Jamie Jarboe, M.D.
Colorectal cancer is the third most commonly diagnosed cancer in the United States (excluding non-melanoma skin cancer) and is the third leading cause of cancer deaths. According to the American Cancer Society and the SEER database, around 4-5% of men and women will be diagnosed with colorectal cancer in his or her lifetime. Colorectal cancer accounts for 8% of all new cancer diagnoses and about 8% of all cancer deaths as well.
The SEER (Medicare) database estimates that 65% of patients with colorectal cancer will survive to five years. Outcomes are, of course, better in patients with early stage disease. The American Cancer Society estimates that 87-92% of patients with Stage I colorectal cancer will live to five years after diagnosis. For stage two the percentage is 80-87%, 84-89% for Stage IIIA, 69-71% for Stage IIIB and 53-58% of patients with stage IIIC disease. Those patients with metastatic disease will make it to five years post-diagnosis in only about 11-12% of the cases. The death rate for colorectal cancer has been decreasing for the last few decades across the country. There does, however, remain areas of the country (and Kentucky included) that remain hot spots for the disease with increased levels of mortality. Correlating with increased mortality is often a finding of decreased screening. One such hot spot was identified in 2015 in west central Appalachia which includes Eastern Kentucky.
Colorectal Cancer in Kentucky
Based upon the most recent published data colorectal cancer represents the second most common malignancy in Kentucky behind only lung cancer. In 2001 Kentucky ranked 50th in colorectal cancer screening with a dismal screening rate of 34.7%. The state was able to increase the screening rate into the 65% range with an improvement in ranking to 23 over 10 years from 2001-2011. This resulted in a 16% decreased incidence and mortality of colorectal cancer.
The state established the Kentucky Colon Cancer Screening Program in 2008 in order to increase awareness and education about screening for colorectal cancer. The website provides valuable data and tools for patients to understand the importance of and options for screening. It also provides tools for physicians to help educate patients. (chfs.ky.gov/dph/coloncancer.htm)
Based upon data in 2013 Kentucky remains in the top third of states in regards to colon cancer incidence and mortality so we still have room for improvement. Part of this high rate is certainly related to the hot spot of colon cancer in Appalachia in Eastern Kentucky.
Colon Cancer Screening
Average risk patients should start screening at the age of 50 (or 45 if African American). The preferred testing is with colonoscopy but there are multiple modalities available for screening.
A number of different medical societies have published guidelines about screening for colon cancer. Guidelines vary for patients at average versus increased risk. I will review average risk guidelines. Patients with family histories of colon cancer or known hereditary cancer syndromes should discuss screening with their physician.
American College of Gastroenterology recommends colonoscopy as the first choice for cancer PREVENTION. If patients decline colonoscopy or other PREVENTION screening then FIT (fecal immunochemical testing to detect blood in a stool sample) is the preferred cancer DETECTION test. ACG recommends beginning screening for average risk patients at the age of 50 except for African Americans for which they suggest starting at the age of 45 (due to an increased risk of colon cancer in this population).
The US Preventative Task Force recommends colon cancer screening, which they define as colonoscopy, sigmoidoscopy, virtual colonoscopy (CT colonography) or fecal occult blood testing, from ages 50-75. Similarly the American Cancer Society recommends colon cancer screening starting at age 50 and they define screening studies as colonoscopy, sigmoidoscopy, barium enema or virtual colonoscopy. The National Comprehensive Cancer Network recommends colonoscopy as screening for average risk patients starting at age 50. Alternatives to colonoscopy include stool-based studies, sigmoidoscopy or virtual colonoscopy.
All patients should discuss colon cancer screening with their primary care physicians in order to determine the best timing and the best test for each patient.
Colon Cancer Prevention
Family history, hereditary syndromes and inflammatory bowel disease can all increase a person’s risk for colon cancer. These are factors we do NOT have any actual control over.
There are several risks that we can and should have control over in order to decrease our personal risk for colon cancer. These include obesity and a sedentary lifestyle. There are numerous studies suggesting a link between obesity and physical inactivity and a variety of malignancies, not just colon cancer.
Smoking is another risk factor for colon cancer and certainly plays a role in the increased incidence and mortality of colon cancer in Kentucky. Heavy alcohol use is another important risk factor for colon cancer. The American Cancer Society recommends not having more than two drinks a day for men and one drink a day for women.
Diet places a role in colon cancer development as well. Diets high in red meat and processed meats along with diets high in meats that are cooked at very high temperatures (grilling, frying) increase a person’s risk of colon cancer. Studies have shown that diets high in fruits and vegetables result in a decreased risk of colon cancer. Importantly, studies looking at fiber supplements showed no benefit.
Signs/Symptoms of Colon Cancer
Colon cancer can present in a number of different ways. Some signs or symptoms that patients might notice include abdominal pain, a change in bowel habits (i.e. constipation, diarrhea or change in stool caliber lasting more than a few days) and blood in the stool or dark tarry stools. Additionally patients may experience fatigue, weight loss, change in appetite and anemia. A patient who develops any of these signs or symptoms should discuss immediately with their primary care physician so proper evaluation can begin.
Colon cancer is an important malignancy for Kentuckians and one that can be prevented and/or detected early. All patients should discuss screening with their physicians to determine the best method and timing for screening. We must continue to get this message out to all areas and to aid in facilitating screening in areas that are underserved.
American Cancer Society
American College of Gastroenterology
Kentucky Colon Cancer Project