Dr. Kevin Most: Colon Cancer
We all heard the news last week about Eddie Olczyk being diagnosed with colon cancer, this caught the attention of all of us, as Eddie is just 50 years old. Remember, 50 is the age we recommend routine screening for colon cancer to begin. It was reported that he had a tumor removed last week and will undergo chemotherapy. Our thoughts and prayers are with him, his family and the entire Blackhawk family. We use stories like this to educate us all about an illness and what we should be doing to help prevent or diagnose the condition.
As has happened in the past with many of our discussions the timing is often quite eerie. Last Tuesday JAMA came out with a study that showed the increased incidence of colon cancer for white Americans under the age of 55. The incidence of colon cancer in younger individuals was first noted a few years ago and reported as concerning but not explainable. We actually discussed it here in January of 2016, following the loss of my cousin to colon cancer at the age of 50. That study in the journal Cancer got a lot of attention as it showed that 1 in 7 colon cancer patients were under the age of 50, and a large spike was noted in 30-40 year olds. That study came out of the University of Michigan, looked at 260,000 patients diagnosed with colon cancer between 1998 and 2011.
The JAMA study from last week took a deeper look at this data. This study now has raised more questions and has not provided many answers. The study has shown that this increase of younger individuals appears to be confined to white women and men. Previously the thought was that some risk factors was causing this increase. The main one being the increase in obesity in the US, however in this study that was not the case as the increase in obesity goes across many races and the increased rate changes are confined to Caucasians. The data shows that mortality rates in this age group for other races is in fact dropping, while for whites in this age group it has been increasing at 1% a year for the past 10 years. It is important to note that the incidence of colon cancer is still higher in blacks, however we continue to show improvement in decreasing the rate in black Americans, the opposite of what we are seeing in white Americans.
Let’s go back and talk generally about colon cancer. We diagnose close to 150,000 new cases of colon cancer each year. It is the 2nd leading cause of cancer related deaths in the United States, and accounts for 50,000 deaths in the US each year. It appears that this is a disease of industrialized nations with many risk factors found, some being, the increased consumption of processed foods, smoking, alcohol use, a diet low in fiber and vegetables, and obesity. Decreasing your chance of colon cancer can be as simple as increasing your activity, increase your consumption of high fiber foods including fruits and vegetables. Eliminate cigarette smoking and limiting alcohol consumption will also decrease your risk of colon cancer. Symptoms include blood noted in your bowel movement, stomach pain that persists and weight loss
Screening is so important in this disease, the accepted age for colon cancer screening is 50 years old, unless there is a family history or some other specific risk factors which push that age down. Between 1970 and 2004 we saw a significant drop in deaths from colon cancer. It is felt that this is due to the acceptance of advanced screening with colonoscopy. This is a well-accepted exam that is performed safely and extensively throughout the US. It was felt to be so important that it was a test that the ACA added to a service that must be covered. This test has allowed physicians to identify and actually treat colon cancers at a very early stage.
Many precancerous lesions and some cancerous lesions can be removed during the colonoscopy. This test also allows for earlier identification of more advanced cancer. Even with this screening, colon cancer remains the 2nd leading cause of cancer related deaths in the United States with 50,000 Americans dying from this each year. We need to be clear that a large percentage of colon cancers are noted after the age of 50 and that is why the screening age was set at 50. Many of the cancers noted after the age of 50 are more slow growing which allows for the timing of screening colonoscopy to be spaced every 5-10 years. . Even with this screening available everywhere and covered by almost every insurance plan, 1/3 of Americans over the age of 50 (25 million people) have never been screened
Talk about a wakeup call, this study has shown that this is actually an increase in the incidence of colon cancer not just an impact of colonoscopy use. This study highlights that 15% of all Colon Cancer patients theoretically would never have had screening as something they should have done. The other disturbing thing about this study is it showed that the young patients tended to have a more advanced cancer than those found after 50
The patients diagnosed in this younger age group often presented with more advanced disease that had spread beyond the colon. One difference is that these individuals for the most part were not diagnosed from screening colonoscopy, they were diagnosed as they presented after noticing other symptoms. Often it is fatigue that brings the patient in to see the doctor and during the extensive work up for fatigue, the cancer is identified. Other symptoms that can trigger the work up are unexplained weight loss or blood in the stool. Being found due to symptoms has also shown that when diagnosed in these young individuals the cancer has often spread beyond the colon. The young age of these patients allows for more aggressive treatment that may save their lives but for many the disease is too advanced and aggressive. The aggressive treatment can often be tolerated by these younger patients but it is hard on their bodies and difficult to tolerate.
The findings of this study should not rock our world but certainly should have the medical field taking time to review the screening guidelines and determine if there is another subset of the population that requires screening at an age earlier than 50. It should trigger research looking into why this increase is occurring. It should also be a reminder to all physicians that colon cancer is not only a disease of seniors and should be in our mind when patients present with symptoms that are not easily explained.
More importantly this should be a reminder of the importance of colonoscopy screening as it has been shown to save lives, talk to your doctor as you approach the age of 50 to make sure you are screened as soon as you turn 50. If you notice blood in your stool, have abdominal pain that persists or fatigue with any of these symptoms, get in to see your physician. Many individuals put this off, many for years (including me) and this study should remind us that the early screening is important.