Media Backgrounder

Colon Cancer Screening

Facts about Colorectal Cancer

Colorectal cancer (CRC), also referred to as colon cancer, develops in the colon or the rectum sometimes also known as the large bowel. The colon and rectum are parts of the digestive system also called the gastrointestinal (GI) tract. The digestive system processes food for energy and eliminates solid waste. CRC usually develops slowly over many years. Most often, colorectal cancer begins as a non-cancerous polyp-grapelike growths that develop on the lining of the colon or rectum that may become cancer. Polyps can be removed to prevent cancer from ever occurring. Colonoscopy, performed by a well-trained endoscopist, gastroenterologist, or surgeon is the most effective screening test and plays an important role in colon cancer prevention because precancerous polyps can be detected and removed when they are discovered.

Statistics about CRC

• CRC is the second-leading cause of death from cancer in the United States for men and women combined. It is the third most commonly diagnosed cancer in the United States (excluding skin cancers).
• More than 150,000 people in the United States are diagnosed with colon cancer each year, and more than 50,000 die because of it each year.
• CRC can be prevented nine out of 10 times through early detection with proper screening. Screening helps prevent CRC by finding precancerous polyps so they can be removed before they turn into cancer.
• Only about 50 percent of adults who should be getting colonoscopies based on known risk factors are doing so. And, more than 60 percent of Americans aged 50 or older-approximately 42 million people-have not utilized any screening method for CRC.
• Exercise and eating healthy foods such as vegetables and fruits can help prevent colorectal cancer.
• There is no federal legislation requiring insurers to cover the cost of preventative CRC screenings. So far only 24 states have passed laws requiring coverage for screening of CRC-a cancer causing 50,000 deaths per year. In contrast, 47 states have passed legislation requiring coverage of screening for breast cancer-a cancer causing 40,000 deaths per year, and 26 states require coverage of screening for prostate cancer-a cancer causing 30,000 deaths per year. Additional efforts to improve colon cancer screening are needed.
• The death rate from CRC has dropped for the past 15 years. Scientist believe that the decrease in CRC death rate is probably because polyps are being found and removed by colonoscopy before becoming cancer. Also, CRC is being found earlier when it is easier to cure, and treatments for cancer once it has occurred have improved. There are approximately one million CRC survivors in the United States, and that number is growing.
• The five-year survival rate for people with CRC treated early is greater than 90 percent. But only 39 percent of CRCs are found at that early stage. Once the cancer has spread to nearby organs or lymph nodes, the five-year survival rate goes down.
• Individuals who have a family member (parent, brother or sister, or child) with colon cancer or polyps have an increased risk of developing colon cancer themselves and may need to undergo more aggressive screening. Individuals who have more than one family member with colon cancer or with other types of cancers may be at particular risk.

Symptoms of CRC
Certain symptoms might indicate this cancer:

• Blood in your stools
• Narrower than normal stools
• Unexplained abdominal pain
• Unexplained change in bowel habits
• Unexplained anemia
• Unexplained weight loss

If you experience any of these symptoms for more than a few days, talk with your physician. CRC can also occur without symptoms, family history, or any predisposing conditions such as inflammatory bowel disease.

Recommendation for Screening
Beginning at age 50, both men and women at average risk for developing CRC should have a colonoscopy every 10 years. The risk of developing CRC increases with age, with more than 90 percent of cases occurring in persons aged 50 or older.

Men and women should begin screening earlier and more often if they have any of the following CRC risk factors: a family history of CRC or polyps, a known family history of inherited CRC syndromes, a personal history of CRC, or a personal history of chronic inflammatory bowel disease (ulcerative colitis or Crohn's disease).

People with risk factors for colon cancer or family history of colon cancer should talk with a gastroenterologist about screening at an earlier age and find out how often they need to be screened. There are several screening methods: stool blood test (known as Fecal Occult Blood Test or FOBT), flexible sigmoidoscopy, colonoscopy, barium enema with air contrast. Colonoscopy, performed by a well-trained endoscopist, who is a gastroenterologist or surgeon, is the most effective screening test. There are several emerging techniques which may provide alternative methods, such as genetic stool testing and CT Colonography (virtual colonography). Additional evaluation and studies are required before population wide implementation.

What African Americans should know about CRC
Although all men and women are at risk for CRC, some people are at higher risk for the disease because of age, lifestyle or personal and family medical history. According to studies, African Americans are at a higher risk for the disease than other populations.

Starting at age 50, everyone should begin routine screening tests. Research shows that African Americans are being diagnosed at a younger average age than other people. Therefore, some experts suggest that African Americans should begin their screening at age 45. If you have a personal or family history of CRC, colorectal polyps or inflammatory bowel disease, talk with your health care professional-you may need to be tested earlier or more frequently.

• The rate of being diagnosed with CRC is higher among African Americans than any other population group in the United States.
• Death rates from CRC are higher among African Americans than any other population group in the United States.
• CRC is the third most common cancer among African Americans, with an estimated 16,000 cases expected to occur among this population per year. Of these, an estimated 7,000 deaths will result.
• There is evidence that African Americans are less likely than Caucasians to get screening tests for CRC.
• African Americans are less likely than Caucasians to have colorectal polyps detected at a time when they can easily be removed.
• African Americans are more likely to be diagnosed with CRC in advanced stages when there are fewer treatment options available. They are less likely to live five or more years after being diagnosed with CRC than other populations.
• There may be genetic factors that contribute to the higher incidence of CRC among some African Americans. Learn your family's medical history and tell your health care professional if a relative -- parent, brother, sister or child -- has had CRC or colorectal polyps.
• African American women have the same chance of getting CRC as men, and are more likely to die of CRC than are women of any other ethnic or racial group.
• African American patients are more likely to have polyps on the right side of the colon, versus the left. A screening endoscopy must examine the entire colon. This is best done with a colonoscopy.
• Routine screening tests can help prevent colorectal cancer and can detect cancer at a treatable stage. Colonoscopy, performed by a well-trained endoscopist, who is a gastroenterologist, or a surgeon is the most effective screening test and plays an important role in colon cancer prevention because precancerous polyps can be removed when they are discovered.

What Hispanic Americans should know about CRC

• Colorectal cancer is the third most commonly diagnosed cancer in Hispanic Americans, accounting for more than 2,300 deaths per year.
• Hispanic Americans are less likely to get screened for the disease than either Caucasians or African Americans. Starting at age 50, all men and women should begin having colorectal cancer screening tests. Some people are at higher risk for the disease because of age, lifestyle or personal and family medical history.
• There are many obstacles to colon screening, including reluctance to talk about colon cancer and embarrassment about having procedures involving the colon or tests which require stool samples. Thus, many people are hesitant to be properly tested.
• Routine screening tests can help prevent colorectal cancer and can detect cancer at a treatable stage. Colonoscopy, performed by a well-trained endoscopist, gastroenterologist, or surgeon is the most effective screening test and plays an important role in colon cancer prevention because precancerous polyps can be removed when they are discovered.