As the third leading cause of death in the nation, with the American Cancer Society estimating it will cause 52,980 deaths this year alone, colorectal cancer is something that all too many are aware of year-round.
But as medicine and understanding of the disease continue to progress, health professionals are seeking to reduce that number by recommending screening for younger patients.
And continuing to draw attention to persistent racial inequities.
While this year's Colorectal Cancer Awareness Month particularly seeks to help get people between the ages of 45 and 49 in for regular screening, health experts are also seeking to bring awareness to disparities in treatment rates between Black patients and the general population at all ages when it comes to accessing screening and preventative care.
Despite its deadliness, doctors are finding that colorectal cancer is particularly responsive to preventative and early treatment, with advances in medicine over the past two decades greatly reducing deaths from the disease, and leading to new screening options.
New age guideline
Following several studies that suggest colorectal cancer tends to be more severe when found in patients younger than 50, which had been the previous age at which colorectal cancer screening was recommended for patients without increased risk factors, the U.S. Preventive Task Force updated its guidelines last May to lower the age of recommended screening to 45 years old.
"It looks like in these younger patients, it's a more aggressive cancer, and to address that they lowered the age of screening," said Dr. Anderson Rowe, gastroenterologist at San Ramon Regional Medical Center.
The updated recommendations continue to emphasize the importance of screening for those between the ages of 50 and 75 as top priority, with a high level of confidence that regular screening in this population has a net benefit, while pointing to a moderate net benefit for those ages 45 to 49. Screening for those age 76 or above is only recommended in select cases by the task force, citing evidence that suggests a minimal net benefit from regular testing in this age group.
Lowe said that while the science seems to be clear that colorectal cancer is more serious in patients between 45 and 50, despite being less prevalent, it's not yet clear as to why this is.
Racial discrepancies in screening and outcomes
While deaths from colon cancer overall have been reduced with medical advances in the 21st century, Lowe said he remains concerned that this has not been the case across all demographics, particularly in Black patients, where rates of diagnoses and deaths continue to be on the rise compared to other demographics.
Similarly to the recent findings about the disease's increased deadliness in patients between 45 and 49, Lowe said that this discrepancy in outcomes across demographics is also poorly understood by scientists and doctors at this point, who haven't been able to pinpoint the reason.
However, Lowe said it is clear that rates of screening are persistently lower in Black patients. This has been the case for more than 15 years, he said, and something he and other professionals have sought to use Colorectal Cancer Awareness Month to bring attention to each year.
According to the Centers for Disease Control and Prevention, the rates of colorectal cancer screenings more than doubled for Black, Hispanic and Asian populations in America between 2000 and 2015, yet the highest rates of screening continued to be reported in white adults.
Options for screening
One reason screening and preventative care for colorectal cancer is emphasized so heavily is because of its effectiveness.
According to Lowe, with nearly 98% of colorectal cancer cases starting as polyps, the goal is to find polyps and remove them, which has high rates of success when they're detected early, reducing risk by approximately 90%.
With the introduction of the colonoscopy 18 years ago having reduced deaths from colorectal cancer by approximately 30% since, Lowe said that new forms of screening that can be less intimidating for patients have been front and center in the fight against colorectal cancer.
"For patients who are hesitant to get a colonoscopy, the important thing is that there are other alternatives they can use to get screened instead," Lowe said.
One of these is Cologuard, which was released in 2014 as a less-invasive alternative to the colonoscopy, which looks for blood and DNA mutations in stool samples that might suggest polyps. It's equally as sensitive to detecting active cancer cells as a colonoscopy, Lowe said, as well as polyps over a centimeter in size
Lowe noted, however, that when it comes to detecting polyps smaller than a centimeter, the colonoscopy remains the most effective screening tool. Despite their relative invasiveness, colonoscopies have the advantage of only being recommended once every 10 years in most cases, whereas Cologuard is recommended every three years.
Nonetheless, the biggest message health officials and medical professionals tried to drive home throughout March was the importance of screening and prevention for colorectal cancer in particular.