Dr. Vashi: It’s time to get screened for colorectal cancer

Dr. Vashi
Dr. Vashi: Let's spread the word on colorectal screening so we may continue to see declines in new cases.

March is National Colorectal Cancer Awareness Month—a good time to talk about getting screened for the disease. Before the COVID-19 pandemic, one in 17 Americans were at risk of developing colorectal cancer, with 90 percent of new cases occurring in people 50 and older. Now experts are worried that delayed screenings during the pandemic may result in missed diagnoses and more advanced cancer cases down the road. In fact, a recent study predicts an 11.9 percent increase in colorectal cancer mortality worldwide because of COVID-19-related delays in screening.

Diagnostic procedures must be given the urgency they require. Over the last year in the United States, approximately 140,000 people would have been screened for colorectal cancer if not for this pandemic. Screening numbers are down. But that’s not because cancer has gone away.

Increased awareness of the importance of screening for colorectal cancer has resulted in more cases being detected early, when more treatment options are available. This has led to a continued decline in incidence and mortality from the disease during the last two decades. The five-year survival rate for patients with stage 3 colorectal cancer is around 75 percent, up from 50 percent just 15 years ago.

New and better treatments

No patient wants to hear the word “cancer.” For many, it is considered a death sentence. But patients with colorectal cancer have seen better outcomes, thanks to treatments with new therapies that have revolutionized our approach to the disease.

The first-line treatment for stage 1-3 colon cancer is still surgery. Stage 3 patients may then receive adjuvant chemotherapy with or without targeted therapy, depending on the genetic build of their tumor. Conversely, the treatment for localized rectal cancer is usually radiation therapy and chemotherapy, followed by surgery. The surgery may involve a permanent colostomy in some patients with rectal cancer. These patients are then followed closely with tests for tumor markers, scans and colonoscopies.

Chemotherapy still remains the main treatment option for stage 4 colorectal cancer. While we’ve seen some improvement in five-year survival rates for patients with stage 4 disease, much work needs to be done in researching new and innovative treatments that may have a dramatic impact on survival. There’s a great deal of optimism about the future of colorectal cancer treatments.

Personalized care

We’re starting to understand the molecular basis and genetic makeup of individual colorectal cancer tumors, which will help us determine the responsiveness or resistance to anti-tumor agents. In the future, it may be possible to tailor each patient’s treatment depending on the genetic makeup of his or her cancer.

However, screening for early detection will remain irreplaceable.

New noninvasive screening options for average-risk patients during these “social distancing” times have become more popular alternatives to colonoscopy. These include fecal immunochemical test (FIT) and fecal DNA testing, such as Cologuard®, which are nearly 94 percent effective in detecting colonic polyps or tumors. These tests are good options for low- to average-risk patients who prefer not to get an invasive colonoscopy procedure. Still, a colonoscopy remains the gold standard for screening for colon cancer.

We need to use social media and other means to continue to increase awareness of all the screening tests available. Let us all work on spreading the word on colorectal screening so we may continue to see declines in new cases, during and after this pandemic.

Learn more about colorectal cancer diagnostics and treatments.