Colorectal Cancer Risk Assessment
Cancer of the colon or rectum (colorectal cancer) usually develops slowly, over several years. Excluding skin cancers, colorectal cancer is the third most common cancer in both men and women in the United States and the second leading cause of cancer-related deaths overall, according to the American Cancer Society (ACS). Still, the death rate from colorectal cancer has been dropping for more than 20 years because of better detection and treatment. Take this simple assessment to learn about your risks for colorectal cancer.
Your relative risk for developing colorectal cancer is . Your risk level is determined by the highest-level risk factor you have reported. (A risk factor is anything that increases your chance of getting a disease or a condition.) Your risk factors and their relative significance are listed below.
The information you provided suggests that your relative risk for developing colorectal cancer is low. You have none of the common risk factors covered in this assessment. Your results show the following preventive factors that decrease your likelihood developing colorectal cancer by varying degrees:
Significant risk factors:
- You have a personal history of colorectal polyps.
- You have a family history of colorectal cancer.
- You have a family history of familial adenomatous polyposis.
- You have a family history of hereditary nonpolyposis colorectal cancer (HNPCC).
- You have a family history of Gardner Syndrome.
Moderate risk factors:
- You are years old. Risk increases rapidly starting at age 50.
- You are obese; your BMI is 30 or greater.
- You smoke.
- You consume more than 14 alcoholic drinks a week.
- You consume more than 7 alcoholic drinks a week.
- You have had ulcerative colitis for 10 years or more.
- You have had Crohn's disease for 10 years or more.
Mild risk factors:
- You do not get enough exercise.
- You are overweight (but not obese).
- Your diet is higher in fat than advisable.
- You are a former smoker.
- You have a personal history of breast cancer.
- You have a personal history of ovarian cancer.
Your results also indicate the following preventive factors that decrease your risk of colorectal cancer by varying degrees:
- You are not yet 50 years old.
- You get at least 30 minutes of moderate exercise on most days.
- You have maintained a healthy weight; your BMI is less than 25.
- Your diet is low in fat.
- You are a vegetarian.
- You have never smoked cigarettes.
- You have had a fecal occult blood test within the last year.
- You have had a sigmoidoscopy within the last 5 years.
- You have had a colonoscopy within the last 10 years.
Understanding risk factors for colorectal cancer
Important risk factors for colorectal cancer include family and personal medical history, especially:
- Family history of colorectal cancer or hereditary colorectal cancer syndromes. Up to 10% of people with colorectal cancer have inherited a genetic abnormality tied to this illness.
- Personal history of adenomatous polyps or chronic inflammatory bowel disease. Adenomatous polyps of the colon or rectum are noncancerous growths that may develop into cancer if not treated. Chronic inflammatory bowel disease includes ulcerative colitis and Crohn's disease.
Other factors that increase the risk for colorectal cancer, according to the ACS:
- Being of African-American or Eastern European Jewish descent
- Advancing age. More than 90 percent of people with colorectal cancer are 50 or older.
- Lifestyle choices, particularly, a diet high in red meat and processed meat, lack of exercise, and smoking
- Excess alcohol consumption (more than two drinks a day for men and one drink a day for women). Excess alcohol intake independently increases risk; excess alcohol may interfere with folic acid intake, and it may interfere with folate metabolism in the body.
- Having type 2 diabetes
The Importance of screening
Screening is important for preventing colorectal cancer. Screening can find polyps (growths that can become cancer) and remove them before they turn into cancer, the ACS says. Screening can also find cancer early, when it is highly curable.
People who have no other risk factors except advancing age should begin regular screening for colorectal cancer at age 50, according to the ACS and the U.S. Preventive Services Task Force. If you have a family history or other risk factors for colorectal cancer, talk with your health care provider about the need for screening at an earlier age or for more frequent screening. Several screening tests are available, but medical experts differ on which test is better or how often to get screened.
For those who are at least 50 years old and of average risk for colorectal cancer, the ACS recommends:
- A fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year, or
- A flexible sigmoidoscopy every five years, or
- A double-contrast barium enema every five years, or
- A colonoscopy every 10 years, or
- A CT colonography (virtual colonoscopy) every five years, or
The ACS recommends that you begin testing at an earlier age or have more frequent screening if you have any of these risk factors:
- A family history of colorectal cancer. If your parent, sibling or child was diagnosed younger than 45, or you have two immediate family members diagnosed at any age.
- A family history of hereditary colorectal cancer syndromes, such as familial adenomatous polyposis or hereditary nonpolyposis colon cancer.
- A personal history of colorectal cancer or adenomatous polyps.
- A personal history of chronic inflammatory bowel disease.
Description of screening tests
Fecal occult blood test (FOBT). This test can find hidden blood in the feces; blood can indicate the presence of polyps or cancers.
Fecal immunochemical test (FIT). This test is similar to a fecal occult blood test, but it doesn't require any restrictions on diet or medications before the test.
Flexible sigmoidoscopy. A slender, flexible, hollow, lighted tube with a small video camera on the end is inserted through the rectum into the lower part of the colon to look for polyps and cancers. Any small polyp found may be removed; polyps, even those that aren't cancerous, eventually may turn into cancer.
Colonoscopy. Just as in the sigmoidoscopy, a slender, flexible, hollow, lighted tube is inserted through the rectum into the colon to look for polyps and cancers, but a colonoscope is longer and allows the health care provider to see the entire length of the colon. If a small polyp is found, your provider may remove it; polyps, even those that are not cancerous, eventually may turn into cancer.
Double-contrast barium enema. Barium sulfate, a chalky substance, is used to partially fill and open up the colon. Air is then pumped in to expand the colon and rectum. An X-ray of the abdomen shows strictures (narrowed areas), obstructions (blockages), and other problems. If problems are seen, a colonoscopy will be needed to examine them further.
CT colonography (virtual colonoscopy). This test uses computerized tomography (CT) scans to examine the colon for polyps or masses. The images are processed by a computer to make a three-dimensional (3-D) model of the colon. Virtual colonoscopy is noninvasive, although it requires a small tube to be inserted into the rectum to pump air into the colon.
Treatment for colon polyps and colorectal cancer
If your health care provider finds a precancerous polyp, it can be removed during a colonoscopy. If your provider finds cancer, he or she will recommend one of several treatment options. The main types of treatment for colorectal cancer are surgery, radiation therapy, chemotherapy, and targeted therapy, the ACS says. Depending on how advanced the cancer is, treatments may be combined or used one after another.
Reducing your risk for colorectal cancer
You can reduce your risk for colorectal cancer by maintaining a healthy weight and eating a nutritious diet that includes plenty of fruits, vegetables, and whole grains. You should also limit how much red and processed meat you eat. You should quit smoking if you smoke and limit your alcohol consumption. You should also get regular exercise; the ACS recommends at least 150 minutes of moderate physical activity a week.
This information is not intended as a substitute for professional health care. Always consult with a health care provider for advice concerning your health. Only your health care provider can do a thorough disease risk assessment or determine if you have colorectal cancer.
November 25, 2012
Alteri, Rick, MD, Sather, Rita, RN