COLON cancer continues to pose a significant burden in many societies worldwide. Globally, colon cancer is the third most common cancer in men and the second most common in women. A similar trend is seen in Jamaica where colon cancer ranks third among men and women combined, and is a leading cause of cancer-related deaths.

There remains a significant challenge since most cases of colon cancer are diagnosed at a more advanced stage, when the likelihood of good outcomes is low. This places a significant burden on families and the health-care system due to poorer quality of life and the significant cost associated with care.

In Jamaica, our own local data show that there are between 700-900 new cases of colon cancer yearly, with an alarming optic which may suggest an increased incidence in individuals younger than age 50. This trend is also seen in the United States where colon cancer is the leading cause of cancer-related deaths in individuals younger than age 50.

There are several factors that may increase a person’s risk of developing colon cancer.

The established risk factors may be non-modifiable, such as age over 50 years and a family history of colon cancer; or modifiable, related primarily to lifestyle choices such as obesity, diabetes, smoking, excess alcohol, inflammatory bowel disease; diets high in processed sugars, red meats, and low in fruits and vegetables, fibre, and important vitamins and minerals such as folic acid and folate, vitamin B6 and calcium.

As with many cancers, the main challenge with colon cancer is that people are often brought to medical attention after developing symptoms — and by then they may be at a more advance stage of disease. There are no clear early symptoms, and up to 70 per cent of individuals may not have significant symptoms. This underscores the importance of screening, for which age 45 has been the recommended starting age since 2021 when the age was lowered from 50.

Common red flag symptoms include A change in bowel habits, rectal bleeding, anaemia associated with low iron levels, unexplained weight loss, and abdominal pain.

Screening allows for early diagnosis and in most instances facilitates identifying and removing precancerous polyps (which give rise to 90 per cent of colon cancer cases). Screening can be done with yearly, stool-based tests to detect blood in the stool — such as a faecal occult blood test or faecal immunochemical test — or with a colonoscopy which allows for examination and removal of precancerous polyps when found. A CT colonography is appropriate for properly selected patients.

The impact of screening has been shown in many societies with organised screening programmes wherein there is a downward trend in the rates of colon cancer due to early diagnosis and removing precancerous polyps.

The month of March is recognised as Colon Cancer Awareness Month, and it is strongly recommended that you have a discussion with your primary care physician about screening to determine what option is right for you.

Dr Jehovah Fairclough, MD, is a consultant gastroenterologist at the University Hospital of the West Indies, board-certified in gastroenterology and hepatology. He completed fellowships in general gastroenterology and advanced therapeutic endoscopy at the University of Ottawa and is published in leading medical journals. Dr Fairclough is passionate about colon cancer awareness and specialises in advanced endoscopic removal of high-risk polyps, helping many patients avoid major surgery.