An oncologist’s advice: The cancer we can often prevent — if we don’t ignore it

Last summer, I met a patient who represented a story I have now seen more than once in my practice. He was in his late forties, working full-time, raising a family, and generally considered himself healthy. He knew colorectal cancer screening was recommended, but he had been busy and assumed he could get to it later. He later developed persistent abdominal pain and rectal bleeding, and a colonoscopy revealed colorectal cancer.

What struck me was not that he had ignored his health. It was quite the opposite; he was conscientious, employed, insured, and engaged in his medical care. Like many people, he simply believed that feeling well meant he could safely postpone screening. It is an unfortunate misconception I encounter regularly, and one reason I continue to encourage eligible adults to discuss screening with their healthcare providers before symptoms appear.

During the past three years practicing oncology in our community, I have cared for patients from Battle Creek, Kalamazoo, and several smaller communities in the area. Every patient’s story is different, but one theme recurs with surprising frequency – many people who develop colorectal cancer never thought they were at risk.

As oncologists, we spend much of our time discussing treatment options, side effects, and prognosis. We are fortunate to have more effective treatments today than at any point in history. Yet some of the hardest conversations are the ones that we could have avoided altogether.

Colorectal cancer is one of the few cancers for which we have an opportunity not only to detect it early, but often to prevent it entirely. That is because many colorectal cancers begin as precancerous polyps. Screening can identify and remove those polyps before they become cancerous. In other words, screening does more than find cancer early. In many cases, it helps prevent cancer from developing in the first place.

In 2018, the American Cancer Society lowered the recommended screening age for average-risk adults from 50 to 45. The change reflected a concerning trend – colorectal cancer is increasingly being diagnosed in younger adults. Yet many people remain unaware that the recommended age has changed. Others assume they can wait because they feel fine.

In fact, feeling fine is exactly when screening is intended to occur.

The purpose of screening is to identify problems before symptoms develop. By the time symptoms such as rectal bleeding, unexplained weight loss, persistent abdominal discomfort, or significant changes in bowel habits appear, cancer may already be present.

Another common misconception is that screening automatically means getting a colonoscopy. Colonoscopy remains an excellent option and, for many people, the preferred one. However, it is no longer the only option. Stool-based screening tests that can be completed at home have expanded access and convenience for many. They are not appropriate for everyone, but they have helped remove one of the barriers that often keeps people from getting screened.

From my perspective, the best screening test is usually the one that gets done.

The public conversation about cancer often focuses on new treatments. Advances in immunotherapy, targeted therapies, and precision medicine have improved outcomes for many patients, and that progress deserves attention. But prevention deserves attention as well. We know that avoiding tobacco, maintaining a healthy weight, staying physically active, limiting alcohol consumption, and participating in recommended screening programs can reduce cancer risk. These interventions are not flashy, and they rarely generate headlines. Yet they remain among the most effective tools we have.

For our readers, my message is simple:

• If you are 45 or older and have not been screened for colorectal cancer, talk to your healthcare provider.

• If you have a family history of colorectal cancer, inflammatory bowel disease, or certain inherited conditions, ask whether screening for you should begin earlier.

Every oncologist hopes to see continued advances in cancer treatment. But if given the choice, we would rather help someone avoid a cancer diagnosis than treat one.

The patient I mentioned earlier eventually underwent surgery and is now cured. I often think about stories like his when discussing screening with others. Not because they are unique. Because they are not.