I don’t have any family history of colorectal cancer or of colorectal polyps. Should I still be tested?

By: Dr. Rama Behara

Recently, I was in clinic when a young, fit 51-year-old-male (we’ll call him Joe) presented as a referral for colon cancer screening.  “Doc, do I really need this? I have no family history of colon cancer, I eat healthy, and I’m in great shape.”  After a fair amount of explaining and convincing, he understood the benefits for getting a colonoscopy simply based on his age. He was very fortunate that he got screened when we recommended it because we found and removed a 3 cm precancerous polyp. Had it not been done, he may have certainly developed colon cancer within the next 5-10 years!

We increase awareness of colon cancer and screening every year in March, since colorectal cancer is the third-leading cause of cancer-related deaths among men and women in the United States, according to the Centers for Disease Control and Prevention.  Many patients strongly believe they will not develop colon cancer since they have no family history or symptoms.  However, the most common sign of colon cancer is no symptom, which is why age is considered the most important factor in determining when to get screened. Current guidelines suggest screening for average risk adults from ages 50 to 80.  However, in 2018 the American Cancer Society recently advised a change in recommendations to start screening early at age 45 due to notable rise in colon cancer in individuals under age 50.  Obesity, diabetes and smoking have been independently associated with an increased risk of colorectal cancer while physical activity has consistently been shown to protect against colorectal cancer. Environmental factors such as consumption of red meat, high fat intake, alcohol use, tobacco usage and menopause confer some risk.  Thus even though there are not any family members with colon cancer, the risk of developing colon cancer is independent of a family history.

The unique fact behind colon cancer compared to other types of cancer in the United States is that we have screening tools to prevent it from occurring in the first place. This is because we can identify and remove premalignant lesions before they become cancer. We know that screening works.  At the end of the day, colonoscopies reduce cancers by 68 to 80 percent in persons who undergo the exam. Despite the optimistic endeavor to adhere to 80percent screening rates, it has not been met.  It is estimated that roughly 1 in 3 people are not up to date with screening for colorectal cancer. Reasons for poor adherence include the fear of being diagnosed with cancer, the misperception that it occurs in males more than females, no family history, bowel preparation needed for testing, and lack of symptoms that may lead to evaluation.   There are a variety of recommended screening tests. The gold standard is the colonoscopy, which provides both screening and prevention. Not only can it detect early stage cancers, but also precancerous lesions called polyps, can be removed to potentially prevent a cancer from developing.  Other testing options include stool collection tests and CT imaging may be done as a substitute for a colonoscopy but, if found to be positive, a colonoscopy is often recommended.

A common misconception is that if you live a healthy lifestyle, have no family history and have no symptoms, you are not at risk for colon cancer. While there is some evidence that engaging in a healthy diet and lifestyle may modestly reduce your risk of developing colorectal cancer, the most modifiable risk factor is failure to get screened.

When “Joe” came back to my clinic afterwards for his results, he was shocked to learn despite him doing his best to live a healthy lifestyle; a delay in having this important screening test may have led to him developing colon cancer. Remind yourself:  don’t be a statistic. If you do not have symptoms but fit an appropriate age to get checked, please consider getting tested. Facing a cancer diagnosis is much scarier than screening. Being diagnosed with colon cancer is not only treatable and curable if caught early, but most importantly preventable. 

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