Importance of Colorectal Cancer Screening

Woman with abdominal pain outside bathroom

March is designated Colorectal Cancer Awareness Month. According to the American Cancer Society (ACS), colorectal cancer is the third most commonly diagnosed cancer (excluding skin cancers) in both women and men and the second most common cause of cancer-related deaths. The ACS estimates colorectal cancer will claim almost 52,980 lives this year.

Though women face a slightly lower colorectal cancer risk than men, about 1 in 25 U.S. women will be diagnosed during their lifetime.

Colorectal cancer is one of the only cancers that can be prevented with regular screening. Colorectal cancer begins as a polyp, a tiny growth which occurs on the inner wall of either the rectum or colon. Polyps may start as benign (non-cancerous) growths, which may change and grow into becoming cancerous as time passes, potentially spreading into the lining of the rectum or colon and going beyond into the bloodstream and lymph system.  Polyps discovered during screening are removed and analyzed, thus eliminating potential colorectal cancer from occurring once polyps are removed.

Recommended colorectal cancer screening is a powerful health tool which can prevent its occurrence, diagnose it at its earliest stages and offer greatest prognosis and outcome. When detected early, colorectal cancer is curable about 90% of the time.

While most 65+ age Americans heed the call for scheduling preventive colorectal cancer screening as recommended, the incidence of colorectal cancer among younger U.S. adults has steadily risen since at least the mid-1990s:

  • Between 2012 through 2016, the number of colorectal cancer diagnoses increased every year by 2% in people younger than age 50 and by 1% in those ages 50 to 64.
  • Deaths from colorectal cancer among people younger than 55 have increased 1% per year from 2008 to 2017.
  • According to the Centers for Disease Control (CDC), Americans in their early 50s (age 50 to 54) are remiss about scheduling their first colorectal screening, with only 50% of the population up to date on recommended colorectal cancer testing.
  • With rising cases among those younger than 50 years, the U.S. Preventive Services Task Force updated its recommendations for screening to begin at age 45 in October 2020, five years earlier than previously designated, for those exhibiting average colorectal cancer risk factors.

Your local Capital Women’s Care team wants to share valuable information concerning signs and symptoms of colorectal cancer specifically relating to women, its associated risk factors plus preventive recommended screening options and lifestyle factors you can implement within your personal health plan to minimize your colorectal cancer risk.

Signs & Symptoms

Many signs and symptoms faced by younger women may be misconstrued as symptoms relating to gender-specific health concerns relating to menstruation or menopause.

It’s important to pay attention to your body and make note of anything out of the ordinary you’re experiencing and discuss signs and symptoms with your physician.

Following recommended screening guidelines are important since early stage colorectal cancer usually presents without any accompanying symptoms.

Symptoms and signs to watch for include:

  • constipation, diarrhea, or additional changes in bowel habits
  • ribbon-like stool consistency or darkened stool coloration
  • blood in stool or rectal bleeding
  • sudden, severe abdominal pain or cramps
  • increased acid reflux even while taking acid prescriptions or over-the-counter medications
  • having the sensation that the bowel hasn’t completely emptied
  • unexplained weight loss
  • and fatigue, feeling weak or having noticeable reduced energy level.

Some colorectal cancer symptoms may be easily mistaken for those symptoms similarly occurring during menstruation cycles. Some examples include:

After menopause, a woman’s risk of all cancers increases. You may also be at increased risk for developing hereditary polyposis colon cancer (HPCC), also known as Lynch syndrome, if you have history of endometrial cancer and carry the gene mutation MMR.

It’s vital to discuss with your healthcare professional if you regularly experience these symptoms or they onset for the first time, even if symptoms align within your menstrual cycle timeframe or linger for more than 1 month. It’s important to also relate if symptoms feel differently than those symptoms usually experienced around your menstrual cycle.

Colorectal Cancer Risk Factors in Women

Most of the same factors that raise the risk of colon cancer for men are the same for women, including:

  • Increased age. Risk tends to increase significantly after the age of 50, though younger people can develop colon cancer.
  • Personal history of polyps. If you’ve had previous benign polyps, you face higher risks of subsequent cancerous polyps. Additionally, having had colon cancer puts you at higher risk of developing new cancerous polyps.
  • Ethnicity. Blacks have a greater risk of colon cancer than other ethnicities. Black Americans are often diagnosed with either more advanced colorectal disease or may have more aggressive disease when they are diagnosed. This group also has the highest colorectal cancer incidence (20%) and mortality rates (40%) of all U.S. groups. Those of Eastern European Ashkenazi Jewish decent have one of the highest colorectal cancer risks of any ethnic group globally.
  • Family history of colon cancer or polyps. Having a parent, sibling or other close relative with colon cancer or history of polyps makes you more likely to develop colon cancer. About 1 in 3 people who develop colorectal cancer have other family members diagnosed with the disease.
  • Radiation treatment. If you’ve received radiation therapy to treat cancers in the abdominal region (including those pertaining to cervical cancer) you may be at higher risk for colorectal cancer.
  • Inflammatory intestinal conditions. Chronic inflammatory colon diseases like ulcerative colitis and Crohn's disease can increase colon cancer risk.
  • Type 2 Diabetes diagnosis. People with diabetes or insulin resistance have increased risk of colon cancer.
  • Hereditary syndromes. Having a diagnosis of familial adenomatous polyposis (FAP) or hereditary non-polyposis colon cancer (HNPCC), also known as Lynch syndrome, increases colorectal cancer risk. The MMR gene mutation has been linked to HPCC. Lynch syndrome accounts for about 2% to 4% of all colorectal cancer cases.
  • Unhealthy lifestyle. A sedentary lifestyle, obesity, high-fat and low fiber diet, smoking and excessive alcohol consumption all can raise risk. Women are advised to limit alcohol intake to one drink per day.

Minimizing Your Colorectal Cancer Risk

Fortunately, there are several factors within your control that directly link to minimizing colorectal cancer risk, including:

  • Maintaining a healthy weight.
  • Getting regular moderate to vigorous physical activity daily.
  • Instituting a healthy, fiber-rich diet featuring plenty of fruits, vegetables and whole grains while minimizing red and processed meats, both of which have been proven to increase colorectal cancer risk.
  • Eliminating smoking.
  • Avoiding moderate to heavy consumption of alcoholic beverages.
  • Maintaining appropriate screening schedules for colorectal cancer.

Colorectal Screening and Testing

Colorectal cancer often doesn’t present noticeable symptoms until its advanced stages. Recent data shows the number of new cases of colorectal cancer in the U.S. is increasing in younger populations.

The American Cancer Society recommends regular colorectal cancer screening for people at average colorectal cancer risk beginning at age 45.

People with a family history of the disease or who have any of the above risk factors should talk with their doctor about initiating colorectal cancer screening at an earlier age.

The U.S. Preventive Services Task Force recognizes two types of tests to screen for colorectal cancer: direct visualization tests and stool-based tests.

Direct visualization tests include procedures where instruments aid the doctor in evaluating the colon and rectum:

Colonoscopy – an outpatient procedure that looks inside the rectum and colon for polyps and abnormalities, including cancer. A colonoscope, a thin, tube-like instrument with light and viewing lens, is inserted through the rectum into the colon. The colonoscope may also have a tool to remove polyps or tissue samples, which are then checked under a microscope for signs of cancer. Patients are sedated during the procedure. Pre-exam preparation includes emptying the digestive tract through ingesting a prescribed laxative to clear the digestive tract so that the entire wall of colon and rectum are highly visible during the procedure.

This test is considered the gold standard of colorectal cancer screening, as all polyps are removed during the procedure and subsequently tested. This screening should be done every 10 years for those of average colorectal cancer risk.

Virtual Colonoscopy (Computed Tomography Colonography CT) - a procedure which uses a series of x-rays called computed tomography to make a series of pictures of the colon. A computer puts the pictures together to create detailed images that may show polyps and/or anything unusual on the colon’s inside surface. Those with average colorectal cancer risk using this screening option should be tested every 5 years.

Flexible Sigmoidoscopy - a procedure to look inside the rectum and sigmoid (lower) colon for polyps, abnormal areas or cancer. A sigmoidoscope is a thin, tube-like instrument with light and viewing lens, is inserted through the rectum into the sigmoid colon. It may also have a tool to remove polyps or tissue samples, which are then checked under a microscope for signs of cancer. Those with average risk who choose this screening option should schedule every 5 years.

Stool-based tests are obtained from your physician and may be done by the patient within the comfort of their home. Once samples are obtained, the completed test is sent out to a specialized laboratory which analyzes stool samples:

Fecal Immunochemical Test (FIT) – this test checks for hidden blood in the stool from the lower intestines. This test, which can be done in the privacy of your own home, must be done every year.

Guaiac-Based Fecal Occult Blood Test (gFOBT) – this test locates hidden (occult) blood in the stool via chemical reaction. This test, which checks more than one stool sample and can be done in the privacy of your own home, must be done every year.

If gFOBT is chosen for colorectal screening, the American Cancer Society recommends the highly sensitive versions be used. Some food or drugs can affect test results and should be avoided to maintain test accuracy.

FIT-DNA Test (Stool DNA Test) – this test combines the FIT with a test detecting 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 cancer cells. This test is recommended every 3 years by the ACS for those with average colorectal cancer risk.

It’s important to discuss and evaluate screening options with your physician based on your family and personal health histories to select the best colorectal cancer screening method for you.

The ACS recommends the following for those of average colorectal cancer risk:

  • People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through age 75.
  • For those ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, their overall health and prior screening history.
  • People 85+ years should no longer get colorectal cancer screening.

The ACS advises if you choose to be screened with a test other than colonoscopy, any abnormal test result should be followed up with a timely colonoscopy.

Some of these tests might also be used if you have other digestive diseases such as inflammatory bowel disease.

The important thing is to integrate recommended regular colorectal cancer screening within your personal health plan for colorectal cancer prevention and also to obtain earliest diagnosis and treatment should colorectal cancer diagnosis occur.

Treatment Options

If your screening results in colorectal cancer, you may undergo any of the following treatments:

Surgery -- In early stages, colon cancer may be treated by simply removing cancerous polyps. If the disease progresses, additional surgeries may be necessary.

Systemic therapies -- powerful chemotherapy medications are often administered intravenously to kill cancer cells. This is often recommended if cancer has spread into the lymph nodes.

Sometimes chemotherapy is started before surgery to help shrink the tumor(s).

Targeted therapies (immunotherapies) may also be recommended and can be used alone or in conjunction with chemotherapy.

Radiation therapy -- powerful energy beams are aimed at cancerous tumors to shrink or destroy them. Radiation therapy is sometimes done in conjunction with chemotherapy and may be recommended prior to surgery.

Survival Outlook

The survival rate for colon cancer is the same for women and men. The main factor affecting survival rate is how far the cancer has spread. Age and overall health are also important factors.

In general, localized colon cancer that hasn’t spread beyond the colon or rectum has a 5-year survival rate of 90 percent.

The 5-year survival rate for cancer that’s spread into nearby lymph nodes or other tissue is 71%. Colon cancer that has spread farther within the body has a much lower survival rate.

When reading survival rate statistics, it’s important to keep in mind treatments are constantly evolving.

Unlike some other types of cancer, colon cancer can usually be detected early through routine screenings and treated before it spreads.

Colon cancer is one of the most treatable cancers, but the only way to detect it is through screening. People with an average risk of colon cancer should start screenings at age 45. Earlier screening may be recommended for anyone with a family history of colon cancer, polyposis syndromes or Lynch syndrome.

If you have any conditions that affect the gastrointestinal (GI) tract, such as irritable bowel disease or Crohn’s disease, talk with your doctor or GI specialist to determine when and how often you should be screened.

Your local Capital Women’s Care team is here to help you incorporate regular preventive screenings within your personal healthcare plan and offer expert and comprehensive professional care and guidance to help you achieve optimal quality and longevity of life.

Sources:

https://www.healthline.com/health/colorectal-cancer/colon-cancer-in-women
Colon cancer - Symptoms and causes - Mayo Clinic
Colon cancer screening: Weighing the options - Mayo Clinic
https://www.roswellpark.org/cancertalk/201803/symptoms-colon-cancer-women
https://www.womenshealthmatters.ca/health-centres/colorectal-cancer/
https://www.womenshealthmag.com/health/a19970430/colorectal-cancer-signs/
https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-cau...
https://newsnetwork.mayoclinic.org/discussion/updated-screening-guidelin...
https://www.cancer.org/latest-news/signs-and-symptoms-of-colon-cancer.html
Colorectal Cancer Rates Higher in African Americans, Rising in Younger People
Colorectal Cancer Rates Rise in Younger Adults
Six Ways to Lower Your Risk for Colon Cancer
Updated screening guidelines for colorectal cancer – Mayo Clinic News Network
Colorectal Cancer Screening (PDQ®)–Patient Version - National Cancer Institute
https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-st...
https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-st...
https://www.cancer.gov/types/colorectal/screening-fact-sheet

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