Let’s take a look at the overview of colorectal cancer and what a colonoscopy really looks like and whether it should be done? Highly prevalent cancer killers Colorectal cancer includes colon cancer and rectal cancer. 1. In the United States, colorectal cancer is one of the highly prevalent cancers and the number two cancer killer. In China, with the improvement of living standard, the incidence of colorectal cancer is catching up; 2. Each person has different risk, on average, about one out of every twenty Americans may develop colorectal cancer. If someone in the immediate family has rectal cancer, the risk increases two to three times; 3. 90% of colorectal cancers are seen in people over the age of 50. In recent years, the incidence rate of young people has increased; 4. The early symptoms of colorectal cancer are neither obvious nor typical, so it is very easy to be missed. Early symptoms include blood in stool, black stool, change in bowel habits (sudden constipation or diarrhea, increased frequency, incomplete defecation, etc.), change in stool characteristics (thinning and deformation, etc.), abdominal distension and pain, unexplained anemia or weight loss, etc. Risk factors for colorectal cancer include obesity, smoking, excessive alcohol consumption, excessive intake of red meat and processed meat products, lack of physical activity, family history, genetic factors and other intestinal diseases, etc. Prevention of colorectal cancer includes weight control, smoking cessation, adjusting the diet structure, reducing meat, consuming more high-fiber food, insisting on regular exercise, maintaining a good mood, etc. How does colorectal cancer occur? The exact cause of colorectal cancer is still unknown, but most colorectal cancers start as a small polyp and usually do not cause any symptoms. There are many kinds of polyps, some of which do not develop into cancer (which can be collectively referred to as benign polyps) and some of which can develop into cancer (which can be collectively referred to as precancerous polyps). Starting with precancerous polyps, they undergo some genetic mutations, develop into atypical hyperplasia, and then develop into cancer often taking years or even a decade. Patients with family history will develop faster. Progression from early stage cancer to advanced stage again takes some time, and the rate of progression often depends on the malignancy of the cancer. About 15% of women and 25% of men over the age of 50 have these precancerous polyps. The purpose of screening is to detect these precancerous lesions and relatively small early cancers and intervene in a timely manner. Although colorectal cancer remains one of the most prevalent cancers, it is also one of the most preventable cancers. This is crucial. If detected early and treated promptly, colorectal cancer can be cured very well. The incidence of colorectal cancer in the United States has been on a downward trend over the past two or three decades, at least in part due to the spread of various screening tools. From 2000 to 2010, colonoscopy screening rates increased from 19% to 55% among people aged 50 to 75 years in the United States, and the incidence of colorectal cancer decreased by 30% over the same period. In China, colorectal cancer has also become a highly prevalent cancer, and most of them are already in the middle and late stages when detected. What’s even more frightening is that the trend of colorectal cancer in China is very young. “The average age of onset of colon cancer in China is 48.3 years old, which is 20 years younger than the average age of onset of colon cancer in the United States (69.8 years old).” Therefore, early detection and treatment is especially important. There are several methods of colorectal cancer screening recommended by the American Cancer Society and the FDA. Colonoscopy is probably the most direct and effective means among them. Not only can colonoscopy directly examine the intestines, but it can also remove suspicious lesions. What does a colonoscopy look like? Preparation: The day before and early in the morning of the test, the patient eats only liquid food and drinks a laxative prescribed by the doctor to cleanse the intestines. These preparations are very important, so that the doctor can see clearly during the examination and find the smallest lesions. The procedure: Simply put, a colonoscope is a thin, flexible, lighted tube with a small lens at the end. The doctor puts it into the patient’s intestines to check for polyps or other abnormal changes. If so, a small device at the front of the colonoscope will cut out the diseased tissue. The entire procedure usually takes less than half an hour. The excised tissue is sent to a pathologist for microscopic examination. Although the doctor doing the colonoscopy will have a general judgment based on the shape of the lesions, it is ultimately up to the pathologist to confirm whether these lesions are benign or malignant. Question 1: Should people younger than 50 years old have a colonoscopy? A friend in his early thirties, after having several bloody stools a few years ago, his doctor recommended a colonoscopy to remove two small polyps, both of which were benign. Just last year, his father was diagnosed with colorectal cancer and had never had a colonoscopy before. So, anyone, regardless of age, with abnormal symptoms, consult your doctor and get the necessary tests, including cancer screening programs. In addition, we should know that screening guidelines are made from a population-based, macroscopic perspective, after considering economic factors and balancing medical investment and prevention and treatment effectiveness. They are guidelines for physicians to practice medicine, not an ironclad law. Cancer screening varies from person to person and from cancer to cancer. In the United States, the incidence of colorectal cancer in young people has been on the rise over the past two or three decades. The exact cause is subject to further investigation. It may be related to both changes in dietary habits and lack of universal screening. It has been reported that the average age of colorectal cancer incidence in China is around 48 years old, and theoretically, the screening age could be earlier than that in the United States, if appropriate. Question 2: Should I have a colonoscopy when I am 70 or 80 years old? U.S. colonoscopy guidelines recommend that people at average risk between the ages of 50 and 75 should have one every 10 years, and those over 76 should consult their doctor. After all, colonoscopy is an invasive test, plus it may require sedation or anesthesia. Each person has different risk factors for the disease, and older people often have other diseases as well. Therefore, for this population, the doctor will assess the benefits and risks of colonoscopy and give recommendations based on each individual’s situation. It is important to emphasize that colonoscopy is only one of the screening tools. All screening tools have limitations and it is impossible to detect all abnormalities. As two examples, Patient A was found to have colorectal cancer in the fifth year after a colonoscopy. Patient B is found to have breast cancer 6 months after having a breast cancer screening. Neither is due for the next screening yet. There are two possibilities; one is that the patient’s cancer occurred after the screening and that the patient’s cancer progressed faster than average. The other is that the last screening may have missed some very small lesions. So, the most fundamental prevention is not which screening, but lies in your every day, no matter what kind of cancer. The prevention we can do includes quitting smoking, controlling alcohol, losing weight, eating healthy, exercising in moderation, and keeping a good state of mind. It is important to repeat: the best cancer prevention is to quit smoking, control alcohol, lose weight, eat a healthy diet, exercise in moderation, and keep a good mood. Colorectal cancer is one of the most prevalent cancers, but it is also a preventable cancer. In addition to weight control, smoking cessation, diet modification, adherence to regular exercise, and maintaining a good mood, early screening is crucial for people of appropriate age. There is more than one screening method, and colonoscopy is the most direct and effective. The time to start screening and the specific method of screening varies from person to person, so it is recommended to discuss with your own doctor.