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March is Colorectal Cancer Awareness Month


Colorectal cancer (CRC) is the third most common cancer in men and women fifth most common cancer-related cause of death. An estimated 149,500 new cases of colorectal cancer were diagnosed in 2021. That same year, 52,980 people died of the disease.

The overall five-year survival rate for CRC is 64.7%; however, when the disease is diagnosed early, five-year survival is 90%. Yet, less than 70% of eligible people were screened for CRC in 2018.

Screening is immensely effective in CRC because it typically takes a precancerous lesion (a polyp) 10 to 15 years to develop into a cancer. Regular screening allows you to identify precancerous polyps and have them removed before they become malignant.

Regular screening also identifies colon cancer early in the disease process, allowing the person to receive curative treatment.  There is virtually no reason anyone should die from CRC.

So, let’s talk about screening for people at average risk for colorectal cancer.  You should begin screening when you turn 45 years of age.  There are several methods for CRC screening, but the gold standard is colonoscopy.

The only uncomfortable part of colonoscopy is the bowel prep performed the evening before, to clear the intestines of stool.  Preparations have improved over the years, reducing the amount of liquid used, making the process much more tolerable.  The day of the procedure, the client is sedated while the procedure is performed. If no polyps are found, and you otherwise at typical risk, you won’t have to repeat the procedure for 10 years.

There are other screening options for patients who cannot tolerate sedation or simply refuse to get a colonoscopy. These include three types of stool testing: guiac fecal occult blood test (FOBT); fecal immunohistochemical test (FIT); and DNA-based test.  While these tests can be performed in your home, they come with their own unpleasant procedures. And you have to repeat FOBT or FIT every year, while the DNA-based test must be repeated every three years.

Stool-based tests are less sensitive than colonoscopy, and there is also a chance of false positives (for example, occult blood from hemorrhoids). If you have a positive stool test, you will still have to have a diagnostic colonoscopy to rule out cancer.

There are two other visual screening tests: flexible sigmoidoscopy and virtual colonoscopy.  The flexible sigmoidoscope is basically a shorter version of the colonoscope and reaches only about halfway into your colon. This test has to be repeated every five years, is usually performed without sedation, and if a polyp is found, you still have to get a colonoscopy to make sure there are no polyps further up your large intestine. You might as well opt for a colonoscopy.

The virtual colonoscopy is a computed tomography (CT) scan. Special software recreates a three-dimensional model of your colon. This test is repeated every five years and requires the same bowel prep as a colonoscopy. But you don’t have to be sedated.


The recommendations above are for people at average risk for colorectal cancer. A small percentage of people have an increased risk of the disease and therefore should consult with their physician about a personalized screening and prevention program.  High risk features include:

  • A personal history of colorectal polyps or colorectal cancer
  • A personal history of inflammatory bowel disease (e.g. Crohn’s Disease)
  • A family history of colorectal cancer or adenomatous polyps
  • Having an inherited syndrome (Lynch Syndrome, HNPCC, FAP)
  • African American racial-ethnic background
  • Ashkenazi Jewish lineage
  • Having type 2 diabetes

Talk to your physician if you have any of these risk factors.


Some studies correlate a reduced risk of CRC to the following behavioral lifestyle modifications:

  • Maintain a healthy weight
  • Exercise (moderate to vigorous physical activity)
  • Limit consumption of red and processed meats
  • Avoid sugary drinks
  • Eat a variety of whole grains, vegetables and fruits
  • Don’t smoke
  • Limit alcohol intake to two drinks per day for men, and one drink per day for women
  • There is some evidence that low levels of Vitamin D, calcium and magnesium are correlated with increased CRC risk. However, vitamin supplementation has not been conclusively proved to reduce risk.  Getting your vitamins and minerals from your diet, rather than from a pill, seems to be more effective.
  • Taking a daily aspirin has also been correlated to a lower CRC; however, daily non-steroidal anti-inflammatory drugs (NSAIDs) also have potentially harmful side effects. Talk with your doctor before taking daily aspirin.

For more information on colorectal cancer, consider visiting the American Cancer Society’s website:


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