Colorectal Cancer Awareness: Key Signs, Screening and Prevention

Dr. Zachariah H. Froda discusses colorectal cancer warning signs like rectal bleeding, unexplained weight loss, and bowel habit changes, emphasizing awareness, early detection and prevention.

In honor of Colorectal Cancer Awareness Month, Dr. Zachariah H. Foda, who is the Assistant Professor of Medicine at Johns Hopkins School of Medicine in Baltimore, joined CURE to discuss the importance of early detection and prevention of colorectal cancer.

Throughout the conversation, Foda highlighted key warning signs that should not be ignored, such as rectal bleeding, unexplained weight loss and changes in bowel habits. These symptoms, particularly when combined, significantly increase the risk of a serious condition.

As colorectal cancer diagnoses continue to rise, especially among younger populations, Foda emphasizes the need for awareness and proactive screening, even for individuals under 50. The conversation also touched on how family history and lifestyle factors, like diet and smoking, influence screening recommendations and the overall risk of developing the disease.

CURE: What are some key warning signs and symptoms of colorectal cancer that patients shouldn't ignore?

Froda: So, when we get concerned about colorectal cancer or other serious things that might be going on for an individual, there are certain signs and symptoms we'll look at, and things to worry about or focus on are things like bleeding from their rectum or bleeding with their stool, [or] if they're having weight loss that they can't explain or is unintentional, abdominal pain as well as change in bowel habits. But the most concerning of those findings actually would be some combination of those. And so, there have been studies to show that multiple, two, three out of that list of findings, if someone has that, it really increases the risk of something concerning going on that should trigger them to go see their physician.

What may be leading to this kind of outcome in younger patients getting diagnosed earlier and earlier, in your opinion? And is there any research being done to kind of look into why this might be?

So the short answer is, we don't know. There are many theories on why this is happening. And you know, some of these theories have been explored and are currently being explored, and [there is] actually lots of research. So, there are lots of resources throughout the country and throughout the world looking at what is sometimes called early-age onset colorectal cancer, or variably also called the birth cohort effect, meaning that it's not necessarily that it's just young onset cancer that's increasing in people born in later decades. It's actually all colorectal cancer is increasing by sort of later decades.

And so, because it is something that is happening to a large amount of people, or a whole cohort of people, the most likely explanation has something to do with something in the environment, whether that's new foods or new chemicals or changes in in lifestyle that are universal. We haven't been able to narrow it down. It'll probably take years, many years, to figure this out, because while the risk is increased, it is actually still exceedingly rare that young individuals have colorectal cancer. And therefore, in order to get enough people with colorectal cancer to do any sort of significant research on it, it takes many, many years to track this. And so, we have our theories, but it will be a long time before we're able to pick one over the other.

What age should individuals start their screenings, and how do risk factors, such as family history or lifestyle, impact the screening recommendations?

American guidelines, both from the American Cancer Society as well as all of the GI [gastrointestinal] professional societies, recommend that individuals start colorectal cancer screening at the age of 45 and that is average-risk individuals. And as you had mentioned, there are individuals who are at increased risk, and individuals that we would consider to be increased risk are those who have a first degree relative or family member, a mother or father, a sibling with colorectal cancer, a first degree relative with large or many colon polyps. And for those cases, we actually start recommending colorectal cancer screening starting at the age of 40. So, five years earlier.

And in terms of other risk factors for colorectal cancer, there are some adjustable ones such as lifestyle and diet. So, we do know that diets high in red meat and processed meat are associated with an increased risk of colorectal cancer, while diets high in fiber, high in calcium, high in yogurt, seem to be associated with the decreased risk of colorectal cancer. We know that smoking increases the risk of all sorts of cancers, and we do know that alcohol can increase the risk of colorectal and other cancers. And so while we don't recommend changes in screening guidelines based on people having those environmental or lifestyle risk factors, we do recommend that people try to temper them, or can adjust those in order to decrease their risk of colorectal cancer.

Transcript has been edited for clarity and conciseness.

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