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Should I Be Worried About Changes in My Stool?

Mar 4, 2024 | Gastroenterology, Your Health

Your stool—a very basic fact of life—is a good reflection of your health. It provides insight into the quality of your diet and, potentially, may indicate certain diseases, such as cancer. While changes in bowel habits are usually not a cause for alarm, they can indicate potential issues. How can you tell if your stool is healthy, and when is it time to see a doctor?

Pascale White, MD, MBA, MS, FACG

In this Q&A, Pascale White, MD, MBA, MS, FACG, Director of the Gastroenterology Clinic, and Associate Professor of Medicine (Gastroenterology), Icahn School of Medicine at Mount Sinai, discusses how to monitor your bowel movements for potential problems, and offers simple tips on how to eat for better gut health.

How often should I be having bowel movements and what should they be like?

Every individual has their own baseline bowel habits, which are largely affected by diet and can vary in frequency for all of us. Here are some general guidelines:

Some bowel frequencies can vary anywhere from three times a day to every other day.
Healthy stool is soft formed, typically sausage-shaped, and should be easy to pass.
The color is typically brown but sometimes varies based on what you eat. In some cases, color may indicate a potential health issue. For example, if your stool is very pale or clay-colored, it may be something you ate or could be a sign of liver disease.

What changes indicate I should see a doctor?

We all experience changes in bowel movements, and occasional changes typically do not indicate a problem. However, if you are experiencing a big change in your typical pattern, you should speak to a doctor, especially if you experience:

Stool that is black and tarry or contains red blood (indicates potential internal bleeding, hemorrhoids, inflammatory bowel disease, or colon cancer)
Hard pellet-like stools that are difficult to pass or will not pass (indicates constipation)
Bowel movements that are completely watery (diarrhea)
Stool that is pencil-thin or ribbon-like (indicates potential colon cancer, polyp, or other lesion causing narrowing of your large intestine)

What can I eat to ensure good colon health?

You should eat a lot of fiber—including fruits, vegetables, nuts, and legumes—which bulks up stool and keeps it moving along, and also produces substances your colon needs. Generally, you should eat 20 to 30 grams of fiber daily. Keep in mind that eating fiber (particularly insoluble fiber) may cause some bloating or loose stools, but it is generally well tolerated. You should also drink plenty of water to prevent constipation.

Colorectal Cancer Is Rising Among Younger People. Here’s What We Know.

What foods should I avoid?

You should avoid red meat in general, which is high in fat and does not contain fiber, and especially processed meats, such as sausage, bacon, and deli meat. The process of curing and smoking meat generates carcinogenic compounds that can promote changes in the colon cells that can lead to cancer.

What are some easy ways to include more fiber in my diet?

Here are some simple steps:

Plan your meals and prepare them in advance. For example, making overnight oats before bed is a great way to ensure you are getting fiber in the morning.
Look for ways to make easy switches to what you normally eat. When eating out, get a salad, ideally one with dark, leafy greens, instead of fries. Instead of drinking fruit juice, eat the whole fruit.
Swap white potatoes for sweet potatoes, which are higher in fiber, and leave the skin. Make sandwiches with whole grain bread instead of white bread.
For a snack, grab a bag of nuts instead of a bag of chips.
You may also find that food-tracking apps are a great way to ensure you are getting enough fiber and other nutrients every day.

What are some other ways to maintain good colon health?

Exercise, moderate your alcohol intake, and do not smoke. If you are over the age of 45, or are considered high risk for colon cancer due to health issues or family history, you qualify for a colonoscopy. The procedure not only screens for colon cancer and other potential issues, but also allows us to remove polyps that can turn into cancer. Stool tests may also help identify potential issues, though they are not as effective as a colonoscopy.

Learn more about Digestive Diseases and Gastroenterology at Mount Sinai

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What You Need to Know About COVID-19 and Other Respiratory Viruses Right Now

Updated on Mar 9, 2024 | Featured, Your Health

It’s that time of the year when everyone seems to know someone who is under the weather. Respiratory illnesses, not just COVID-19, have been on the rise.

Experts say your best defense remains the same: Keep up to date with your vaccinations, consider taking steps to limit your exposure to large indoor crowds and wearing a well-fitting mask at public gatherings, and talk with your health care provider if you are feeling sick.

New Guidelines Shorten the Time You Should Isolate if You Are Infected

If you have COVID-19, or another respiratory infection, health experts say you can return to work or school sooner. New recommendations from the U.S. Centers for Disease Control and Prevention (CDC) suggest returning to normal activities when, for at least 24 hours, symptoms are improving, and if a fever was present, it has been gone without the use of fever-reducing medication. (Previous guidance from the CDC recommended people who were infected with COVID-19 remain in isolation for five days.)

Now the CDC says that once people resume normal activities, they are encouraged to take additional prevention strategies for the next five days to curb disease spread, such as taking more steps for cleaner air, enhancing hygiene practices, wearing a well-fitting mask, keeping a distance from others, and/or getting tested for respiratory viruses. Enhanced precautions are especially important to protect those most at risk for severe illness, including those over 65 and people with weakened immune systems, according to the CDC. Click here to read more from the CDC.

Note: The updated CDC guidelines do not apply to health care facilities. Click here for the latest Mount Sinai visitor policy.

“It’s the season for respiratory viruses,” says Bernard Camins, MD, MSC, Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai and the Medical Director for Infection Prevention for the Mount Sinai Health System. “It’s no longer all about COVID-19. That is now just one of a number of respiratory viruses we need to contend with.”

In addition to COVID-19, health authorities are watching a number of respiratory viruses that are circulating: influenza or seasonal flu (there are actually two forms of it this year); respiratory syncytial virus (RSV); and the common cold (rhinovirus). Taken together, they can make for a difficult season for patients and health care providers alike.

A Spike in Influenza, COVID-19, and Other Respiratory Illnesses Can Lead to a Rise in Cardiovascular Complications

Mount Sinai cardiologists are warning about the risk of heart problems this winter. Click here to read more

For COVID-19, the New York City Department of Health and Mental Hygiene reports hospitalizations in New York had surged at the end of December to their highest levels in about a year, following a smaller upturn in September. But the numbers were about half of what they were during a surge a year ago, and they are about one-tenth of the number in January of 2022 during the last big surge.

Bernard Camins, MD, MSC

Vaccinations for COVID-19 and the flu may not completely prevent you from becoming infected, but they are likely to keep you from getting seriously ill and requiring hospitalization. For both of these illnesses, it’s not too late to get vaccinated if you have not already done so. The flu season typically extends until spring.

RSV commonly causes mild, cold-like symptoms in most healthy adults and goes away after a few days. However, for infants and older adults with pre-existing conditions like heart disease or lung disease, RSV can cause severe disease and even death. The CDC recommends the RSV vaccine for adults 60 and older. The vaccine is also recommended for expectant mothers towards the end of their pregnancies so their newborns will have antibodies against RSV. The last preventive measure is a monoclonal antibody against RSV administered to newborns less than 8 months old.

Dr. Camins’ general recommendations for keeping healthy remain unchanged:

Those at risk for complications from respiratory infections may want to wear a more protective mask in crowded areas, such as riding the bus or subway or shopping. A surgical mask provides some protection but not as much as a high-quality N95 or KN95 mask.
Wash your hands frequently especially when you get home or arrive at work.
Individuals at high-risk should talk with their health care provider and have a plan for how to get antiviral medications if they become infected with COVID-19 or the flu, as these prescription medications must be taken within the first days of symptom onset. Those at high-risk include older adults, those with chronic medical conditions, such as diabetes, and those with reduced ability to fight infections, such as those being treated for some cancers.

Dr. Camins offers these additional key takeaways:

Staying home: If you are feeling very sick, you should stay home, especially if you have a fever. You may go to work when you’re feeling better, and you may want to wear a mask until your symptoms fully resolve to prevent infecting your co-workers. There’s no need for extended isolation at home as people were doing in the midst of the COVID-19 pandemic, he says.

Taking medications: Talk with your provider about medications if you become infected. Anti-viral mediations make good sense. Paxlovid™ (nirmatrelvir/ritonavir) for COVID-19 can help adults who may be at high risk for more severe illness. Anti-viral medications such as Tamiflu® (oseltamivir) for seasonal flu can lessen symptoms and shorten the time you are sick, and they can be helpful for those at risk of complications.

The new variant: The latest variant of the virus that causes COVID-19, JN.1, does not seem to be any more worrisome than others that came before it, and existing treatments work well against it. “We will probably continue to see more variants as the virus that causes COVID-19 mutates,” says Dr. Camins. “You just have to accept there is always going to be a new variant.”

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Researchers Find That Antibody Responses Induced by COVID-19 Vaccines Are Long-Lasting

First Gene Therapies Approved for Sickle Cell Disease: What Do They Spell for Patients?

Updated on Mar 1, 2024 | Featured, Research, Your Health

In December 2023, the U.S. Food and Drug Administration announced its approval of two gene therapies for sickle cell disease—the first of their kind for the condition.

Casgevy™ (exagamglogene autotemcel), a cell-based gene therapy developed by CRISPR Therapeutics using its CRISPR/Cas9 genome editing technology, was approved for use in patients 12 years and older with recurrent vaso-occlusive crises (VOCs). Lyfgenia™ (lovotibeglogene autotemcel), also a cell-based gene therapy by bluebird bio, was similarly approved for treating patients 12 and up with a history of VOCs; it uses a lentiviral vector for genetic modifications.

“This is absolutely a development that physicians treating sickle cell disease are excited about,” says Jeffrey Glassberg, MD, Professor of Emergency Medicine, and Medicine (Hematology and Medical Oncology), at the Icahn School of Medicine at Mount Sinai, and Director of the Mount Sinai Center for Sickle Cell Disease.

For a long time, sickle cell disease could only be cured with a bone marrow transplant, but that procedure involves challenges, starting with finding a match and also including the potential for complications, Dr. Glassberg says. “With these gene therapies, we’re taking stem cells from your own blood and taking it to a manufacturing facility to edit the DNA. When we give the stem cells back, you begin making new blood that’s yours without sickle cell disease,” he says. “This resolves a lot of the limitations of a bone marrow transplant.”

How do Casgevy and Lyfgenia work in curing sickle cell disease, and how do they differ from bone marrow transplants? Dr. Glassberg explains in this Q&A.

What goes on in a bone marrow transplant?

So with bone marrow transplant, you need a match. You need somebody to donate the bone marrow. While it’s unlike an organ transplant—where you’re waiting for an organ to become available either through a donation or after someone dies—there is a registry where people are willing to donate. However, finding a 100 percent match is tricky. If you’re lucky, you might have a sibling where their marrow matches perfectly. If not, it’s a rigorous search through this registry.

We can do bone marrow transplants with only half-matches, but those don’t work as well. And even for well-matched transplants, there remains the risk of developing a complication called graft-versus-host disease (GvHD). That is a condition where the donor immune cells recognize the host as foreign and attack the recipient’s body cells. GvHD can be pretty common—occurring in about 50 percent of cases—but only a small percentage turn into catastrophic GvHD.

Jeffrey Glassberg, MD, Director of the Mount Sinai Center for Sickle Cell Disease

What is sickle cell disease?

Sickle cell disease is a group of inherited blood disorders, where a mutation in hemoglobin—a protein in red blood cells that delivers oxygen to tissues—causes the red blood cells to develop a sickle shape. These sickled cells can restrict blood flow in blood vessels and deliver oxygen inefficiently, which can cause pain or organ damage—also known as vaso-occlusive crises. This condition affects approximately 100,000 people in the United States and is most common in Black people. Even with good management, the life expectancy of a person with sickle cell disease is around 50 years

How do the gene therapies avoid these issues?

With the gene therapies, the patient is essentially still going through a bone marrow transplant. The individual still receives a large amount of toxic chemotherapy to kill off existing stem cells, and receives new cells. However, the difference is that it is your own stem cells taken out and fixed. You are donating marrow to yourself, so it will always be a 100 percent match when reintroduced to your body and would not attack the host.

What are the technology differences behind the two gene therapies?

Casgevy uses CRISPR/Cas9, which is basically a protein discovered from bacteria that can cut tiny pieces out of your DNA. The therapy uses CRISPR to turn down a gene called BCL11A, which suppresses the production of fetal hemoglobin after babies are born and activates beta hemoglobin, which is affected by the sickle-cell mutation. By turning down that gene, the patient stops making adult hemoglobin and switches to making fetal hemoglobin.

Lyfgenia uses a lentivirus to create a so-called transgene. The lentivirus drops in a whole gene which contains instructions for producing functional hemoglobin. This approach produces a type of hemoglobin called HbA^T87Q, which works even better than regular adult hemoglobin and can be identified with a lab test. The differentiation is helpful in telling exactly how well the gene therapy is working by the amount of HbA^T87Q.

In a way, for both fetal hemoglobin and HbA^T87Q, they work slightly better than regular hemoglobin for adults with sickle cell disease. Both have similar or slightly better oxygen-binding affinity, and each possesses “anti-sickling” globins that limit or inhibit hemoglobin S levels, which are tied to the sickling of red blood cells.

Are these gene therapies available at Mount Sinai?

Yes, we’ll be doing the therapies starting in late February. We’ve got four patients approved already, and have a list of dozens of people who are being evaluated. You can make an appointment at the Mount Sinai Sickle Cell Disease Center.

To call Mount Sinai Sickle Cell Disease Center
212-241-3650

What goes into the process of receiving these therapies?

It’s a long road. It starts with a visit at a sickle cell disease center. If the physicians have not identified any big reasons why you should not be a candidate, you’ll be referred to a gene therapy team—these doctors also work with bone marrow transplants. They will ensure any medical issues before and after the therapy are accounted for.

Administrative and finance teams will work with you to ensure these therapies are covered. These are expensive products—about $2 million or so—and each gene therapy is an individual negotiation and contract between the insurance company and drug company.

If everything is approved, you’ll make an appointment to come into the hospital for a procedure called apheresis. It’s almost like dialysis, where you’re hooked up to a machine. Your blood is pulled into the machine where stem cells are extracted over a period of about six hours. The stem cells are sent off to a manufacturing facility where the drug company does the gene therapy. This could take up to six months.

When the product is ready, you’ll check into the hospital again. You’ll be given chemotherapy to kill off all the stem cells in your body that make blood. Once all the stem cells are gone, a bag containing the gene therapy gets transfused into you, and the modified cells find their way back into the bones and start making blood that doesn’t have sickle cell disease.

Similar to a bone marrow transplant, you’ll be in the hospital for four to six weeks, because you have no immune system following the transfusion, and the product takes about a month to get into your body. This would be the biggest danger period of the whole process. But after that, you leave the hospital pretty much cured of sickle cell disease, though you might have to come back for several checkups.

What are some risks associated with the gene therapies?

Like in bone marrow transplant, the involvement of chemotherapy does carry a small risk of death. And there is a small risk of secondary cancers from the chemotherapy. It is very likely a person opting for this therapy might not be able to have children afterward unless you preserve your eggs or sperm. After the therapy, you would have to be careful for a while because your immune system is still reconstituting itself, and a simple case of influenza can make you much sicker than it normally would.

Who might be ideal for this sort of therapy?

The sickest of patients would be too frail to undergo chemotherapy, and a patient with mild disease wouldn’t find the risk-benefit attractive. It would essentially be someone with severe disease who isn’t responding well to current available drugs, but is strong enough to undertake the risk of chemotherapy to not have sickle cell disease anymore.

In adult medicine, we have moved away from paternalism, so our approach is: if you have sickle cell disease, and you understand the procedure, risks, and alternatives, and you still want to opt for the gene therapy, we will support you and do our best to help you succeed. It’s a shared decision-making process with the patient to make sure they understand what they’re getting themselves into.

In children for whom this therapy is appropriate, it’s a different approach. It’s more a medicine-based approach, where you only reach for the extreme care when you’ve exhausted all other options and you can say with relative certainty that the child would otherwise be certain to experience bad outcomes. An example would be if a child had had a stroke after maximal treatment and continued to have another stroke, then a transplant or gene therapy could be considered.

There might be many who would not opt for this, given that there are many good treatments that could help manage the condition, as well as more drugs in development. But these gene therapies open up options for a tremendous number of people. They are a cure for sickle cell disease as much as a bone marrow transplant is considered a cure. We know from bone marrow transplant patients who have lived decades after the procedure that the benefit continues to be a durable effect for the rest of their life. While we can’t predict how patients will fare decades down the road, since the first patients for these gene therapies got them in 2014, we are hopeful they will see similar durable benefit as well.

Learn more about the Mount Sinai Center for Sickle Cell Disease

Three Fiber-Full Breakfasts to Start Your Day

Updated on Feb 26, 2024 | Recipes

Fiber is the roughage in plant-based foods that your digestive system cannot break down. Fiber makes your stool soft, contains bacteria essential to gut health, and may even reduce your risk for colon cancer. According to the Centers for Disease Control and Prevention, you should eat at least 25 grams of fiber a day. If you need more fiber in your diet, these fiber-filled breakfasts are a delicious way to start.

Bircher Müesli (Swiss Oatmeal)

Ingredients

Juice of 1 lemon or orange (substitute 1 cup orange juice)
1 large apple, coarsely grated
2 cups grain, rolled oats or unsweetened muesli mix
1 to 2 teaspoons of seeds, your favorite
1 tablespoon nuts, your favorite
2 cups coarsely chopped fruit
1 cup milk substitute
1 to 2 cups yogurt or yogurt substitute

Preparation
Pour whichever juice you are using into a bowl. Grate apple into the juice and mix. Add preferred grain (oats or muesli mix), seeds, nuts, fruit, milk, and yogurt. Mix well, and dig in. If you prefer a softer texture, refrigerate it for a couple of hours or even overnight.

Serves four
344 calories per serving

This is a Swiss staple eaten for breakfast or any meal. It is a very common food in Switzerland, and is a super healthy and nutritious dish. It is my favorite breakfast food. Adapt the recipe to make it vegan by replacing the milk and yogurt with non-dairy substitutes. – Ursula, Research Program Coordinator, Mount Sinai Health System

Egg Sandwich With Avocado

Ingredients
1 egg
1 slice of whole grain or high fiber bread
1 cup arugula
1/2 ripe avocado, sliced
1/2 teaspoon hot sauce
Salt and pepper

Preparation
Slice the avocado and wash and dry the arugula. Toast the bread. Coat a small skillet or frying pan with cooking spray and heat over medium heat source. Crack the egg gently into the heated skillet. Cook for approximately 2 to 3 minutes until done to your liking. Assemble sandwich by placing the toasted whole grain bread on a plate. Spread the avocado onto the toast and layer first with the arugula. Place the egg on top. Add a dash of hot sauce and salt and pepper to taste.

Serves one
273 calories per serving

Four Ingredient Banana Pancakes

Ingredients
1 banana
2 eggs
1/4 teaspoon cinnamon
2 tablespoons of almond flour
Maple syrup, honey, berries to serve

Preparation
In a bowl, mash the banana with a fork. Add eggs, almond flour, and cinnamon. Mix until combined with the banana.

Heat a nonstick skillet over medium heat. Add a spoonful of batter to form a small pancake; repeat leaving space between each pancake. Cook for 3 to 4 minutes, and flip and cook for an additional 3-4 minutes. Remove from the pan with a spatula and serve with your syrup, honey, or berry topping of choice.

Serves four

Nutritional Information per serving
Approximately 78 calories
Carbohydrates: 7.4 g
Protein: 3.85 g
Fat: 3.72 g

This is a quick and easy breakfast that is well loved by my toddler. It can also be a great snack to share with playmates and a dessert for the parents, too. -Dora, Diabetes Alliance, Mount Sinai Health System

Click here for more healthy recipes in Mount Sinai's Calm & Fit Wellness Cookbook.

How Can I Develop a Healthy Eating Pattern?

Updated on Feb 26, 2024 | Cardiology, Diet and Nutrition, Your Health

Hypertension, cholesterol, diabetes, and obesity—these are all drivers for heart disease, the leading cause of death in the United States. Treating each individually often means seeing multiple specialists. But one thing is clear: If you reduce excess body fat with a healthy lifestyle, your cholesterol, blood pressure, and risk for diabetes or prediabetes will likely drop, and so will your risk for heart disease.

Jeffrey I. Mechanick, MD

In this Q&A, Jeffrey I. Mechanick, MD, Professor of Medicine and Medical Director of the Marie-Josee and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Fuster Heart Hospital, explains how adopting a healthy eating pattern, rather than restrictive or fad dieting, can reduce your risk for heart disease and other chronic illnesses.

How do I know if I am at risk for heart disease?

Your body mass index (BMI) should be 18.5 to 24.9 (for Asian Americans, a healthy BMI is 18.5 to 22.9). Keep in mind that for some people, such as those who are more muscular or have a lot of swelling, BMI may not be accurate. Your goal should not be to lose weight but to be healthy and enjoy your life. Instead of going on a diet or eliminating certain foods or food groups, focus on developing a healthy eating pattern.

Calculate My BMI >>

What is a healthy eating pattern?

First, do not think about a single food as being good or bad. Rather, consider how the pattern of foods you eat over the course of 24 hours—the total aggregate of the foods and the nutrients that are in them—are affecting your risk for heart disease. A healthy eating pattern is one that reduces your risk.

How do I develop a healthy eating pattern?

Here is what I often tell my patients:

An ideal plate is a healthy food plate, the majority of which should consist of hi-fiber plants.
If you include meat, make sure it is lean meat.
Keep in mind that quantity (portion size) is not as important as the quality of the food (whole, high-fiber foods).
Try to get in at least five to seven servings of fresh fruits and vegetables (one serving fits in the palm of your hand), as well as beans, lentils, nuts, and whole grains, every day.
Include a good quality protein—such as poultry, fish, or vegetable protein such as beans and lentils—with every meal.
Avoid processed foods, and eat treats only on occasion.
Instead of baked goods, have whole grain breads or even Ezekiel breads, which are made out of sprouts and lentils (this will help you transition your eating pattern to those healthier whole grains).
Limit alcohol as much as you can—no amount is considered healthy.
Do not skip meals.

If you’re having trouble, seek out a professional, such your primary care physician, heart specialist, or registered dietitian, who can help structure an eating pattern for you to achieve a healthy weight.

Learn how to meal plan for heart health and weight management.

What should I look for in food labels?

Look for foods that are high in fiber but lower in calories, fat, sodium, and simple sugars. Be aware that these numbers are often listed on Nutrition Facts labels as “per serving” and not per the total amount in the food product.

Dietary fiber: The more fiber, the better. Both soluble and insoluble fiber are good for gut health and decrease your risk for chronic diseases, such as heart disease and cancer. Fiber also decreases appetite and helps you feel full, so you are not as tempted to snack on high-calorie foods.

Sodium: The official recommendations are to have only about two grams of sodium a day—roughly one teaspoon of table salt per day. If you are already at risk for heart disease, you may need to limit sodium even more.

Saturated fat, trans fats, and simple sugars: While the data on how much saturated fat is safe is unclear, you should stick to foods that have little to no saturated fat. Avoid trans fats and simple sugars—again, you can find the amount on the Nutrition Facts labels of packaged foods or just by looking up information online.

What should I look for in restaurant menus?

Here’s a trick I give my patients: Don’t ask for the menu. Research the restaurant online at a time when you’re not hungry (such as after a meal at home) and decide what you will eat before you go, or ask the server about specific items they might have—the fish of the day, lean proteins that are cooked without sauces, salads and raw or steamed vegetables, plant-based entrees and side dishes, and even berries for dessert. This way, you won’t be tempted by the less healthy options on the menu or enticing specials.

Will dietary supplements reduce my risk for heart disease?

There is really no need to take dietary supplements unless there is a medical reason. If you are following a healthy eating pattern, you will reduce your risk for deficiencies. If you have any question or doubt, definitely discuss it with your physician.

What else will help me reduce my risk for heart disease?

Get sufficient amounts of physical activity, including a mix of aerobic exercise and strength training, especially progressive resistance training. Sleep a minimum of seven hours a night. Do not smoke or do drugs, and reduce stress as much as possible. If you are overly worried or struggle with addiction, don’t delay—seek help from a mental health professional or counselor.

Learn how to create a weight loss program that works for you.

Learn more about Your Health.

Your Guide to Colorectal Cancer Awareness and Prevention

Updated on Sep 11, 2024 | Community, Your Health

A colorectal cancer awareness event at The Mount Sinai Hospital. Click here to learn more about colorectal cancer and early screening with Mount Sinai’s CHOICE Program. To discuss your screening options or if you have a referral, call 212-824-7887.

Colorectal cancer is the second leading cause of cancer deaths in both men and women in the United States. Although this cancer is highly treatable and preventable, about 140,000 Americans are diagnosed and more than 50,000 people die each year, according to the Centers for Disease Control and Prevention (CDC). In 2021, the United States Preventative Task Force updated its guidelines and lowered the starting age of screening from 50 to 45.

More than 93 percent of colorectal cancer cases occur in people 45 years old or older. More than 75-90 percent of colorectal cancer cases can be avoided through early detection and removal of pre-cancerous polyps, and as many as 60 percent of colorectal cancer deaths could be prevented if men and women over the age of 45 were screened routinely.

In the United States, more than half (55 percent) of all cases of colorectal cancer are attributable to lifestyle factors, such as an unhealthy diet, insufficient physical activity, high alcohol consumption, and smoking. Increasing screening to 80 percent of people could reduce the number diagnosed with colorectal cancer by 22 percent by 2030. But survey data indicates that screening prevalence among adults remains low in those aged 45 to 54.

In an effort to increase awareness and screening, Mount Sinai has expanded colorectal cancer awareness initiatives across all eight hospital sites during March to provide patients with access to health professionals to discuss prevention, screening options, and risk factors. Mount Sinai experts will be available to answer questions on diet, genetic counseling, the colonoscopy procedure, and ways to schedule and offer support after diagnosis.

Here are some prevention tips:

Schedule a Screening

A colonoscopy is the preferred screening method as it allows for both detection and removal of precancerous polyps during the same procedure. Other screening options include a flexible sigmoidoscopy, CT colonography, and home-based stool tests, including the fecal occult blood test (FOBT), fecal immunochemical test (FIT), and a combined fecal immunochemical test with DNA test (FIT-DNA test). Individuals should discuss all of these options with their doctor to find which method works best for their lifestyle.

Know Your Risk Factors

Age: More than 90 percent of colorectal cancer cases occur in people 45 years old or older and death rate increases with age. In New York, 44 percent of those 45 to 54 are up to date with colorectal screening.

Family history: As many as 1 in 3 people who develop colorectal cancer have other family members who have been affected by this disease. The risk is even higher if a relative was diagnosed under age 50 or if more than one first-degree relative (parent, sibling, or child) has been affected.

Racial and ethnic background: Colorectal cancer affects people of all races and ethnicities. However, colorectal cancer disproportionately affects the Black community, where the rates are the highest of any racial/ethnic group in the United States. Black individuals are most likely to be diagnosed with late-stage colorectal cancer. The incidence of this cancer in Black individuals is 15 percent higher than in white individuals. Death rates have declined in Black individuals by 3 percent. Colorectal cancer screening rates are now lowest among Asian Americans and Hispanic/Latino communities.

Lifestyle factors: Common lifestyle factors that may increase colorectal cancer risk include obesity; cigarette smoking; lack of exercise; overconsumption of fat, red, and processed meats; not eating enough fiber, fruits, and vegetables; and drinking alcohol excessively.

Pre-existing health conditions: Inflammatory bowel diseases (IBD), such as ulcerative colitis or Crohn’s disease, and less common genetic syndromes, such as familial adenomatous polyposis (FAP) or Lynch syndrome, significantly increase the risk of developing colorectal cancer. These patients are recommended to start screening at a younger age and more frequently.

Warning Signs and Symptoms

A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, lasting for more than a few days.
Rectal bleeding, dark stools, or blood in the stool.
Cramping or abdominal pain.
Weakness and fatigue.
Unintended weight loss.

To learn more about colorectal cancer and early screening, visit Mount Sinai’s CHOICE Program.

To discuss your screening options or if you have a referral, call Mount Sinai's Choice Program at 212-824-7887.

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