Should We Be Screening for Colorectal Cancer Earlier?

Regular physical activity to counter all that time we log at our desks and on our sofas can help in that regard, too. “Physical activity improves gut health and reduces inflammation,” says Whyte. “By increasing gut diversity, you decrease the number of harmful bacteria that promote cancer cell formation.”

Have the talk

We know we’re not supposed to bring up religion or politics (especially this election year) around the family table, so how about talking about colon history instead? It’s just as uncomfortable but the outcome may actually be helpful. Talking to your family about their medical history is so important, says Dr. Luo, because the disease has a genetic component.

“Do polyps run in the family? Does inflammatory bowel disease run in the family because that increases the risk,” says Dr. Luo. Sharing family history with your doctor will help them determine when and what type of screening you need. Also, be mindful of any changes in your own body like shifting bowel habits (constipation? diarrhea?), blood in your stool, unexplained weight loss, or persistent abdominal discomfort. If you see something, say something. Dr. Luo adds that iron deficiency is also a tell-tale sign for her that there may be something amiss.

Screen, screen, screen

While the numbers feel staggering, it’s important to remember that the risk remains relatively low. What’s crucial in curbing the rates of colon cancer diagnoses is making screenings available for everyone who needs one. “Screening is the most important preventative for colorectal cancer,” says Dr. Dahut. And it’s only good if you do it early, adds Dr. Luo.

A colonoscopy remains the gold-standard screening method. That’s where a flexible tube with a camera is inserted in your rectum to search for polyps or detect cancer, usually while under sedation. If the doctor finds polyps (benign growths of tissue) they can be removed during the procedure. (That's something, Dr. Luo says, happens 30% of the time.) The biggest drag is the day-of prep it requires (lots of laxatives and lots of hours spent on the toilet), but the procedure itself is usually quick and painless.

Then there are stool-based tests like FIT or gFOBT or Cologuard, which involve collecting poop in a box and shipping it off for analysis, or, as of this year, a pricy home blood test by Guardant that looks for DNA fragments from tumor cells. But while these can sometimes catch advanced polyps, says Dr. Luo, they’re not ideal for spotting the early-stage ones. “They’re not what I would say is a colon cancer prevention tool because their goal is to catch stage one, two, and three colon cancer, no small polyps,” she adds. The goal of colonoscopies is not to find cancer but to find and remove polyps before they potentially turn into it.

If not now, when?

The US Preventive Services Task Force recommends that most people begin getting regular screenings at 45. If you have a family history of colorectal cancer or another genetic predisposition, then your doctor may advise you to start as early as 40. But if the numbers of young people getting diagnosed are on an upswing, should we all be getting screened earlier?

There is a growing debate around lowering the age for routine screenings, says Dr. Whyte, though he adds that insurance coverage and recommendations lag behind the latest research and trends. What may be more critical than lowering it is ensuring that everyone, no matter what their socioeconomic background, has access to screenings by the current recommended age. “We need to do a much better job in terms of addressing health care disparities," says Dr. Luo. "In terms of both access to colonoscopy screenings and for diagnostic testing.”