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Oncologists at Norris Cotton Cancer Center offer recommendations on colorectal cancer screening and risk

By Staff | May 5, 2021

LEBANON – Despite being one of few cancers that are actually preventable through screening, colorectal cancer, which forms on the lining of the colon or rectum, continues to be the third most commonly diagnosed cancer and second most common cause of cancer death in the U.S. During the height of the COVID-19 pandemic, rates of colorectal cancer screening dropped by as much as 80 percent and rates of diagnosis, meaning patients with colon cancer were identified and could begin needed treatment, dropped by nearly 50 percent, according to the National Comprehensive Cancer Network and American Cancer Society.

Dartmouth’s and Dartmouth-Hitchcock’s Norris Cotton Cancer Center (NCCC), New Hampshire’s only NCI-designated Comprehensive Cancer Center, encourages patients to fit life-saving cancer screening, including those for colon and rectal cancer, back into regular routines.

Screening options include stool sample testing that can be done at home and colonoscopy, which detects polyps – small growths that can develop into cancer if they go untreated. “We recommend people talk with their providers about which screening option is right for them,” said Lynn F. Butterly, Director of Colorectal Cancer Screening at NCCC.

A number of factors influence your risk level for colorectal cancer, including:

Personal history: One of the most important risk factors is a personal history of certain types of polyps or colorectal cancer. Other factors include history of inflammatory bowel diseases, such as ulcerative colitis or Crohn’s disease, which can lead to potentially cancerous changes.

Age: Risk also increases with age. “Our patients are usually over the age of 60, but there is an increase in colorectal cancer among people under 50 and it’s not fully clear why that is,” said Srinivas Joga Ivatury, MD, MHA, division chief of Colon and Rectal Surgery in the Gastrointestinal Oncology Program at NCCC.

Family history and genetics: People with family members who have had colorectal cancer or polyps are at risk for developing colorectal cancer, as are those with certain hereditary syndromes, such as Lynch Syndrome. Genetic testing can be considered for patients who are younger, or who have a strong family history of colon or rectal cancer or other potentially related cancers such as endometrial or ovarian cancer. “Genetic testing is often covered by insurance and may be very informative for the tested individual as well as the other family members,” said medical oncologist Bradley A. Arrick, MD, PhD, MHCM, who directs NCCC’s Familial Cancer Program.

Health habits: Smoking, diet, exercise and obesity all play a role in risk as well, with smoking being the most important of these – possibly even more of a risk factor than family history.

Which screening method is best? “We use colonoscopy to test people at increased risk because there’s a greater chance of finding colorectal polyps than if a person is at average risk, where several other screening test options, including colonoscopy, would also be appropriate,” Butterly said. “For those at average risk, we generally begin screening at age 50. However, this recommendation will likely soon change to age 45, due to the increase in colorectal cancer among people under 50.”

For more information, visit: https://cancer.dartmouth.edu.

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