As more young people get colon cancer, it may be time for a colonoscopy

By Dr. Jamin Brahmbhatt, CNN

(CNN) — Editor’s note: Dr. Jamin Brahmbhatt is a urologist and robotic surgeon with Orlando Health and past president of the Florida Urological Society.

Colon cancer may seem like a distant concern for some, but with the growing trend of younger people being diagnosed, staying informed and proactive is crucial. March marks Colorectal Cancer Awareness Month, a time to educate people about this prevalent and potentially lethal disease on the rise.

As a surgeon, I’m acutely aware of the impact cancer can have. I lost a dear friend — a doctor, father and husband, just like myself — to colon cancer in 2017. He was only 38. His memory is a constant reminder of the importance of awareness and early detection in the fight against colon cancer.

Just one year after I lost him, I started experiencing sharp abdominal pain and a change in my bowel habits. Never mind that I’m a urologist; I still freaked out and feared the worst. I consulted my doctor and underwent a CT scan, which thankfully showed no major cancers. Still, my doctor recommended that I have a colonoscopy.

I was in my 30s, so I didn’t meet the criteria for a screening colonoscopy, but he needed it for diagnostic purposes to complete my workup for abdominal symptoms. Technically the colonoscopy was optional, but with my friend’s memory always on my mind, I did not hesitate.

Most people should start screening with colonoscopies by age 45, experts recommend. A select group may need to start earlier than 45; beginning a conversation with your primary doctor can help with a road map on when to start and at what frequency.

The risks of colon cancer

The American Cancer Society estimates that there will be about 106,590 new cases of colon cancer in the United States this year, nearly evenly split between men and women. The rate of diagnosis for colon cancer has been dropping overall since the mid-1980s, mainly because people are getting screened and changing lifestyle-related risk factors. However, this downward trend is mostly seen in older adults. For individuals younger than 55, rates have been increasing by 1% to 2% a year since the mid-1990s.

Overall, the lifetime risk of developing colorectal cancer is about 1 in 23 for men and 1 in 25 for women. However, each person’s risk might be higher or lower than this, depending on their risk factors for colorectal cancer. Not everyone needs an early colonoscopy, but everyone should be aware of the signs, symptoms and benefits of screening.

Understand your colon

The colon, or large intestine, plays a crucial role in our digestive system, acting essentially as the waste processing and recycling center of the body. After the stomach and small intestine break down food and absorb nutrients, the colon manages what’s left. Its main job is to remove water and salts from this material, transforming it from a liquid state into solid waste or feces, or as my kids like to call it, poop.

Beyond waste management, the colon also houses a complex microbiome, which plays a key role in overall digestive health, immune function and even mood regulation. The entire colon is about 5 feet (150 centimeters) long and divided into five major segments, with the rectum as the last anatomic segment before the anus. That’s why it’s called Colorectal Cancer Awareness Month and not just colon cancer awareness. Cancer can occur in any of these segments, highlighting the importance of a comprehensive colonoscopy when indicated.

The great colonoscopy prep adventure

The preparation for a colonoscopy might be the most memorable part of the process. It’s less of a medical procedure and more of a rite of passage. The day before, you start on a bowel-cleaning cocktail meant to clear out the colon for optimal visualization during the colonoscopy.

The “prep” is not as bad as one might think. Dehydration and exhaustion can occur, and I remember being unable to sleep the night before, still feeling the need to “go.” It was quite the experience but essential for a successful colonoscopy.

The colonoscopy procedure

A colonoscope, a camera on a flexible tube, takes a tour through your colon, transmitting live images that allow the doctor to spot any abnormalities. It’s akin to sending a rover to explore the moon or Mars. If doctors find something suspicious, such as a polyp, they can biopsy and/or remove it on the spot, preventing potential future complications. This proactive approach isn’t just diagnostic; it’s a powerful form of prevention that can offer peace of mind and actionable insights into your health.

Fortunately for me, the colonoscopy revealed no signs of cancer, and my symptoms had already resolved by then. Although my procedure was primarily for diagnostic reasons, regular screenings are essential for many, serving as a key preventive measure.

What should you do next?

The US Preventive Services Task Force advises adults ages 45 to 75 to undergo regular colorectal cancer screenings, emphasizing the importance of early detection.

Those with an elevated risk, perhaps due to family history or other factors, should consult their health care provider to determine the best screening schedule and methods tailored to their specific needs.

Despite these recommendations, a significant portion of the eligible population hesitates to participate in screenings. Common deterrents include the discomfort associated with stool-based tests, the preparation required for procedures, and anxiety surrounding colonoscopy examinations.

This apprehension may contribute to only about 60% of those eligible for colorectal cancer screenings staying up to date on the recommended tests. If it weren’t for the memory of my friend, I would have likely been in the “I’ll skip all this” group. 

In a promising development, a new blood-based screening test for colon cancer boasted an 83% effectiveness in detecting the disease, according to a study published March 13 in The New England Journal of Medicine. This test identifies DNA markers released by cancer cells in the blood, specific to colorectal cancer. While not a replacement for a colonoscopy, a positive result from this test indicates the need for further examination. The hope is, once approved by the US Food and Drug Administration, this blood test would increase screening for colorectal cancer.

If you have any abnormal symptoms anywhere in your body, get checked. The earlier you do so, the longer you will likely live thanks to getting proactive care.

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