Colon cancer is the second leading cause of cancer death in men and women and the third most common cancer diagnosis. In addition, an alarming number of young people are being diagnosed with the disease, including actor Chadwick Boseman, whose death from colon cancer at age 43 shed light on how the disease affects people under the age of 50 and, disproportionately, blacks.
According to dr. Kimmie Ng, director of the colorectal research center at the Dana-Farber Cancer Institute, earlier detection is always better when it comes to survival rates (as with all cancers). Unfortunately, the symptoms of colon cancer tend to be somewhat generic, and asymptomatic colon cancer is very common. That is why screening is becoming the most important tool for diagnosis in the early detection of the disease.
But many guys (and girls, for that matter) don’t know when and how they should be screened, in part because bloody stools aren’t exactly the conversation someone feels eager to lead, and in part because colon cancer is simply not one about cancer which we often talk about. In addition, examinations are usually colonoscopies, which is a notoriously awkward procedure. Many Dr. Nga patients have symptoms for a long time and are not examined until a family member invites them to leave.
But we are trying to change that. GQ spoke with Dr. Ngo to get answers to all the questions you have about colon cancer prevention – because the more we talk about it, the better our chances of preventing and surviving it.
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When should I start being screened?
In February, the American Cancer Society updated its guidelines for colorectal cancer screening, lowering the age for screening from 50 to 45 years. This means that if you are completely healthy – no symptoms, no family history and no risk conditions – you should start with projections at 45. For those with Risk factors, which include inflammatory bowel disease, Crohn’s and ulcerative colitis, your doctor will probably recommend that you start testing right away. Another key risk factor is a family history of colon polyps – small, usually harmless clusters of cells that can become cancerous and, if caught early, can be removed before they turn into tumors. It’s something worth pushing through the embarrassment of talking to family.
How hard is it to get a projection?
A major deterrent for both health care providers and patients is that colon cancer screenings are invasive, inconvenient, and often expensive procedures. Terrible colonoscopy is considered, as Ng puts it, “the absolute gold standard for colon cancer screening,” because the procedure allows doctors to catch and remove polyps before they become cancerous. Complications from colonoscopy are very rare and usually occur only in patients older than 75 years, so, apart from general discomfort, the procedure has nothing to emphasize too much. Plus: since a U.S. Preventive Services Task Force official updated his guidelines to match the ACS, most insurance companies will now cover projections starting at age 45.
If for any reason colonoscopy is not an option for you, Ng says that “any examination is better than none.” Several countries use stool-based tests at home as the screening test of choice, and they can actually be quite effective in early detection of cancer. The downside? They have to be done every year, and if something goes wrong, you will have to continue with a colonoscopy.
What are the symptoms?
If you are under the age of 45 and notice symptoms of colon cancer, talk to your doctor about a checkup. Recognizing the symptoms of colon cancer is a bit inconvenient, as it will often seem like something less serious or like just a strange phase that your body is going through. Ng says it is crucial to pay attention to how long the problem remains. If it’s been more than a few weeks or it’s getting worse, that’s a pretty solid sign that you should get tested. Symptoms range from more obvious (rectal bleeding or bloody stools) to generic (abdominal pain, fatigue, unintentional weight loss, anemia, difficulty breathing on exertion). Sure, you’ll always be a little out of breath on the treadmill, but keep in mind if speeds that would normally be a breeze suddenly leave you breathless. The same goes for any inconsistencies in the stool that last longer than a meal you haven’t digested well: prolonged diarrhea or constipation can be important indicators.
If they find something bad, what happens next?
By consistent testing, doctors can often catch and remove polyps before they become cancer. But if a tumor has formed, the prognosis in stage I is still pretty good: a five-year survival rate of over 90%. Typically, stages I and II will only require a simple procedure to remove the cancerous area. Stage III means that the cancer has spread to regional lymph nodes near the tumor and at that point, chemotherapy or radiation is likely to be needed. By stage IV, the five-year survival rate drops to 14%. (As much as it was worth it, Chadwick Boseman was diagnosed with phase III and advanced stage IV.) This dive is because educating people about testing is so important – doctors want to catch those things as soon as possible.
I’m black. Should I be examined earlier or more often?
Blacks are at a significantly higher risk of colon cancer than whites of non-Hispanic descent, and have an even higher mortality rate. This now seems to be for the same reason that black communities have increasing disease rates: inequalities in access to health care. Composing the fact that examination and treatment require solid health care, other diseases that are more prevalent for blacks also make them more at risk for colon cancer. Obesity and diabetes, for example, are two known risk factors for colon cancer – and two diseases Blacks have higher rates.
There is a possibility that biological factors are also at play here – that the tumors that occur in blacks are somehow different – but Ng says research is still ongoing and there is still no conclusive evidence.
What else should I do to reduce my risk of colon cancer?
In addition to the following screening guidelines, Ng says the best way to prevent cancer is simply a healthy life. Smoking, unhealthy diet and inactive patterns are all high risk factors for colon cancer. Exercising, eating lots of fruits and vegetables, and minimizing red meat and alcohol consumption will help reduce your risk.