March is National Colorectal Cancer Awareness Month. Kentucky consistently ranks among the worst in colon cancer screenings and rates, but did you know that patients can modify their own risks for colon cancer and there are multiple screening alternatives to colonoscopies? Frederick Hardin, MD, KentuckyOne Health Gastroenterology Associates shares four things providers need to know about colorectal cancer.
- The American Cancer Society recently updated their guidelines to lower the average risk screening age.
In 2018, the ACS published guidelines lowering the screening age for average risk individuals from 50 years old to 45. This is in response to data showing a 51 percent increase in incidence of colorectal cancer in adults younger than 55 from 1994 to 2014. However, the U.S. Preventive Services Task Force still recommends screening average risk patients beginning at age 50, and health plans may or may not yet cover the screening test for individuals younger than 50. This could result in out-of-pocket expenses.
2. Patients can modify their own risk factors for colon cancer.
The risk of colon cancer increases with cigarette smoking, excess body weight, high consumption of alcohol and processed meat, physical inactivity, and low consumption of fruits, vegetables, and dietary fiber.
3. Prompt follow-up of positive non-colonoscopy screening such as FIT or Cologuard is imperative.
If a colonoscopy is delayed by 10 months or more after a positive fecal immunochemical test (FIT), there is a 48 percent greater risk of colorectal cancer, and the risk of advanced stage (stage III or IV) disease is double that of patients who receive a prompt follow-up colonoscopy. Effective screening requires an organizational program to ensure timely patient navigation.
4. Colonoscopy is still the gold standard for screening, especially in the increased risk group of patients, and the only modality that allows removal of premalignant lesions.
Multiple modalities exist for colorectal cancer screening, including FIT test, CT colonography, barium enema, and Cologuard. These offer an opportunity to increase screening compliance, primarily because of increased patient convenience, but there are drawbacks. Cologuard, for example, has a greater than 7 percent miss rate for colon cancer and only detects 69 percent of polyps with high grade dysplasia (soon to be malignant) and only 42 percent of polyps larger than one centimeter. Only colonoscopy is indicated for patients at increased risk, such as those with a family history of colon cancer or advanced polyps, personal history of polyps, history of inflammatory bowel disease, or personal or family history of a polyposis syndrome such as FAP or Lynch syndrome.