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Prevention
By Mayo Clinic staff
Get screened for colon cancer
Regular colon cancer screening should begin at age 50 for people at average risk of colon cancer. The American College of Gastroenterology recommends African-Americans, who have an increased risk of colon cancer, begin screening at age 45. Several screening options exist — each with its own benefits and drawbacks. Talk about your options with your doctor, and together you can decide which tests are appropriate for you.
Guidelines issued by the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer and the American College of Radiology include several options for colon cancer screening:
- Annual fecal occult blood testing
- Flexible sigmoidoscopy every five years
- Double-contrast barium enema every five years
- Colonoscopy every 10 years
- Virtual colonoscopy (CT colonography) every five years
- Stool DNA testing — new screening approach; test is available, but not certified by the Food and Drug Administration; research under way to increase accuracy and determine how often test should be done
More frequent or earlier screening may be recommended if you're at increased risk of colon cancer. Discuss the benefits and risks of each screening option with your doctor. You may decide one or more tests are appropriate for you. One factor to consider is whether your health insurance covers colon cancer screening.
Medicare covers colon cancer screening procedures. If you're older than 50 and have Medicare benefits, Medicare will cover annual fecal occult blood tests and sigmoidoscopy every four years. If you're at high risk of colorectal cancer, you'll be covered for colonoscopy every two years, or every 10 years if you're of average risk. Double-contrast barium enema — which is sometimes supplemented with flexible sigmoidoscopy — can be used as an alternative, if your doctor thinks it's a better choice for you.
Make lifestyle changes to reduce your risk
You can take steps to reduce your risk of colon cancer by making changes in your everyday life. Take steps to:
- Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer prevention. Choose a variety of fruits and vegetables so that you get an array of vitamins and nutrients.
- Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount of alcohol you drink to no more than one drink a day for women and two for men.
- Stop smoking. Talk to your doctor about ways to quit that may work for you.
- Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If you've been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise program.
- Maintain a healthy weight. If you have a healthy weight, work to maintain your weight by combining a healthy diet with daily exercise. If you need to lose weight, ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly by increasing the amount of exercise you get and reducing the number of calories you eat.
Colon cancer prevention for people with a high risk
Some treatments, including medications and surgery, have been found to reduce the risk of precancerous polyps or colon cancer. However, not enough evidence exists to recommend these medications to people who have an average risk of colon cancer. If you have an increased risk of colon cancer, you might discuss the benefits and risks of these preventive treatments with your doctor:
- Aspirin. Some evidence links a reduced risk of polyps and colon cancer to regular aspirin use. However, studies of low-dose aspirin or short-term use of aspirin haven't found this to be true. It's likely that you may be able to reduce your risk of colon cancer by taking large doses of aspirin over a long period of time. But using aspirin in this way is likely to cause side effects, such as gastrointestinal bleeding and ulcers.
- Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin. This class of pain-relief medications includes drugs such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others). Some studies have found NSAIDs may reduce the risk of precancerous polyps and colon cancer. But side effects include ulcers and gastrointestinal bleeding. Some NSAIDs have been linked to an increased risk of heart problems.
- Celecoxib (Celebrex). Celecoxib and other drugs known as COX-2 inhibitors work similarly to NSAIDs to provide pain relief. Some evidence suggests COX-2 drugs can reduce the risk of precancerous polyps in people who've been diagnosed with these polyps in the past. But COX-2 drugs carry a risk of heart problems, including heart attack. Two COX-2 inhibitor drugs were removed from the market because of these risks.
- Surgery to prevent cancer. In cases of rare, inherited syndromes such as familial adenomatous polyposis, or inflammatory bowel disease such as ulcerative colitis, your doctor may recommend removal of your entire colon and rectum in order to prevent cancer from occurring in the future.
- Compton C, et al. Colon cancer. In: Abeloff MD, et al. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa.: Churchill Livingstone; 2008:1477.
- What you need to know about cancer of the colon and rectum. National Cancer Institute. http://www.cancer.gov/cancertopics/wyntk/colon-and-rectal/allpages/print. Accessed July 2, 2009.
- Colon cancer. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/colon.pdf. Accessed July 2, 2009.
- Cappell MS. Pathophysiology, clinical presentation and management of colon cancer. Gastroenterology Clinics of North America. 2008;37:1.
- Wilkes G, et al. Colon, rectal and anal cancers. Seminars in Oncology Nursing. 2009:25:32.
- Distress management. Fort Washington, Pa.: National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf. Accessed July 7, 2009.
- Levin B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA: A Cancer Journal for Clinicians. 2008;58:1.
- Colon cancer screening (Colorectal). Medicare.gov. http://www.medicare.gov/health/coloncancer.asp. Accessed July 7, 2009.
- Young MC. Colon cancer. In: Rakel D. Integrative Medicine. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/147305686-4/0/1494/0.html. Accessed July 2, 2009.
- Elwood PC, et al. Aspirin, salicylates and cancer. The Lancet. 2009;373:1301.
- Rex DK, et al. American College of Gastroenterology guidelines for colorectal cancer screening 2008. American Journal of Gastroenterology. 2009;104:739.
