March is Colorectal Cancer Awareness Month, and screening for colon and rectal cancer is increasingly important. According to the American Cancer Society, colorectal cancer is the third-most-commonly-diagnosed and the second-deadliest cancer in the U.S.
“Colorectal” refers specifically to the portion of the large intestine called the colon and to the rectum, which is the shorter, final section of the large intestine. The lifetime risk for developing colorectal cancer is 1-in-24 for men and 1-in-26 for women.
The month of March also includes Anal Cancer Awareness Day on March 21.
Anal cancer is found exclusively in the anal canal, a short tube at the end of the rectum or on the perianal skin outside of the anus. Anal cancer is less common and less deadly than colorectal cancer. Chances of developing it are only 1-in- 500 but higher for those with certain risk factors. Among people living with HIV, it is the fourth most common cancer.
Colorectal cancers are typically caused by sporadic mutations to cell DNA. This may be due to an inherited risk, lifestyle choices or exposure to carcinogens.
Alternatively, anal cancers, like most cervical cancers, are typically caused by certain strains of the human papillomavirus, better known as HPV. HPV is spread through skin-to-skin sexual contact, and the CDC reports that nearly everyone will get HPV at some point in their lives.
Many HPV infections go away on their own within two years; some will last longer, and some can lead to cancer.
Prevention
HPV vaccines are the most effective way to protect yourself from anal cancer, and it can also protect you from many cervical, vaginal, penile and throat cancers as well as genital warts.
The vaccine is most effective when a person receives the series in their teenage years, beginning around 11 or 12 years old. However, research has shown that even through age 45, adults could still benefit from the vaccine.
Guidelines have recently changed to include this older group, so if you have not yet been vaccinated, you should discuss the possible benefits with your doctor.
What to know about colorectal screening
It is recommended that people get screened for colorectal cancer beginning at age 45, though it may be earlier if you have inflammatory bowel disease, a history of polyps or a family history of colorectal cancer.
When it comes to colorectal cancer screening, you have options including some that can be done at home, and you should discuss with your doctor which is best for you.
• Annual tests include guaiac-based fecal occult blood test and fecal immunochemical test (FIT).
• A FIT-DNA test, combining FIT results and DNA biomarker evaluations, are recommended every three years.
• Sigmoidoscopies and colonoscopies are recommended every five to 10 years depending on risk factors and annual FIT test results.
What to know about anal cancer screening
The lesser-talked-about but also important screening that you should be requesting from your doctor is an anal pap smear.
That’s right: Pap smears aren’t just for cervixes. An anal pap can screen for both cancerous and pre-cancerous cells. And it is a simple procedure involving a cotton swab in the anus and does not require any pre-appointment preparation like a colonoscopy, nor does it require anesthesia.
Guidelines from the International Anal Neoplasia Society recommend anal cancer screening for men who have sex with men and transgender women who are living with HIV starting at age 35.
It is recommended that women living with HIV and men who have sex with women who are living with HIV as well as transgender women and men who have sex with men begin getting screened at 45. However, some providers may recommend that anyone age 45 or older who participates in anal play should get an anal pap.
Other groups considered to be at high risk are people with a history of vulvar high-grade squamous intraepithelial cells (abnormal cervical pap smear) who should get an anal pap within one year of their abnormal cervical pap findings, and also solid organ transplant recipients beginning 10 years post-transplant.
If an anal pap comes back abnormal, a high-resolution anoscopy will likely be needed, and your doctor may have to refer you to another provider for that procedure.
In honor of both Colorectal Cancer Awareness Month and Anal Cancer Awareness Day this March, I would encourage you to find time this month to schedule an appointment with your provider to get screened. If you are seeking a new provider, visit PHNTx.org/form-patient-appointment-request/ to request an appointment with one of Prism Health North Texas’ providers at one of five clinics in the area.
Our staff is knowledgeable, kind and focused on your health. We care for anyone regardless of their ability to pay, with a sliding fee scale based on income.
Cancer screenings can help identify areas of concern early before they turn into problems that may be more difficult to treat later. I also encourage you to speak openly with your provider and work together to build a plan for future screenings. Do it for you and your health.
Dr. William Hays is chief medical officer of Prism Health North Texas. Find more information on Dr. Hays and on Prism at PHNTx.org.