Colorectal Cancer Awareness Month

Women & Colorectal Cancer: Safeguarding Your Health

Colorectal cancer is the third leading cause of cancer deaths among U.S. women -- yet it is the only type of cancer that can be prevented through getting and following appropriate recommended proactive screenings.

Yale Medicine researchers identified a disturbing trend of continued rising colon cancer incidences among those born in 1990 and afterwards. The American Cancer Society (ACS) also iterates colorectal cancer incidence rates are increasing among those younger than age 50 years for as-of-yet undetermined reasons.

In 2020, almost 20% (or one-fifth) of U.S. adults aged 50 to 75 years haven’t been screened for colorectal cancer at all, according to the Centers for Disease Control (CDC.) The CDC further states approximately 7 out of 10 adults ages 50 to 75 years (or only 70%) were current with colorectal cancer screenings in 2020.

The overall lifetime risk of developing colorectal cancer is about 1 in 23 (4.3%) for men and 1 in 25 (4.0%) for women.

Colorectal cancer screening saves lives. In May 2021, the U.S. Preventive Services Task Force changed its colorectal cancer screening recommendation. The age at which adults with average colorectal cancer risk was recommended to begin screening was lowered from 50 years to 45 years, in effort to curb rising colorectal cancer diagnoses in younger populations, a trend several medical researchers identified in recent years.

March is Colorectal Cancer Awareness Month. Your local Capital Women’s Care team of women’s health professionals share important information about colorectal cancer; its risk factors, symptoms, screening guidelines and options; plus, what you can do to optimize your colorectal health, so you enjoy a long quality life.

What Is Colorectal Cancer?

Colorectal cancer occurs when cells in the colon (large intestine or large bowel) or rectum (passageway connecting the colon to the anus) grow out of control, according to the CDC. Sometimes abnormal growths (polyps) form in the colon or rectum. Over time, some polyps may turn into cancer. Screening tests can locate polyps so they can be removed before they turn into cancer. Screening also helps find colorectal cancer at an early stage when treatment offers best indications for positive outcome.

Colorectal Screening Recommendations

Regular screening, beginning at age 45, is key to preventing colorectal cancer and finding it early.

The U.S. Preventive Services Task Force (Task Force) recommends adults aged 45 to 75 years be screened for colorectal cancer. Adults aged 76 to 85 years are recommended by the Task Force to talk with their doctor about colorectal screening.

Those with identified colorectal cancer risk factors should speak with their practitioner to determine the best personalized screening plan to optimize their colorectal health.

Colorectal Cancer Risk Factors

In a recent report, the ACS identified ethnic disparities regarding colorectal cancer incidence and death rates.

Those identifying as American Indian or Alaska Native (AIAN) have the highest incidence rates for colorectal cancer. During 2014 to 2018, their rates were about 40% higher than those of Caucasians.

Colorectal cancer death rates are highest among Black Americans. During 2015 to 2019, death rates were almost 40% higher than rates among Caucasians. However, these data are based on information in death certificates, which is known to be missing accurate information on race for 1 in 3 people who are American Indian or Alaska Native. This indicates that all death rates for American Indian and Alaska Native people are underestimated by approximately 30%, which would mean colorectal cancer mortality rates are probably highest within this population.

More than half (55%) of colorectal cancers in the U.S. can be directly attributed to these potentially modifiable risk factors:

carrying excess body weight
being physically inactive
smoking for many years
eating too much red or processed meat
not eating enough foods with calcium, like milk, fortified plant-based milk (soy or almond milk), fortified orange juice, and tofu that contains calcium salt
drinking too much alcohol
and eating very few fruits, vegetables and whole grains.

Other colorectal risk factors include:

becoming older. Colorectal cancer risk increases with age.
being diagnosed with inflammatory bowel disease (like Crohn’s disease or ulcerative colitis.)
having a personal or family history of colorectal cancer or colorectal polyps.
having a diagnosed genetic syndrome like familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome.)

Symptoms in Women

It's important to note colorectal cancer can present symptoms in women, especially those relating to stool changes, like those experienced during menstrual cycles.

Prior to menstruation, your body releases hormones known as prostaglandins, which stimulate uterine contractions. These prostaglandins also may stimulate muscle contractions in your intestines and bowels, which are situated close to your uterus, causing more frequent bowel movements. Prostaglandins also reduce how well water is absorbed by the body, making the stool softer, thus increasing diarrhea risk.

Progesterone is another hormone that increases right before your period. For some, progesterone can affect the gastrointestinal tract, causing either constipation or diarrhea. In women having chronic bowel issues or an inflammatory bowel disease (IBD) like ulcerative colitis or Crohn’s disease, menstruation can make symptoms worse. Women diagnosed with endometriosis, uterine fibroids and ovarian cysts often experience increased risk of bowel changes due to increased progesterone levels accompanying menstruation.

Other factors associated with changes in bowel habits during menstruation include increased stress and anxiety plus dietary changes.

If you have monthly menstrual cycles and experience bowel changes, monitor symptoms and their timing to determine their correlation with your cycle. Discuss any concerns you may have with your local Capital Women’s Care practitioner to determine if further investigation is recommended.

Colorectal cancer symptoms to watch for include:

Rectal bleeding, including blood from the rectum, in the stool or in the toilet after a bowel movement.
Unusual stools having different appearances. Watch for dark or black stools, an indication of bleeding from a potential tumor. Talk to your doctor if you pass narrow, thin or ribbon-like stool, which may signal a tumor may be obstructing bowels or rectum.
Any changes in bowel movements, whether loose stool (diarrhea) or constipation (less than 3 bowel movements a week), especially if changes last for 2 weeks or longer.
Low energy or tiredness is a possible signal of anemia due to blood loss. Young women diagnosed with chronic anemia should explore additional causes beyond menstrual bleeding.

Colorectal Screening

Recommended screening can locate precancerous polyps (abnormal growths in the colon or rectum) that can be removed before turning into cancer. Screening also helps find colorectal cancer at an early stage when treatment presents best possible outcome.

Several screening tests can be used to find polyps or colorectal cancer. The Task Force outlines the following colorectal cancer screening strategies. It’s important to know that if your test result is positive or abnormal on some screening tests (stool tests, flexible sigmoidoscopy, and CT colonography), a colonoscopy test is necessary to complete the screening process.

Talk to your doctor about what tests are right for you:

Stool Tests

The guaiac-based fecal occult blood test (gFOBT) uses the chemical guaiac to detect blood in the stool and is done once a year. For this test, you receive a test kit from your health care provider. At home, you use a stick or brush to obtain a small amount of stool. You return the test kit to the doctor or a lab, where the stool samples are checked for the presence of blood.
The fecal immunochemical test (FIT) uses antibodies to detect blood in the stool and is also done once a year in the same manner as the gFOBT.
The FIT-DNA test (also referred to as the stool DNA test) combines the FIT with a test that detects altered DNA in the stool. For this test, you collect an entire bowel movement and send it to a lab, where it is checked for altered DNA and for the presence of blood. It is done once every 3 years.

Flexible Sigmoidoscopy

For this test, the doctor puts a short, thin, flexible, lighted tube into your rectum. The doctor checks for polyps or cancer inside the rectum and lower third of the colon. The test is done every 5 years, or every 10 years with a FIT test every year.

Colonoscopy

The colonoscopy is still considered the gold standard method for colorectal cancer screening. Colonoscopy is like flexible sigmoidoscopy, except the doctor uses a longer, thin, flexible, lighted tube to check for polyps or cancer inside the rectum and the entire colon. During the test, the doctor can find and remove most polyps and some cancers. Colonoscopy also is used as a follow-up test if anything unusual is found during one of the other screening tests. Colonoscopy is prescribed every 10 years for people who do not have an increased risk of colorectal cancer. If polyps are found, your doctor may recommend colonoscopy screening in 5 years to determine if polyps recur.

CT Colonography (Virtual Colonoscopy)

Computed tomography (CT) colonography, also called a virtual colonoscopy, uses X-rays and computers to produce images of the entire colon, which are displayed on a computer screen for the doctor to analyze. This test is done every 5 years.

The best screening method for you should be based on your personal and/or family history relating to colorectal cancer, your personal colorectal cancer risk factors or any concerning symptoms you may be experiencing.

Optimizing Colorectal Health

Fortunately, there are many things you can do to reduce risk of colorectal cancer:

Know your family history of colorectal cancer. Inform your practitioner of changes in your family’s health history so you can modify or augment your personal health plan to optimize your colorectal health.
Maintain a healthy weight. Monitor your diet and get your body moving to avoid additional colorectal cancer risks.
Exercise daily. Strive to be active at least 30 minutes per day. Be sure to include cardiovascular and strength training exercises you enjoy doing to optimize your health.
Eat a healthy diet. Plan to eat whole fruits and vegetables, lean proteins and intake plenty of fiber, calcium and water daily with both snacks and meals. Avoid processed foods, trans and saturated fats, excess sugar and salt, red and processed meats, and food additives. Treat your body like a machine by giving it healthy fuel filled with necessary nutrients to keep it strong and healthy.
Quit smoking, vaping or tobacco use entirely. It’s never too late to quit and the health benefits begin within minutes after you cease tobacco use.
Reduce alcohol consumption. Limit alcohol consumption to 1 drink and modify social drinking habits to reduce its effect on your colorectal cancer (as well as other types of cancer) risk.
Follow colorectal screening guidelines and recommendations determined with your practitioner to optimize your colorectal health. Getting routine screenings completed as recommended are sound practices to both monitor and maximize your colorectal health.

Your local Capital Women’s Care team of women’s health professionals is here to answer your questions or address your concerns relating to colorectal cancer or any women’s health issue. Our family of caring, compassionate doctors, nurses and support staff prioritize your health and wellbeing so you can achieve and enjoy a long quality life.