Colorectal cancer killed nearly 52,000 Americans in 2019, the latest year reported, according to the Centers for Disease Control (CDC). The incidence was higher in men than women: 42 cases per 100,000 men as compared to 32 per 100,000 women. The mortality rate was also higher in men: 15 per 100,000 as compared to 11 per 100,000 women.
Many, if not most, of these deaths might have been prevented because what’s especially significant about colon cancer is that it is very treatable if detected early. Screening colonoscopies for everyone over the age of 50 have been very effective at reducing the number of cases of the disease.
If you have symptoms of bowel problems — such as bleeding, abdominal pain, unexplained weight-loss, change in frequency — that are confirmed by colonoscopy to be due to colon cancer, modern medical and surgical treatments can be very effective, especially if the cancer is caught and dealt with early.
Unfortunately, in Western culture, and perhaps everywhere in the world, natural bodily functions too often become the target of jokes or shame. These attitudes lead too many adults to avoid getting the timely colorectal screening that could save their lives.
FIT tests are only helpful if you use them, something too few people do.
Colonoscopies are the gold standard in terms of diagnosis and detecting colon cancer or pre-cancerous polyps, but it is not practical for everyone to have one. There are not enough skilled specialists and not enough health care funding to offer a screening colonoscopy to everyone.
Luckily, there are other very good screening techniques available. One is the at-home stool fecal immunochemical test (FIT). FIT looks for traces of blood in your stool sample. If positive, then the next step is usually a colonoscopy to determine whether or not you have colon cancer or something else such as irritable bowel syndrome that might produce blood in your stool.
FIT tests are, however, only helpful if you use them, something too few people do. A recent study, led by Nicholas Clarke from Dublin City University in Ireland, reports that many people have “defensive beliefs” that make it more likely that they will not avail themselves of the FIT test.
To assess these defensive beliefs, the Irish researchers surveyed Dubliners in 2015 who had been invited to participate in a 2008-2012 FIT screening program. Questionnaires were completed by 1,988 people. Despite two reminders, another 311 alumni of the FIT screening program did not respond to the survey.
“People who react defensively to the invitation to colorectal cancer screening are less likely to take part, and this seems to be due to such misconceptions that having a healthy lifestyle or having regular bowel movements means that they do not need to be screened. Similarly, some people believe testing can be delayed while they wait for a ‘better’ test (even though the current test works very well) or wait until their other health concerns are under control,” Clarke explained. “Some people also react defensively because they believe cancer is always fatal, which is not true. All of these factors can result in people making a decision not to take the home-based screening test.”
In the case of most cancers, delaying testing and treatment is not a good idea. “The results suggest that screening programs need strategies to decrease procrastination and address misconceptions about colorectal cancer and screening,” Dr. Clarke added.
This brings us back full circle to the cultural issues of shame that are associated with bodily functions, particularly those involving the digestive system. We must find ways to make colorectal cancer screening something that everyone routinely does when they reach middle age, Clarke believes.
The study is published in the journal Cancer.