early with proper screening. And unfortunately, it is no longer just a disease of the over-50 crowd.
More Colon Cancers in Younger Adults
A recent study by the American Cancer Society found that colorectal cancer incidence in the U.S. “is declining rapidly overall but, curiously, is increasing among young adults.”
The study looked at data collected between 1974 and 2013 on more than 490,000 people in the U.S.
“We’re having more people diagnosed with colorectal cancer, especially in their 40s, but also in their 30s and even in their 20s,” said Dr. Otis Brawley, chief medical and scientific officer and executive vice president of the American Cancer Society. Between 20 and 25 percent of rectal cancers are now diagnosed in people under 55, he said.
The (screening) test that you want and the test you can get is the best test for you.
— Dr. Otis Brawley, American Cancer Society
“The analogy might be this is a canary in the coal mine kind of thing. And we desperately need to look at why is this happening, why the change and what we can do to thwart the change,” Brawley said. Europe is not experiencing the same trend, he added.
A Possible Culprit?
Brawley said many epidemiologists believe the rise in colorectal cancers among younger people is due to changes in diet and exercise over the last 30 to 50 years. But at this point, that’s speculation.
“Our average daily calorie intake in the United States has increased dramatically; obesity patterns have increased dramatically,” Brawley said. “We’ve gone from 15 percent of all American adults being obese to closer to 40 percent today.”
Exercise was built into everyday life much more in prior decades, he said. It’s now common for families to have more than one car and drive for even short-distance trips, reducing the amount of walking they do.
A Deadly Disease
Colon cancer is the third most common cancer diagnosed among men and women in the United States. It is the second leading cause of cancer-related death in men and the third leading cause of cancer-related death in women. It is expected to kill more than 50,000 people in 2017, according to the American Cancer Society.
That’s why it is so important that people get screened for the disease, said Michael Sapienza, CEO of the Colon Cancer Alliance.
“It does, in general, take colorectal cancer a long time to develop in your colon or in your rectum and screening absolutely does save people’s lives,” he said. “It is one of the most preventable cancers — 90 percent preventable, when caught early. So not only getting screened that first time, but making sure people go back during those intervals, and the correct intervals, is really important.”
Only 60 to 65 percent of Americans over 50 are getting a screening test.
Sapienza’s own mother was diagnosed with colon cancer in 2009 at age 56. She died at 59. She had not had a colonoscopy, he said. It was that tragedy that prompted Sapienza to drop his career as a professional trumpet player and join the Colon Cancer Alliance.
Why People Avoid Colonoscopies
So what keeps people from getting screened? Sapienza said there are a number of reasons. “I think there is a large subset of our population and our communities and friends and family that just don’t want to take the time off of work,” he said. “They’re fearful of the test, they’re afraid it costs money even though it generally does not unless you have polyps and you’re a Medicare patient — then there is a co-pay.” (There are some exceptions to that Affordable Care Act rule. You can read about them here.)
Stigma may also play a role, Sapienza said. “There’s also in certain populations some machismo effect — they don’t want something stuck where the sun don’t shine.”
Fortunately, today, there are other options besides colonoscopy for at least an initial screening.
Other Types of Tests
Less invasive tests include a fecal occult blood test (FOBT), a fecal immunochemical test (FIT test), a home stool DNA test (currently being marketed as Cologuard), and a flexible sigmoidoscopy.
These tests need to be done more frequently than a colonoscopy, which is recommended every 10 years beginning at age 50. If any abnormalities are detected in any of the tests, the doctor will recommend a colonoscopy.
More frequent colonoscopies — every three to five years — will be done if polyps are found in the initial colonoscopy. And the test should be done earlier than 50 if an individual has a family history of colorectal cancer or a personal history of Crohn’s disease or ulcerative colitis.
All of the tests save lives, Brawley said. “The test that you want and the test you can get is the best test for you,” he noted.
Symptoms of Colorectal Cancer
Pay attention to symptoms — at any age, Brawley cautioned. Sometimes doctors don’t even recognize that the symptoms may indicate colorectal cancer when their patient is young, he said. The symptoms, according to the American Cancer Society, include:
- A change in your bowel movements, such as diarrhea, constipation or narrowing of the stool (“pencil-thin stool”) that lasts for more than a few days
- A feeling that your bowel is not emptying completely
- Rectal bleeding with bright red blood
- Blood in the stool, which may make it look dark
- Cramping or abdominal pain
- Weakness and fatigue
- Unexplained weight loss
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