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March is National Colorectal Cancer Awareness Month and, although the incidence rates for the disease have decreased, overall lifetime risk of developing colorectal cancer is 1 in 20, making it the third most common cancer in both men and women. The good news is that due to screening and treatment advances, colorectal cancer is one of the most preventable and treatable types of cancer. As a result, there are now more than 1 million colorectal cancer survivors in the United States.

Risk factors
As with all cancers, knowing your risk and taking early action is a very important part of cancer prevention. Risk factors of colorectal cancer include:

• Age – Younger adults can develop colorectal cancer, but 9 out of 10 people diagnosed are at least 50 years old.
  
  
• Personal and family history – A history of colorectal polyps, colorectal cancer or inflammatory bowel disease (which includes ulcerative colitis and Crohn’s disease) increases the risk of developing colorectal cancer. Also, a hereditary genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (HNPCC/Lynch syndrome) increases risk.
  
  
• Racial and ethnic background – African Americans have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States. Jews of Eastern European descent have one of the highest colorectal cancer risks of any ethnic group in the world.
  
  
• Type 2 diabetes – People with type 2 diabetes share some of the same risk factors as colorectal cancer, such as excess weight, and they tend to have a less favorable outlook after diagnosis.
  
  
• Lifestyle factors – Lifestyle factors that may contribute to an increased risk of colorectal cancer include: lack of regular physical activity, low-fiber/high-fat diet, low fruit and vegetable intake, obesity, alcohol consumption and tobacco use.

Screening
The most common form of colorectal screening is colonoscopy, which uses a flexible fiber-optic tube to check for cancer or suspicious growths in the colon or rectum called polyps. According to the American Cancer Society (ACS), from the time the first abnormal cells start to grow into polyps, it usually takes about 10 to 15 years for them to develop into colorectal cancer. When caught early, polyps can be removed and, in many cases, prevent the cancer altogether. Early detection through screening can also find the cancer during its beginning stages when it is most treatable.

The ACS recommends that people who have no identified risk factors (other than age) should begin regular screening at age 50. Those who have a family history or other risk factors for colorectal polyps or cancer should talk with their doctor about starting screening at a younger age and/or getting screened more frequently.

Other forms of screening include: sigmoidoscopy, which checks just the lower colon (rectum), double-contrast barium enema, fecal occult blood test and fecal immunoschemical test. Consult your physician to determine the best screening test for you. For more information about colorectal cancer, visit www.massey.vcu.edu/cancer/colorectal/.

About the authors
Tzann T. Fang (pronounced “Fong”), M.D., and Paul G. Goetowski, M.D. (known as “Dr. G.”), are assistant professors at VCU Massey Cancer Center. Dr. Fang is the medical director of CMH Cancer & Specialty Care and specializes in medical oncology, hematology and bone marrow transplantation. Dr. G. is the radiation oncology director at CMH and has extensive experience in using radiation to treat many cancer types and noncancerous diseases.

Written by: Alaina Schneider