Yes, in Kansas City last year a giant inflatable colon prop used to enhance Colo-Rectal Cancer Awareness (CRC) was stolen. This nefarious deed went viral and the Colon Cancer Coalition whose role is to educate people about colorectal cancer was able to raise more than $11,000 for colon cancer awareness. The additional good news was that Kansas City police officers received an anonymous tip and found the giant inflatable, pilfered intestine in a vacant house. I relate this story to remind you all that although we’ve come a long way toward making Americans aware of colorectal cancer risks, we still have a long way to go before we reach the goal of screening all Americans. In 2018, the American College of Gastroenterology set the goal to have 80 percent of Americans screened for colorectal cancer. We, however, did not meet that goal, with about 60 percent of Americans screened.

Colorectal cancer remains a formidable adversary and a significant public health problem. It remains the number-two cause of cancer deaths among Americans. In 2018, it is estimated that 140,000 colorectal cancers were identified with 50,630 deaths. Our lifetime risk of developing colorectal cancer remains high at 5.7 percent. These numbers remain too high, particularly since we have the potential to prevent and diagnose colorectal cancer. We have made progress, however, in decreasing colorectal cancer incidence over the past 30 years. This observation is felt to be secondary to the U.S. Preventive Health Task Force and the American Cancer Society’s recommendation that all Americans should be screened for colorectal cancer starting at age 50. This recommendation and the widespread utilization of colonoscopy to remove precancerous growths (polyps) from the colon has made a difference in reducing colon cancer incidence.

I have some disturbing news. Although we’ve managed to decrease the incidence and mortality of colorectal cancers in the age group greater than 50 years of age, we’ve seen an alarming increase in colorectal cancer incidence and death in the 40 to 49 year old group. Over the past 20 years, there has been a 50 percent increase in cancers with a 10 percent increase in mortality in this younger age group. These cancers tend to be rectal and diagnosed at a late stage. We don’t know why this is happening. Some have speculated it has to do with our diets, food additives, or even the obesity epidemic. In response to this alarming observation, the American Cancer Society in 2018 published new guidelines recommending that the first screening colonoscopy be lowered to 45 years of age from the current 50 years of age in average risk individuals. These recommendations have not yet been widely endorsed, but I expect they will in the coming year.

March is Colon Cancer Screening month. There are many choices for screening, with colonoscopy remaining the gold standard. We live in the world of personalized medicine, so please discuss with your physician what screening modality is appropriate for you.

Dr. Myron Brand is a clinical professor of medicine at the Yale University School of Medicine. He is medical director of the Yale Shoreline Endoscocpy Center in Guilford. He is a member of Gastroenterology Consultants with offices in Guilford, New Haven, Hamden, and North Haven.