#391 ‒ Colorectal cancer screening: importance of early screening, colonoscopy as a screening and preventive tool, and how to build a personalized strategy

**Peter Attia** (0:10)
Hey everyone, welcome to a sneak peek episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com/subscribe.
So without further delay, here's today's sneak peek of the episode.
Welcome to a new episode of The Drive. In today's episode, I'm diving into colorectal cancer screening. Why colorectal cancer is one of the most preventable cancers we know of, and why getting screening right matters so much. In this episode, I'm going to discuss many things, but among them, how colorectal cancer develops. Why colonoscopy is uniquely valuable as both a screening and preventive tool, the troubling rise in early onset colorectal cancer, and how to think clearly about the growing menu of non-invasive screening options and their limitations. If you're not a subscriber, you'll only be able to listen to a sneak peek here. So without further delay, I hope you'll enjoy today's episode of The Drive.
Colorectal cancer, or CRC as we'll abbreviate it, is the second leading cause of cancer death in the United States. And it's projected to be responsible for roughly 55,000 deaths this year, according to the American Cancer Society. That puts it behind only lung cancer as far as cancer mortality. And yet, unlike many other cancers, CRC is arguably the most preventable cancer we know of.
And the reason for this is that CRC follows a well-characterized, slow progression from completely normal tissue to a benign polyp, to a precancerous polyp, to frank malignancy. And that progression almost always takes years, often a decade or more. And because the colon is a hollow organ, and sits outside the body, as crazy as that sounds, we can directly access and visualize it. We have the ability to not only detect those precancerous lesions, but also remove them before they ever become cancer. So no other common cancer screening test can make that claim. A mammogram can detect breast cancer, a low dose CT scan can detect lung cancer, but neither of those are able to look directly at the cancer. And so a colonoscopy can not only do that, but it can also remove the precancerous lesion in the first place. And yet a 2020 CDC estimate claims that 68% of colorectal cancer deaths may be prevented with screening, even at the traditional recommended intervals. Again, that statistic should stop you cold. We're talking about a cancer that in most cases gives us a decades-long window to intervene, and we're still losing nearly 70% of people out of that 55,000 deaths a year because they never walked through the front door to get a colonoscopy. Even more, I would argue that this number could be closer to 100%, i.e. 100% reduction in colorectal cancer death, with more aggressive screening protocols, including starting earlier and screening more often. So today, I want to cover this topic comprehensively. We'll start with the basic biology of colorectal cancer and why it's uniquely suited to screening. Then we'll talk about the rise of early onset colorectal cancer in younger adults. From there, we'll go into the colonoscopy itself, how to prepare for one, how to ensure you're getting a high quality exam, and how to think about screening intervals. We'll discuss real risks and trade-offs, and finally, we'll walk through the growing landscape of non-invasive screening alternatives, both stool-based tests and blood-based tests, and talk about what they can and can't do.
The goal here is to leave you with a very clear, practical picture of colorectal cancer screening, whether you're 35 and wondering when to start, or 55 and wondering when your coli guard test is good enough.
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