We are two colorectal cancer survivors in our 30s and a team of doctors/experts on the topic. Ask Us Anything.

Despite my family history (dad died from stage 4, cousin has stage 3) my insurance won't cover a Colonoscopy because I'm "too young". How can we raise awareness that this isn't a "50 and older" issue? How can I get a colonoscopy other than saying I'm bleeding down there?

A letter to your insurance company explaining your risk factors and that you are high risk (i.e. family history) including society guidelines (i.e. American Cancer Society, American College of Gastroenterology) oftentimes will help to get coverage for a preventative colonoscopy. You could also consider doing annual stool tests looking for microscopic blood. Finally, many practices performing colonoscopies will consider payment plans. - Dr. Sonenshine

You are supposed to be covered by insurance 10 years earlier than your family member's diagnosis. I would raise my voice and remind them that paying for cancer treatment is A LOT more expensive than a colonoscopy. I know people who have had their doctors write a letter and/or call the insurance companies. I have had to call my insurance company about bills multiple times before action happened. Spam them with articles about early onset colorectal cancer. There are a ton of us who speak about the fact that you are never too young for this disease! - Allison Rosen

I agree completely that your insurance company is not making the right decision. They may be doing so because your family history was not communicated to them. The 50-and over-guideline is for those without family history. For those with family history, the guidelines from ACS and others are clear: 10 years before youngest person in family to get colon cancer. (Your cousin is not a first-degree relative, but your father would definitely count.) I would make sure they are aware of this, and there are ways your physician can appeal this denial.- Dr. Alok

How do I get over the fear of having a colonoscopy? I just feel so apprehensive and vulnerable being in the company of strangers doing the procedure.

We completely understand the fear of undergoing colonoscopy. At the time of consultation for colonoscopy we place an emphasis on safety and privacy. The physicians and supporting staff are empathetic to the fact that for some patients it is “embarrassing.” It’s important to realize however that all of us have the same bodily functions. We are there to make sure your experience is comfortable and as seamless as possible. - Dr M

From a colon cancer survivor perspective, I understand the fear of a colonoscopy but they are really no big deal and take no time at all. Sometimes they even give you medicine so that you don’t remember anything, just wake up and the procedure is all over. You will be in the very capable hands of experts doing the procedure. What I always tell people is that a colonoscopy saved my life and if I had not gotten one I would not be alive right now so it was 100% worth it. There are so many little tricks to drinking the prep, which is the hardest part of the whole colonoscopy procedure. Ask your doctors for some of these tricks! -Allison Rosen

Can you be more specific/graphic as to what a "change of bowl habits" might consist in? This phrase is always getting tossed around and I'm never quite sure what it means.

In my case, my change in bowel habits were simple, I regularly went to the restroom and then I noticed I was constipated and not going to the bathroom as much. It turned out that my tumor was blocking anything from moving down my colon. This was specific for me but you know your daily bowel habits and if they suddenly change for no reason at all this should spark some conversation with your doctor. -Allison Rosen

I hear that colorectal cancer rates are rising, especially among young people. Why is that, y'all think? And what can we do to prevent this cancer?

Good question. We are unclear on the factors causing a higher prevalence in younger adults. All speculation, but I suspect diet and obesity are playing a large role. To prevent such, the American Cancer Society did just reduce the age for screening all asymptomatic patients from 50 to 45 years old. - Dr. Sonenshine

This is absolutely true and indeed very concerning. We still don’t fully understand why this is happening but an incomplete list of potential risk factors includes: global westernization of diets (more red meats/processed meats), increased prevalence of obesity worldwide, more widespread use of antibiotics which may affect gut microbiome, increased physical inactivity as more of our jobs are becoming desk-based and not physical. - Dr. Alok

From someone who was diagnosed at the age of 32 I urge anyone that is under the age of 45 that has any unexplainable symptoms like sudden weight loss, severe fatigue, change in bowel habits, and blood in my stool like I had to go see their doctors ASAP. I know some young survivors who had to go see multiple doctors until they finally took their symptoms seriously. As a young person you can do everything right but you know your body best and when something is obviously wrong seeking medical attention could save your life. -Allison Rosen

Does celiac disease contribute to developing colorectal cancer?

No. There is no current evidence linking celiac disease and colorectal cancer. In extremely rare cases of uncontrolled celiac disease, there is an association with small bowel lymphoma. - MBS

Thank you for taking the time to answer. As a celiac with constant digestive issues, this has been a concern of mine.

In celiac disease, if gluten exposure continues, your risk of small intestinal cancer is increased. Large bowel (colon cancer) is not increased in this condition. Therefore, colonoscopy would not detect this rare complication of celiac disease. Radiological images would likely be the best test for small bowel cancers. - Dr M

What is the current thinking on the role of alcohol in colorectal cancer, and in the value in reducing/eliminating alcohol consumption? How big of a risk factor is this?

Alcohol has not been linked to a significant increase risk in colorectal cancer. However, a lifestyle of significant alcohol consumption probably leads to other risk factors -- physical inactivity, poor eating habits, tobacco consumption, etc. So, moderation is super important - like in most things! Alcohol does increase the risk for other conditions; so, I typically recommend no more than 1.5 drinks on average per day. - MBS

I'm 28 and actually just found out last year I had colorectal cancer. Two surgeries and a lot of chemo and radiation and it looks like I'm in the clear.

I don't think I'll ever get fully used to my ostomy bag. Any tips living with it?

Also fellas, you are never too young to get checked out! My doc told me if I had gotten checked out when I was 18 I wouldn't have a permanent ostomy bag.

I am living with a permanent illeostomy bag and at first I thought my life was over, I seriously was very upset by it. Now I have realized I can do anything with my bag, and my life is not over, it is just beginning. I have gone surfing, rock climbing, jumped out of a plane, you name it I have probably done it, and if not I will most likely try it at some point. I wear normal clothes so people have no idea it is even there. It took me awhile to deal with my new body image, but it is very empowering to help understand that living with an ostomy is just living with a new part of your body. If the technology didn't exist I would not be alive, as I had my colon removed, so an ostomy was a requirement. I choose not to show mine when wearing a swimsuit, others do, to each his own. I, however, I am proud of what I have gone through and what my body has endured, and my ostomy is a part of that.

A few of my best Ostomy Tips:

1. I stop eating at roughly 7pm so that my bowels slow down so they don't interrupt my sleep
2. I change mine in the morning when things are less “active”.
3. Things such as the BRAT diet help with output (https://www.webmd.com/children/qa/what-is-the-brat-diet)
4. Talk to the each company that makes the supplies to find what works best for you. Everyone is different and most of the time the people answering the phone have an ostomy themselves.
5. They have ostomy support groups throughout the US (https://www.ostomy.org/) and a lot of online communities.
6. See a GI nutritionist to help with diet. For example I cannot eat corn, nuts, raw vegetables anymore etc. Marshmallows help slow my bowels down. Who knew!

I have written numerous articles about living with an ostomy but here is one of my favorite: https://www.washingtonpost.com/news/soloish/wp/2018/05/14/dating-after-cancer-theres-one-piece-of-baggage-i-cant-hide/ - Allison Rosen

I always see that blood in the stool in a warning sign and should be evaluated. I've also heard there is a difference in the color of the blood that might further provide an indication - bright red (like from a cut on the skin) vs darker red.

Is there any guidance here on what *exactly* one should look for? Is liquid, bright red, drops of blood while defecating any different than darker red blood mixed/colored into the stool itself?

You are correct that blood in the stool is a warning sign that should be evaluated. It doesn’t matter from what the blood ‘looks like’. You need to get it checked out. In terms of what the doctor concludes from your symptoms, bright red blood will come from lower in your colon or rectum. If bleeding occurs higher in the colon or in the stomach or small intestine it can get mixed in the stool and get digested where it may appear darker -- even black with a thick, tarry texture that is difficult to clean off your bottom. Either can be serious and needs to be evaluated by your doctor. - Arefa Cassoobhoy

What are some common misconceptions you’d like to dispel?

That colonoscopies are somehow painful or difficult. They’re really not. The prep is a little messy, but it’s actually quite slimming. I’ve now had several and although they’re not my favorite the benefits vastly outweigh the dangers in not having one done. They’re also the only effective method of recognizing precancerous signs, so we should all get used to the idea of having a camera up there sooner or later. I’ve had headshots that were more uncomfortable! - Pat Moote

One misconception arises from the public health focus on starting screening at age 50. Screening is when colonoscopies are done in people without any symptoms to find polyps or cancers. However, some people interpret this to mean that colonoscopies will not be covered if they have symptoms before age 50 and I have had patients who put off getting colonoscopies until they turned 50 even though they were having bleeding and could have been diagnosed at an earlier stage. If you are having symptoms such as bleeding, rectal discomfort or change in bowel habits then you should be evaluated by a physician and colonoscopy will be covered if indicated even if you are not yet age 50 - Dr. Alok

People are always scared of getting a colonoscopy, but like the others have said it is no big deal and depending on what is found sometimes you do not have to have another one for 10 years. The prep is the worst part and there are preps now that are much easier to drink than even a few years ago so ask your doctors about options. They are not painful either, I wake up and feel like I have just had a very long nap. Screening saves lives and this is the case for a colonoscopy, it could save your life. -Allison Rosen

Are there any promising treatments on the horizon? My understanding is that the chemo cocktails used have not had any significant advancements in some time.

I was diagnosed with Stage IIIb colorectal cancer in 2012. At my 5 year checkup, they found a small nodule in my lung from that same cancer. That was removed 2 years ago, and both my surgeon and oncologist are ready (if biannual tests this month show nothing concerning) to put me back on a more normal schedule for testing.

Thanks for sharing your story and I’m so glad that you are now cancer-free. There are several promising treatments on the horizon or even already approved, mostly based on specific mutations in the tumor tissue (e.g., antiEGFR drugs for patients with WT KRAS, BEACON regimen for patients with BRAF mutations, immunotherapy for patients with MSI-H tumors). Continued research on this subject is going to lead to even more drugs becoming available in the very near future. Best wishes to you and fingers crossed that you stay in remission and never need any of these drugs in the future! - Dr. Alok

Two questions:

1. What is one truth about colorectal cancer you wish people knew?
2. What is one thing people under 50 can do today to lower their chance of colorectal cancer?

1. One truth I wish people knew was that you are NEVER TOO YOUNG for colorectal cancer!!!!!!!

2. I am by no means a doctor, but I work in cancer prevention and one thing I tell the community I work with is no matter what age you are you should know your body, and if something is not right, no matter what age you are, you should go see a doctor. Sometimes all you have is your voice. It could save your life, it saved mine. - Allison Rosen

1. One truth- Colonoscopy at age 50 is for those at “normal” risk (i.e. those without symptoms and without family history). Anyone with symptoms or family history should/can get colonoscopy sooner than age 50 (starting age 40 or 10 years before youngest first-degree relative for those with family history of colon cancer or colonic polyps).

2. Healthy diet and lifestyle (regular exercise, less red meat or processed meat consumption), avoiding obesity and sedentary lifestyle, avoiding smoking are all “one” things that can reduce risk of colorectal cancer and are also good for preventing many other diseases. - Dr. Alok

Colon cancer can occur in all people - young or old, Caucasian or African American or Hispanic, male or female. Further, there are ways to reduce your risk of dying from colon cancer -- healthy eating, exercising, keeping BMI less than 25, avoiding tobacco, adhering to screening recommendations, and listening to your body (when symptoms come up, go to your physician). - Dr. Sonenshine

1. Over the last several decades the colon cancer rates in people over 50 have been going down, while the rates in people under 50 have been going up, and it’s all in relation to their access to colonoscopies.
   
2. Eat more plants! We can significantly protect ourselves with a healthy diet consisting of mostly plants. I only eat meat once or twice a month, and rarely will it be red meat. If that sounds awful to you just watch “Game Changers” on Netflix and it’ll scare ya plant based. -Pat Moote

My twin brother (mid-30s) has had a couple colonoscopies due to sudden bleeding during bowel movements, but they turned up negative for any findings thankfully. I had a relative (unknown relation) pass away in their 30s from colorectal cancer a while back, and my own father (70s) had a few polyps discovered in his colon a few years ago which were removed.

I'm currently fine in that area as far as bleeding goes, although I do want to have a colonoscopy soon to be safe since it's never too late.

Would there be any other symptoms aside from just bleeding which could point to colorectal cancer or polyps?

Additional symptoms of colon cancer or advanced polyps are abdominal pain, changes in bowel habits or stool size, and unintentional weight loss. However, in early disease you may NO symptoms. There are also signs including iron deficiency anemia. - Dr M

My sister was diagnosed last summer with stage 3 at age 36 and is expected to make a full recovery. I have a mutual friend who is losing his battle and he was diagnosed at 32. I'm 30 and got my colonoscopy done last month, and I'm in the clear.

My question is; Is there a rise in people getting colorectal cancer at earlier stages in life? If so, are there any studies being done as to figure bout why?

I am sorry to hear about your sister and friend’s diagnoses. There is indeed a rise in colorectal cancer at younger ages (technical term is early-onset colorectal cancer). This rise appears to be worldwide and is associated with the trends of globalization of the western diet (more red/processed meat intake), increase in sedentary lifestyle/reduced physical activity and increase in rates of obesity across most countries. There are several risk factors that are being studied but no one clear answer. - Dr. Khorana

Hi, thanks for doing this AMA! I come from a family with a predisposition to colon cancer. My uncle died at 37 years old from it in 2001. My father and many of his other siblings have had polyps removed in their 40s. I started getting screened at 18 and have had some polyps removed myself. I’m curious as to how colon cancer treatment has advanced since the early 2000s and if there’s anything besides screening and generally trying to live healthy that a high risk person such as myself can do to mitigate risk of developing this cancer?

Being mindful of your family history and staying up on screening with interval colonoscopies is important. A well-balanced diet, avoiding tobacco, exercise in addition to screening will reduce your risk. Patients with multiple relatives having colorectal cancer should be evaluated for genetic testing. - MBS

I would highly recommend genetic testing to figure out if there is a known hereditary mutation that is responsible for your family history. Specific recommendations can follow if a specific mutation is found. Genetic testing should be done through a genetic counselor since the direct-to-consumer genetic tests do not test for all known hereditary mutations. Most insurance companies cover hereditary testing and cost of such tests has dropped dramatically in the past year. - Dr. Alok

Thank you!

There are all sorts of online communities for people like you to get more information from other previvors, survivors, patients, caregivers, and the CRC community. I highly suggest you check out Blue Hope Nation or Colontown, both amazing online communities on Facebook where I turned for that connection to others like me that understood what I was going through. -Allison Rosen

What do you think of what Exact Sciences has done/is doing with Cologuard?

With Cologuard, Exact Sciences has increased attention to screening for colorectal cancer. Personally, I do not believe the science nor the economics make Cologuard superior or even non-inferior to a colonoscopy. If a patient has the option to get a colonoscopy, I believe it is a much better test and even more economical than a Cologuard. If a patient lives in a rural area without access to a colonoscopy, then Cologuard is probably a reasonable alternative. Remember, convenience doesn’t equal better or even the same. -MBS

It is exciting as a survivor to see more screening options coming out on the market. Screening saves lives and there are so many ways to get screened now that I think it is best to talk to your insurance company and doctor about what screening is best for you. -Allison Rosen

Can I eliminate my chances of getting colon cancer by getting a colonoscopy and having any potentially bad cells removed?

Absolutely. Colon cancer typically takes years to grow. It starts with a small polyp and over time the polyp develops more mutations leading to its growths and eventually turning into a cancer. A colonoscopy allows your doctor to look for any abnormalities and then remove a polyp (growth). I consider polyps like moles on the skin but in the colon. To prevent skin cancer, we do certain measures (wear sunscreen, stay out of the sun, get annual checks). Unfortunately, we can’t see into the colon without a cleanse and scope, but, a colonoscopy can find precancerous growths (polyps) and remove them. For patients who have polyps, we monitor them more closely than those that do not. - MBS (Sonenshine)

I was being seen by GI doctor for 8.5 years for rectal bleeding related to a case of Hemorrhoids. By the time I got in for a colonoscopy at 34, I had 9 polyps, and one had developed into a 5.5 cm tumor that had spread to the lymph nodes in my colon. At any point if they had suggested a colonoscopy during that time they would have seen the polyps and removed them. - Pat Moote

how can i cope with the fear that i might get it (a form of cancer) one day? what can i do to avoid it, i am healthy and my family has no history of any cancer

You can just be vigilant with living a healthy life and knowing your body and if something seems off then make sure to visit your doctor. Do not ignore your health screenings and wellness check-ups. You are in control of your own body. You also cannot live life with the fear of maybe one day getting sick. I have in the back of my mind the fear of recurrence, but I do not let that fear control my life. I live life to the fullest and tell those that are important to me that I love them every day, I take the time to travel and enjoy life. You only have one life and it is worth living and you should do that. After cancer I have gone skiing for the first time, jumped out of a plane on National Cancer Survivors day, I travel whenever I get the opportunity, and I advocate on Capitol Hill and in Texas in hopes of helping future patients. I am in control of my life and my happiness.
Also talking openly about this fear is ok. Our mental health is important and should be taken seriously as well. I am proud to say I attend support groups and see a professional to help deal with my fears. -Allison Rosen

What are the risks of having something go wrong during a colonoscopy?

The risk of complication during a colonoscopy are extremely low. The instruments have become more flexible over the years and the viewing screens are high definition. The potential risk bleeding, infection and perforation (poking a hole in the intestines) is extremely rare 1 out of 1750 in some trials. You are closely monitored for any potential complications by anesthesia, nursing staff as well as the proceduralist. Patients do well when a complication is recognized early. - Dr M

My mom had colorectal cancer and refuses to go back to the doctor since remission (5 yrs). I believe she has some trauma from the whole thing. Any advice here? She wont go to therapy.

She also still has an colostomy that shed like to get rid of (told her that requires the doctor). How will she know when it’s time to have that conversation?

Thank you so much for doing an AMA and wish you all the best. As my mom’s caretaker, it seemed to be a particularly brutal experience, so my heart goes out to you.

I am sorry to hear about this. Would she be open to going to a support group (online or IRL)? I think finding other patients with shared experiences can make things easier. I would also suggest counseling (most cancer centers have counselors who specifically deal with mental health issues related to cancer diagnosis). - Dr. Alok

Does having diverticulitis increase the chances of developing colorectal cancer?
What are the risks of colon resection surgery?

Diverticulitis does not increase the risk for colon cancer. However, in rare cases, a CT scan that looks like diverticulitis may actually be cancer. So, all patients should have a current colonoscopy or 6 weeks after being treated for diverticulitis. Colon resection with diverticulitis depends on the severity (i.e. presence of abscess or perforation) and frequency of having diverticulitis. -MBS

Why is it recommended to start colonoscopies when you are 50 and not 30?

Great question! Any public health screening intervention has to balance the importance of finding positive findings which benefit patients against the risk of procedures (even if small) including the anxiety induced by the procedure and the chance of false-positive findings. Although rates of colon cancer are rising among younger patients, overall rates are still quite low compared to older people. No evidence based data show that starting screening at say age 30 improves outcomes for a large population so it is not currently recommended. Some guidelines have dropped the recommendation to age 45 (e.g., ACS) but others have not. Some institutions recommend age 45 for African-American patients because of concern for higher risk. Finally, these recommendations are for screening- if you are having symptoms then colonoscopy is indicated to evaluate the cause of symptoms regardless of your age. - Dr. Alok

It is actually now recommended by the American Cancer Society that average-risk patients get their first colonoscopy at age 45 due to current research. If you are younger and have any of the symptoms mentioned in any of the earlier answers you should absolutely talk to your doctor about the possibility of screening. I was 32 when diagnosed and had many of the symptoms. I know I am not the norm but if I had ignored my symptoms and not talked to my doctor and gotten a colonoscopy I would not be here today! -Allison Rosen

Does anal sex increase the rate of colorectal cancer?

Unprotected anal intercourse does not increase rate of colorectal cancer but it does increase risk of anal squamous cell cancer. Both anal and cervical cancers are caused by the HPV virus. Hopefully, with greater use of HPV vaccine, rates of both anal and cervical cancers will decline. - Dr Alok

A little off topic, but Pat, what is your best “Hey, that guy looks like Aaron Rodgers” story?

Well one time I pretended to be a fictitious brother of Aaron Rodgers named Trevor at a Packers rally in Atlanta. I was signing autographs and taking pictures. It was all fun and games until I signed some kid's football. A year later I had cancer, so, uh, I guess Karma is real. - Pat Moote

In Fall of 2017 at 32 years old, after a checkup for a severe hemorrhoid and a doctor giving me a flex-sig to ensure everything’s clear, they found a few polyps. One colonoscopy later and they removed something like 12 polyps, all non-cancerous.

My questions are:

Is there anything I can do now (being at risk with these polyps) to further reduce my risk?

How often should I get a colonoscopy considering the above?

I don’t think I can provide individual advice without knowing details of size/type of polyps but the number is on the higher size, particularly given your age. I would have a discussion with your physician about whether genetic testing would be indicated. The timing of next colonoscopy depends on the histology of the polyp (i.e., microscopic appearance), size and other characteristics. - Dr. Alok

HNPCC or APC, or something else still?

And as a follow-up, how are the doctors preventing future harm?

The best way to prevent future harm is to get diagnosed early. This is primarily based on screening (starting at age 50 for most people, earlier if you have a family history) but also for seeking medical attention if you have any symptoms of concern (bleeding, change in bowel habits, discomfort in the area). - Dr. Alok

What signs/symptoms did you have before your diagnoses and did your doctors listen to you?

My symptoms were change in bowel habits, I went from going regularly to being constipated all the time. I lost weight, I thought it was from all the Zumba I was doing but it obviously was not. I was more fatigued and tired than normal and it turned out I was very deficient in iron (found out with a blood test). Also the most obvious symptom was blood in my stool, this is NOT normal. I was lucky that my doctor believed me when I told her something was not right and arranged for a colonoscopy. If a doctor blows it off and says it is just hemorrhoids I would insist on some form of screening and if they won’t find a doctor who will. Many of my friends have been misdiagnosed with hemorrhoids or other things that turned out to be CRC. You know your body best and if something doesn't seem right it probably is not! -Allison Rosen

If more people in their 30's are getting cancer, but a colonoscopy is routine only at age 50, what factors should encourage a healthy person in their 30's to get the procedure (aside from family history)?

Great question, because of the rising incidence in colorectal cancer the American Cancer Society has lowered the age to begin screenings to 45 years of age. Certainly if there is a family history or personal history of colon cancer then screenings should begin 10 years prior to age at family member diagnosis or age 40, whichever comes first. However, any signs of bleeding or changes in bowel habits warrants a thorough evaluation including colonoscopy. - Dr M

Any advice for those with Lynch?

I would highly recommend being followed at a “high risk” clinic i.e., a clinic that follows patients at high risk for various gastrointestinal cancers with appropriate surveillance protocols. This allows multidisciplinary care and access to experts from genetics, colorectal surgery and advanced endoscopists, among others. Depending on where you live, many large academic centers have such high-risk clinics set up. - Dr. Alok

How do you distinguish the difference between bleeding due to internal hemorrhoids or colon problems? For years I've been getting sporadic bleeding while I have bowel movements, it usually only happens if I'm feeling slightly constipated that day. Always assumed it was hemmorhoids because the blood is bright red lol

It could be hemorrhoids, but best to have it checked out by a physician. Bright red blood is usually due to hemorrhoids but cancers in the lower part of the GI tract can also lead to bright red blood. - Dr Alok

I have a 24 yr. brother who always says that he has pain in his left side. He sits at his computer all day for work, but does exercise every morning. Could this be a symptom of colorectal or more likely due to sitting for prolonged periods of time?

Pain can be from so many causes -- sedentary lifestyle, constipation, irritable bowel, urinary issues, inflammation in the colon, growths like cancer, and much more. One symptom in a vacuum without other history makes it difficult to diagnose the problem. A thorough history and physical exam by a trained professional is important. -MBS

A close friend was recently diagnosed at the age of 28. What tips do you have for going through treatment at that age?

It is never easy to go through cancer treatment at any age, but when you are younger, specifically an adolescent and young adult (18-39), there are specific needs that need to be addressed. Some of these include genetic testing, career and school counseling, fertility preservation, support groups, and mental health needs, to just name a few.

Check out these articles for more information: https://www.webmd.com/colorectal-cancer/news/20190607/more-young-adults-getting-dying-from-colon-cancer , https://www.cancer.gov/types/aya and https://www.mdanderson.org/patients-family/diagnosis-treatment/care-centers-clinics/childrens-cancer-hospital/treatment-highlights/adolescent-and-young-adult-program.html.

- Allison Rosen

I always worry about what diseases and predispositions are lurking in my genes. :( I do not know the health history of my biological parents.

Do you have any advice for someone who has no clue if this is in their family history?

I imagine it can be concerning not knowing your family history. You could speak to a genetic counselor to understand what is reasonable and doable in terms of finding out your genetic risk for various conditions. I would not do genetic tests on your own without the input of a genetic counselor. Some tests on the market are not reliable, and may not accurately address your question. It’s important to know you do have some control by keeping up with your regular checkups for screening tests, and focusing on a healthy lifestyle. - Arefa

I asked my doctor about genetic testing and they referred me to a genetic counselor. I would highly suggest asking your doctor about this. Genetic testing has become much more affordable than it used to be even a few years ago. Based on your medical history that might be able to get some genetic testing covered by your insurance. My insurance covered all my testing and I only had to pay $50 but this is different for every person based on their medical history and insurance. -Allison Rosen

Is the USA unique in encouraging it citizens to have a baseline screening done at age 50? I asked my GP about having one done when I hit 50 and he said that the current advise from the Canadian medical governing body is not to refer patients for the procedure unless they have a family history or are experiencing intestinal tract issues. I kind of read into his response that the problem is probably lack of funding or scarcity of resources to handle that many patients ongoing.

I should mention though that provinces send out screening kits to everyone who turns 50. IANAD, but I'm unsure how efficacious those screens actually are given that occult blood may be present in your stool but the site you sample from is clear

The screening for colon cancer starting at age 50 is not unique to the US. I am not familiar with Canadian practice, but the Canadian task force does recommend it. Note that screening does not necessarily have to be colonoscopy but can also be less expensive measures such as testing stool for occult blood (there are pros and cons to various approaches for screening that are well discussed in the US PSTF guidelines discussion).- Dr. Alok

Hi, I had Hodgkin's lymphoma five years back and have a PET/CT scan done every year as a regular checkup. Does colorectal cancer come up on that kind of scan? Am I at increased risk because of my previous cancer?

Colorectal cancer does show up on PET although PET is not a screening test for colorectal cancer. Polyps (which can be precursors to colon cancer) are generally not PET positive. So, if age appropriate, you should consider specific colon cancer screening. There is not a clear linkage between the two cancers. - Dr. Alok