National Colorectal Cancer Awareness Month: MUSC Health Surgeon on Colorectal Cancer Risk Factors and Preventative Measures

As part of National Colorectal Cancer Awareness Month, we caught up with chief of colorectal surgery at MUSC Health, Virgilio George, M.D., to discuss statistics and the importance of scheduling a colonoscopy, particularly when it comes to younger people.

There's room to both rejoice and be wary, George says.

On the positive side, George applauds the public health achievements of the last several decades: The number of colorectal cancer (CRC) cases have reduced by 3% in recent years, due in large part to a decrease in patient risk factors as well as increased screenings and polypectomies. (Performed during a colonoscopy, a polypectomy effectively removes polyps from the colon.)

But while the overall rate of CRC has decreased, the number of CRC patients under 50 has actually increased. The change is relatively recent.

In the 1970s, the number of CRC patients under 50 saw a decrease while the opposite was true in patients older than 55. By the 1980s, there was a shift, with the trends completely reversing.

"Interestingly, with each passing decade, this increasing incidence seemed to travel with this younger age group such that the incidence of colorectal cancer in patients aged 40 to 49 years is now increasing by 1.3% per year while in patients aged 50 to 54 years, the incidence is increasing by 0.5% per year," says George, who's also part of MUSC Hollings Cancer Center. As of 2013, nearly one third of all new rectal cancers in the United States are diagnosed inpatients younger than 55.

In a closer look at CRC in different age groups, it's come to light that millennials (people born in the 1980s) are at greater risk of CRC than their parents. Why? The reason for this pattern is not entirely understood yet, but experts suspect that environmental factors, dietary shifts, and obesity are all contributors.

One thing that is true and undeniable is this: Younger patients are getting CRC and the only way to slow this down is to be more aware of risk factors so that an early diagnosis can be made promptly and treated accordingly.

What you should know about your risk:

• On average, 1 in 24 Americans will be diagnosed with CRC in their lifetime. Some people may be at increased risk.
• CRC can be hereditary: If you have an immediate family member who's had CRC, your risk is almost twice as high.
• That risk increases if more than one relative is affected.
• The earlier the relative is diagnosed, the higher the risk. For example, the risk triples with patients with immediate family diagnosed before the age of 50.
• Patients with second-degree relatives with CRC have a 75% higher chance of developing the disease than patients without a CRC family history.
• Even if you have no CRC family history, the presence of adenomatous colorectal polyps increases your risk. (Adenomatous polyps of the colon and rectum are noncancerous growths but if they are not removed, they continue to grow and can become cancerous.)

What you should do:

• If you have any blood in your stool, change in bowel habits or unintended weight loss, bring this to the attention of your primary doctor regardless of your age. You may benefit from a colonoscopy to better understand the cause of those symptoms.
• If you have no family history of CRC, most societies recommend screening, or colonoscopy, in the absence of symptoms, to begin at age 45.
• If you have immediate family younger than 60 or at least two relatives who have been diagnosed with CRC at any age, you should schedule screening colonoscopy at the age of 40, or at least ten years before the earliest CRC (whichever is earlier) detected in the family.
• After your first colonoscopy, the amount of time until your next colonoscopy depends on family history and the number/type of polyps found. Your doctor will let you know when to schedule your next colonoscopy.

To get screened:

The big takeaway here is that getting screened and diagnosed early are the best ways to prevent and effectively treat CRC. Everyone should speak to a doctor to discuss how age and family history affect their risks. To schedule a screening with the MUSC Health Digestive Center, call 843-792-6982.