Preventing Death from Colorectal Cancer

This story was originally published in the Winter 2021 edition of Providence Health Matters.

Know how to protect yourself with risk assessment and screening. 

One of the most startling trends in cancer is an increase in the rates of colorectal cancer among people under age 50. We asked Anton J. Bilchik, MD, PhD, director of our gastrointestinal and hepatobiliary program at Providence Saint John’s Health Center, to explain the trend and why personalized and timely colorectal cancer screening is so important. At Providence Saint John’s, we offer comprehensive colorectal cancer care, including prevention, screening and treatment.

Can you describe the changing rates of colorectal cancer in the U.S.?

Rates are going down in people ages 65 and older, but there is a massive increase in young people being diagnosed with colorectal cancer. For people under age 50, rates have gone up five- to sixfold. The rates have gone up even more among younger African Americans. Because of this trend, the American Cancer Society has reduced the recommended screening age to 45 for most people and 40 for African Americans and people with a strong family history of colon cancer.

What accounts for the upswing in cases among younger people?

There are numerous studies going on looking at the immune system, the bacteria in one’s body (known as the microbiome), nutrition, diet, exercise, and genetic and environmental factors. The exact cause is unknown.

Is the increasing rate among younger adults alarming?

It’s more than alarming. I’m seeing people under age 50 every week with colorectal cancer. That was never the case before. It used to be seen in people over age 65. I can’t think of any other cancer going up in younger people at the same rate as colorectal cancer.

How can we lower the risk of this cancer?

I think everyone has to be aware that colorectal cancer is mostly preventable. Prevention starts at a young age. Obesity is going up in the U.S., and obesity is linked to colorectal cancer. School-age kids should be eating a healthier diet, particularly fruit and vegetables, with less processed food.

Many studies have also shown that exercise is important, because it reduces obesity and has an anti-inflammatory effect that may reduce the chance of getting both colorectal cancer and cardiovascular disease.

How much does family history play a role in the risk of developing colorectal cancer?

Family history is really important in trying to determine at what age people should be screened. Every person should be aware of their family history. If a teenager, for example, has a parent diagnosed at age 50 or less, there is a chance that the teenager may be carrying a gene for colorectal cancer and should be screened earlier.

Is colonoscopy still the gold standard for screening?

Yes. Colonoscopy is safe; the chances of injury during colonoscopy are exceedingly low, and the benefits far outweigh the risks. Most people have no issue with a colonoscopy, but rather the bowel prep the day before.

Unfortunately, not everyone has access to a colonoscopy, especially people who live in underserved and rural areas. For people who can’t access a colonoscopy or who are enormously fearful of colonoscopy, there are stool test kits, which are a good alternative. These tests are
both sensitive and specific, but are not a replacement for colonoscopy.

Have there been changes in the treatment of colorectal cancer?

Surgical resection continues to offer the best chance for cure. At Providence Saint John’s, surgeons are skilled at using minimally invasive techniques such as laparoscopy or robotics. Many patients are discharged home within a few days of surgery. Providence Saint John’s was recently recognized for excellent care in Los Angeles by U.S. News and World Report.

For more information on our colorectal cancer screening and treatment programs, call 844-987-0489.