Why is it important to get a screening colonoscopy?

After lung cancer, colorectal cancer is the second leading cause of cancer deaths in the United States. Annually, approximately 150,000 new cases of colorectal cancer are diagnosed in the United States and 50,000 people die from the disease. It has been
estimated that increased awareness and screening would save at least 30,000 lives each year.

The most important factor in surviving colorectal cancer is the stage at which it is diagnosed. If the lesion is contained in the colon lining, the 5-year survival rate is 90%. If the cancer has grown into regional lymph nodes, the survival rate drops to 71% and
with distant involvement (liver or lung metastasis for example) we are at 14%. The United States has the best 5-year survival rate globally at 63% for all stages combined.

In North Dakota, close to 45% of colorectal cancer cases are diagnosed at an advanced stage.

Colorectal cancer is highly preventable. Colonoscopy allows us to detect and remove polyps (small growths in the lining of the colon). Removal of these polyps results in a major reduction in the likelihood of developing colorectal cancer in the future.

Colorectal Cancer Impact

Based on the most recent numbers from the North American Association of Central Cancer Registry (NCAACCR), an estimated 147,950 colorectal cancers will be diagnosed in the United States in 2020. Of those, a total of 52,300 people will die from the disease, with 17,930 under the age of 50 years old.

North Dakota will see around 360 new cases and 110 deaths. However, these numbers may be skewed due to the recent pandemic and decrease in screening and seeking medical care. In ND the estimated incidence for 2020 is slightly above the national
average with 51.9 cases per 100,000 for men, and 38.6 cases per 100,000 for women.

Colorectal cancer death rates in adults age 50 and older have been decreasing by 2-3% per year since 2000. This is due to improved screening methods and treatment advances. Notably, in younger individuals the death rate for colon cancer has been
increasing by 1.3% since 2004. In ND, our mortality rate is similar to the national average at 16.5 per 100,000 for men and 11.0 per 100,000 for women.

Who’s at risk?

The risk of developing colorectal cancer is slightly higher in men (1 in 23 or 4.4%) than women (1 in 25 or 4.1%). Since the mid-1980’s, the incidence or number of cases per 100,000 people has declined in adults 50 years and older due predominantly to an increase in screening measures for colon cancer.

Beginning at age 50, all men and women should be screened for colorectal cancer. Do not wait for symptoms such as blood in your stool or changes to your bowel habit (diarrhea/constipation) to occur before scheduling your exam. Colon cancer is often without symptoms until the later stages of disease.

What options do I have for screening tests?

Talk to your healthcare provider about which test is best for you. Current recommended screening options* include:

Currently the American Cancer Society recommends to start screening both men and women at age 45, and future guidelines from the USPSTF (United States Preventive Services Task Force) will recommend the same in the near future. Unfortunately most insurance carriers for now, are denying screening for people below the age 50.

• High sensitivity Fecal Occult Blood Test (FOBT) or Fecal immunochemical test (FIT) every 1 year; or
• A flexible sigmoidoscopy every 5 years; or
• A combined sigmoidoscopy (every 5 years) plus a high sensitivity stool test (FOBT/FIT) every 3 years; or
• A complete colonoscopy every 10 years.

*Important: You may need to begin periodic screening colonoscopy earlier than age 50 years if you have a personal or family history of colorectal cancer, polyps or long-standing inflammatory bowel disease.

Early onset colorectal cancer

According to the American Cancer Society, in 2020, 12% (18,000) of colorectal cancer cases will be diagnosed in people under 50. Unfortunately, since the mid-1990’s, we have noticed a 2.2% increase in the rate of younger people with colorectal cancer, especially those between the ages of 20-49.

The delay in diagnosis is likely two-fold; patients may not be seeking medical care early enough, and professional healthcare delays appropriate testing. A good portion of these patients have a family history or hereditary condition that may have been overlooked and warranted an early screening exam. Despite the increase in incidence, it is still much lower than in those aged 50 and older.

ND has been identified as one of the states with higher incidence of early onset colorectal cancer. Research is ongoing to understand this cancer’s behavior and identify risk factors.