Preventing colorectal cancer
Colorectal cancer rates among people younger than age 55 have nearly doubled since 1995, with colorectal cancer deaths also increasing in those younger than 55 each year.
Colorectal cancer develops from abnormal growths in the colon or rectum called polyps. Polyps are common, affecting 15–40 percent of people depending on age. Not all polyps become cancerous.
Monterey County resident and colorectal cancer survivor Jacqueline Chiesa is part of that increasingly younger population diagnosed with the disease.
Chiesa has an extensive history of Crohn’s disease which causes an increased colorectal cancer risk. She received 11 colonoscopies over the past 22 years, all of which were negative for signs of cancer.
Many people are hesitant about colorectal cancer screenings because they’re uncomfortable or don’t like the preparation, but screenings are easier than surgery or chemotherapy. Nobody should have to tell their family they have colon cancer, might die, and could have prevented it with screening.
— Dr. Michael Joel Mendoza, Gastroenterology and Internal Medicine, Community Hospital of the Monterey Peninsula
In 2022 when Chiesa underwent a hemicolectomy — a procedure to treat severe Crohn’s disease symptoms where part of the colon is removed — doctors were shocked to find a stage 3B cancerous polyp.
Doctors completely removed the polyp, and Chiesa underwent four rounds of chemotherapy to remove all the cancer cells. She says she will be closely monitored for the rest of her life.
“I never expected that at my age, with no family history of colorectal cancer, this would be my diagnosis,” Chiesa says. “I’m grateful to Dr. Mendoza at Community Hospital of the Monterey Peninsula and my surgical team at UCSF for giving me the ability to say I’m a cancer survivor."
Colorectal cancer screening, family history, and prevention
Gastroenterologist and internal medicine doctor Daniel Luba says the best ways to reduce colorectal cancer risk are regular screenings, being aware of family history, and living a healthy lifestyle by maintaining a healthy bodyweight, eating a healthy diet, exercising, not smoking, and limiting alcohol intake.
“Every adult should talk to their doctor about their family history of colorectal cancer, as well as screenings,” Luba says. “It could save your life.”
Colorectal cancer screening is critical to its prevention since the disease can be symptomless or hard to notice in early stages.
Official guidelines recommend screenings should start at age 45 for the general population.
For those with a family history of colorectal cancer, Luba says screenings should start at age 40 or 10 years prior to the age when the relative was diagnosed and should be done at an increased frequency.
Patients with a family history of colorectal cancer or Lynch syndrome — a gene mutation that increases hereditary cancer risk — should receive genetic testing to determine their risk.
If genetic testing indicates an increased risk, patients should receive enhanced screenings.
Family histories that indicate a recommendation for genetic testing:
- A blood-related father, mother, brother, or sister who developed colon cancer at or before age 50, or who carries the Lynch syndrome gene mutation
- Two or more second-degree relatives (e.g., aunt, uncle, grandparent, half-sibling) who developed colorectal cancer at or before age 50, or who carry the Lynch syndrome gene mutation
Those who test positive for the Lynch syndrome gene should start colorectal cancer screening in their early 20s.
When precancerous or early-stage cancerous polyps are found, they can easily be removed, often during the colonoscopy, to eliminate the cancer risk. When the cancer goes undetected and spreads, intensive treatment is required such as chemotherapy, radiation, and surgery.
Colorectal cancer screening options
Fecal immunochemical test (FIT)
- Performed yearly or as instructed by a doctor
- At-home fecal test that detects blood in stool, which could indicate a cancerous polyp
- Patient mails a fecal sample to a lab
FIT-DNA test
- Performed every three years or as instructed by a doctor
- Combines the FIT test with a test that detects abnormal DNA
- Patient mails entire bowel movement to a lab
Colonoscopy
- Performed every 10 years or as instructed by a doctor
- Patient is sedated for an examination
- Patient drinks a gallon of solution to prepare for the examination
- Preparation alternatives include methods using pills or a smaller volume of liquid
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CT colonography
- Performed every five years or as instructed by a doctor
- Also called a virtual colonoscopy
- Faster and less invasive than a traditional colonoscopy
- Checks for early signs of disease in the large intestine
- Preparation similar to colonoscopy
Sigmoidoscopy
- Performed every five years or as instructed by a doctor
- Minimally invasive examination
- Does not require sedation
- Preparation similar to colonoscopy
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A doctor and patient choose a screening plan depending on the patient’s risk level and preferences.
“Many people are hesitant about colorectal cancer screenings because they’re uncomfortable or don’t like the preparation,” Luba says, “but screenings are easier than surgery or chemotherapy. Nobody should have to tell their family they have colon cancer, might die, and could have prevented it with screening.”
Learn more about colorectal cancer screening, detection, diagnosis, treatment, gastroenterology, and more at Montage Health.
