We can slow the rise in colon cancer with better communication about polyps

Recently, I heard about a 38-year-old Long Island man who went in for a colonoscopy after dealing with irregular bowel movements.

His visit came well before the U.S. Preventive Task Force’s recommendation that people should start screening for colorectal cancer at 45 years of age.

The good news: The man was not diagnosed with cancer. Instead, he had two polyps removed, one of which was large (over 1 centimeter), and therefore considered an advanced polyp. He was told he should let his children know that since dad had a large polyp at an early age, medical guidelines call for them to start screening at 40, or 10 years before his polyp diagnosis (28 in this case), whichever comes first. It’s better to be safe than sorry.

His kids, however, were little children — so delivering the news to his next of kin seemed meaningless at the time.

Strangely, no one recommended the patient speak to his siblings, both of whom could benefit from this information. The example I used is not uncommon. The reality is when it comes to colorectal cancer screening, most patients go in for a colonoscopy, get their results, and if all goes well remember that they’re due for another in one, three, five, or 10 years, depending on the findings. 

Most patients don’t know the type of polyp that was removed or the size of the polyp(s) found. What they hear is “benign polyps, come back in five years.” This must change. We need to change the trajectory of colorectal cancer cases.

Unfortunately, colorectal cancer continues to rise among younger adults in the United States. The American Cancer Society reports that the number of colorectal cancer cases for people under 50 increased by 2% every year from 2011 to 2019. As of 2019, 20% of colon cancer cases occurred in adults under 55, up from just 11% in 1995.

We don’t know all the reasons for that alarming increase but we do know that family history of advanced polyps plays a role — not just a history of colorectal cancer but whether someone has larger polyps a centimeter in size or greater, or if the polyps have specific microscopic features that increase the risk to transform into a colorectal cancer. 

People should know whether their parents or siblings were diagnosed with an advanced polyp following a colonoscopy. This critical information will determine whether a patient should have a colonoscopy before the recommended age of 45.

Patients should feel empowered to know the details of their colorectal care and share it with family members. Ask your doctor about the size and characteristics of any polyps removed when they inform you of the results. After all, you took the time to undergo this test, so make sure you have all the details of your findings.

The bottom line — get a colonoscopy and when you get the results, call your brother, call your sister, and tell your children that they need to be screened at an earlier age if you have been diagnosed with an advanced polyp.

Better education and communication can play a big role in lowering the number of new, and especially early onset, colorectal cases. Based on the latest statistics, we are in desperate need of a change in how we treat the results from colonoscopies. 

This guest essay reflects the views of Christine Molmenti, associate professor in the Department of Occupational Medicine, Epidemiology and Prevention at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and associate investigator at the Feinstein Institutes for Medical Research.