GI Functional Medicine

Screenings and lifestyle choices help reduce the risk of colon cancer.

Colorectal cancer is the second leading cause of cancer-related deaths in the United States for men and women combined. According to the American Cancer Society, it is expected to cause about 51,020 deaths in 2019.

Since March is Colorectal Cancer Awareness Month, we asked Dr. Jennifer Driver, a board-certified family physician at Touro, to explain the importance of screening. “Colon cancer almost always develops from precancerous polyps or abnormal growths in the colon or rectum, though most polyps are actually benign (non-cancerous),” she says. “From the time the first abnormal cells start to grow into polyps, it usually takes about 10 to 15 years for them to progress to cancer. With regular screening, these precancerous polyps can be found and removed before they have the chance to turn into cancer. Unfortunately, millions of people in the U.S. are not getting screened as recommended, and they are missing the chance to prevent colorectal cancer or find it early when treatment often leads to a cure. Although there’s no sure way to prevent colorectal cancer, a large majority of colon cancers can be reduced with regular screenings and by choosing healthy behaviors.”

SCREENING GUIDELINES
The American Cancer Society reports the lifetime risk of developing colorectal cancer is slightly less for women (1 in 24) than for men (1 in 22). For those with average risk, screening should begin at age 50 until age 75, although some guidelines recommend starting at age 45. Individuals with increased or high risk of colorectal cancer may need to start screening before age 45 and be screened more often.

Increased risks include:

• Inflammatory bowel disease such as Crohn’s Disease or ulcerative colitis
• A personal or family history of colorectal cancer in a first-degree relative before age 60
• Genetic syndromes such as familial adenomatous polyposis or Hereditary Nonpolyposis Colorectal Cancer (Lynch Syndrome)
• History of radiation treatment to the abdomen or pelvis

“At age 76 to 84, the decision to be screened should be based on life expectancy, personal history, risk factors and personal preference, and, after 85 years, we recommend against screening,” Dr. Driver says.

THE TEST
There are several different screening tests available, but the most notable is the colonoscopy. Although drinking a laxative prep to cleanse the bowel is not everyone’s favorite thing to do, it is a key component of having a colonoscopy. “Many people are afraid of the prep, but the liquid bowel-cleansing agents have become much more palatable,” Dr. Driver says. “Now there are several better-tasting and lower-volume solutions including the split-dose approach, which has improved the patient’s experience. Because there are smaller quantities to digest, there is not as much GI distress.”

Over the past decade, the instruments used to perform a colonoscopy have also become more flexible and easier to manipulate. As a result, the time required for the colonoscopy test has diminished. “A colonoscopy is safe and painless for the patient,” Dr. Driver says. “It is also an essential tool used to help us reduce the risks for cancer.

“Of course, there are several test options available for colorectal screening, including stool-based tests, such as a yearly FIT test, yearly FOBT and every three-year DNA stool test; along with other visual-based tests, such as every five-year CT colonography (virtual colonoscopy) and every five-year flexible sigmoidoscopy,” Dr Driver adds.

However, if a person chooses to be screened with a test other than a colonoscopy, any abnormal test should be followed up with colonoscopy. “I do my best to educate my patients on the importance of these tests since the most important thing is to get screened,” Dr. Driver says. “We are fortunate that there are cancer screenings available for cancers such as breast, cervical, colon, prostate and skin, and we look forward to the day that there will also be screenings for pancreatic and ovarian cancer, among others.”

LIFESTYLE CHOICES
Lifestyle factors may contribute to an increased risk of colorectal cancer. “You might be able to lower your risk of colorectal cancer by managing some of the risk factors that you can control, like diet and physical activity,” Dr. Driver says. Here are five lifestyle changes that may help you prevent colon cancer:

Engage in physical activity. Along with improving your overall health and mental clarity, you can reduce your risk for many chronic diseases including colorectal cancer and polyps.

Keep off the excess weight. Being overweight or obese increases the risk of colorectal cancer. “Obesity is a risk factor for several cancers,” Dr. Driver says. “The reasons are not fully understood, but likely have to do with increased levels of inflammation and changes in certain hormones. Staying at a healthy weight and avoiding weight gain around the midsection may help lower your risk.”

Quit smoking. On top of raising the risk of serious diseases such as heart disease, stroke and emphysema, smoking is a major cause of at least 14 different cancers including colorectal cancer.
Avoid excess alcohol. Several studies have found a higher risk of colorectal cancer with increased alcohol intake, especially among men.

Eat a healthy diet. “Overall, diets that are high in vegetables, fruits and whole grains (and low in red and processed meats) are linked to lower colorectal cancer risk,” Dr. Driver says. “Studies show there is also a link between red meat (beef, pork and lamb) or processed meats (such as hot dogs, sausage and lunch meat) and increased colorectal cancer risk.”

Explaining her role as a primary care doctor, Dr. Driver adds, “Family medicine is a great fit for me. I love that it offers a continuity of care across generations, and it is our goal as doctors to give our patients the best opportunity to live longer and healthier lives.”