Colorectal cancer (CRC) is one of the most preventable cancers but remains the second-leading cause of cancer-related deaths in the United States. Learn more about CRC prevention from our partners at OhioGastro.

Why this matters now 

Colorectal cancer (CRC) is one of the most preventable cancers – yet: 

• It is the second-leading cause of cancer-related deaths in the United States.  
• It is the leading cause of cancer death among individuals under the age of 50.  
• The lifetime risk of developing colorectal cancer is approximately 1 in 24 for men and 1 in 26 for women.  
• About 1 in 3 Ohioans are not up-to-date with recommended screening. 

Development & Symptoms – Often silent 

CRC typically develops from colonic polyps - precancerous growths that undergo genetic changes over time and may eventually progress to cancer. Precancerous polyp subtypes include adenomas, sessile serrated polyps, and sessile serrated adenomas. These lesions can accumulate progressive mutations that ultimately lead to malignant transformation. 

Most polyps and early-stage CRC are asymptomatic, causing no symptoms. One of the earliest clinical signs may be iron deficiency anemia due to occult gastrointestinal blood loss. As the disease advances, symptoms may include abdominal pain, changes in bowel habits, rectal bleeding, or unexplained weight loss. 

Mortality from colorectal cancer is strongly correlated with stage at diagnosis. The five-year survival rate for stage I disease is approximately 91%, compared with just 13% for metastatic disease. Early detection dramatically improves survival outcomes. 

Screening - Colonoscopies stand apart 

Colonoscopy is both a diagnostic tool and therapeutic intervention. Polyps can be removed by gastroenterologists during the procedure—preventing progression to malignancy. A landmark 2013 study published in the New England Journal of Medicine demonstrated that both colorectal cancer incidence and mortality were significantly reduced among individuals who underwent colonoscopy screening.  

The best test is the one a patient completes. But the most comprehensive test for prevention is colonoscopy. 

Screening tests at-a-glance 

*Beginning at age 45 for people at average risk - no personal history of colorectal cancer or advanced polyps, no first-degree family history of colorectal cancer or advanced polyps, and no history of inflammatory bowel disease 

Screening guidelines 

According to the American Cancer Society: 

• Individuals at average risk should begin colorectal cancer screening at age 45. Average risk refers to individuals without a personal history of colorectal cancer or advanced polyps, no first-degree family history of colorectal cancer or advanced polyps, and no history of inflammatory bowel disease.  
• Individuals with family history of a first-degree relative diagnosed with colorectal cancer or advanced polyps at a young age, or those with multiple affected family members, screening should begin 10 years prior to the age at diagnosis of the youngest affected relative. This may result in screening before age 45. 

Taking Points for Patients 

• Quiet disease - “Most early cancers and polyps that may turn into cancer are silent. Screening is how we find it sooner, making treatment easier.” 
• Prevent vs. detect - “The best way to prevent cancer is to find and remove polyps. Colonoscopy can detect and prevent it by removing polyps with the highest accuracy. Stool or blood tests are noninvasive and can detect cancer and polyps; but are less accurate and if abnormal, you’ll still need a colonoscopy.”
• One-and-done feel - “If your colonoscopy is normal, you may not need another for 10 years.” 
• Your why - “CRC is the second-leading cause of cancer-related deaths in the United States and is now the leading cause of cancer related deaths under 50. Screening starting at 45 and following your schedule is how we help prevent it.” 

Actions you can take today 

• Default to colonoscopy - When the patient is eligible and agreeable default to a colonoscopy; offer alternatives if they decline or have access barriers. 
• Address fears up front - Pain control, sedation, transportation, time off work, cost. 
• Close-the-loop - Track all positive stool or blood tests until colonoscopy is completed. 
• EHR nudges - Add an age 45 health maintenance prompt and an iron-deficiency anemia alert that suggests colonoscopy. 
• Run a gap list – Identify and reach out to patients 45–75 who do not have documented up-to-date CRC screening.