Colorectal Cancer Risks and Screening Concerns - Surgery

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Questions about colorectal cancer?


Hello Doctor, I am a student living away from home.
Recently, I have been browsing various articles on this website and have greatly benefited from them.
However, I still have some questions I would like to ask you.
My direct relatives on my father's side are considered a high-risk group for colorectal cancer (my grandfather passed away from rectal cancer) and my father is currently 56 years old and has not been diagnosed with it.
Therefore, for the past two months, I have started to improve my diet by including fruits and yogurt in every meal, exercising regularly, and drinking 1500cc of water.
However, I still experience constipation, which makes me very curious about the reasons behind it.
Additionally, since the symptoms of colorectal cancer can be vague, I often worry about the possibility of having a hereditary disease.
I have previously expressed to my family my desire to undergo a colonoscopy, but since I am currently studying away from home and the health insurance system seems to have changed, it may be an out-of-pocket expense, which is quite high.
Therefore, I am not considering it for the time being.
I would like to ask the doctor if I am being overly anxious.
I am concerned that there may be harmful polyps in my body, but is it too early for someone my age to have a colonoscopy? Thank you, Doctor.

Nan Tongxue, 20~29 year old female. Ask Date: 2016/08/23

Dr. Ke Fangxu reply Surgery


First, let's clarify a concept: having a family member with colorectal cancer is different from hereditary colorectal cancer.
In the former case, an individual's risk of developing colorectal cancer increases by twofold, from 0.03% to 0.06%, so no special preventive measures are necessary.
In the latter case, the risk is 50-80%.
If interested, you can search for HNPCC (Hereditary Nonpolyposis Colorectal Cancer).
If it is the latter, prophylactic total colectomy is a preventive option, similar to Angelina Jolie's decision to undergo prophylactic mastectomy.
However, this is likely not the preventive method you would prefer.
The generally recommended preventive measure is to undergo a fecal occult blood test every two years and a colonoscopy every five years, which is acceptable even under health insurance guidelines.
Even abroad, the cost of these tests is not very high.
If the fecal occult blood test is positive, then a colonoscopy should be arranged.
Even if the fecal occult blood test is negative, having a colonoscopy every five years is also advisable.

Reply Date: 2016/08/23

More Info


Understanding the risks of colorectal cancer, especially in the context of family history, is crucial for early detection and prevention. Given your concerns about your family's history of colorectal cancer, particularly with your grandfather's passing from rectal cancer, it's understandable that you are feeling anxious about your own health.
Colorectal cancer can indeed have a hereditary component, and individuals with a family history of the disease are at a higher risk. The fact that your father is currently 56 years old and has not been diagnosed with cancer is a positive sign, but it does not eliminate the risk entirely. It's important to note that colorectal cancer can develop silently, often without noticeable symptoms until it reaches a more advanced stage.
Your proactive approach to improving your diet and increasing your physical activity is commendable. A diet rich in fruits, vegetables, and fiber, along with regular exercise, can significantly reduce your risk of developing colorectal cancer. Staying hydrated is also essential, as it can help alleviate constipation, which you mentioned experiencing. Constipation can be caused by various factors, including dietary choices, hydration levels, and stress. If you continue to experience this issue, it may be worthwhile to consult a healthcare professional for further evaluation.

Regarding your concerns about undergoing a colonoscopy at your age, it's generally recommended that individuals with a family history of colorectal cancer begin screening earlier than the standard age of 45. The American Cancer Society suggests that those with a first-degree relative (like a parent or sibling) diagnosed with colorectal cancer before the age of 60 should begin screening at age 40 or 10 years younger than the age at which their relative was diagnosed, whichever comes first. Given your family history, discussing the possibility of a colonoscopy with your healthcare provider is advisable, even if it may involve out-of-pocket expenses.

While it may seem like you are worrying excessively, your concerns are valid, especially considering your family history. Early detection through screening can lead to better outcomes if any abnormalities, such as polyps, are found. Polyps can be benign, but some can develop into cancer over time, making it essential to monitor and remove them when necessary.

If cost is a significant barrier to getting a colonoscopy, consider discussing this with your healthcare provider. They may be able to offer alternatives or suggest programs that can help cover the costs. Additionally, some clinics offer sliding scale fees based on income, which could make the procedure more affordable.

In summary, while your concerns about colorectal cancer are understandable, taking proactive steps such as improving your diet, staying active, and considering early screening can significantly mitigate your risks. It's essential to maintain open communication with your healthcare provider about your family history and any symptoms you may experience. They can help guide you on the best course of action for your health and well-being.

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