Dr. Fola May is an associate professor of medicine at the David Geffen School of Medicine at UCLA David Geffen School of Medicine at UCLA, a research collaborator at the UCLA Health Jonsson Comprehensive Cancer Center, and associate director at the UCLA Kaiser Permanente Center for Health Equity.
UCLA Health cancer prevention researcher and gastroenterologist at UCLA Health, is available for interview on a variety of topics during colorectal cancer awareness month, including early-onset disease, genetic risks, prevention, disparities in care, and screening guidelines and options.
Here, Dr. May addresses frequently asked questions about the disease.
How common is colorectal cancer?
The estimates 107,320 people in the U.S. will be diagnosed with colorectal cancer in 2025. Most people are surprised to learn that it’s the third most common cancer in men, and the third most common cancer in women. And when you look at deaths from cancer, it is the number two cause of cancer deaths when numbers for men and women are combined.
Why is colorectal cancer on the rise?
Overall, it's actually on a decline. That's because since the late 1990s, we've had colonoscopy and other screening modalities. But since the 1990s, we've seen a 1% to 2% increase per year in cases in people under the age of 50. The reasons are still unknown. It is certainly something environmental over genetic, meaning that the human genome has not changed or would not change that rapidly. We think that it probably has to do with diet, and also environmental toxins and exposures that have yet to have been discovered. But those are all actively being pursued in scientific research now.
Is colorectal cancer hereditary?
It can be hereditary, and some genetic syndromes are linked to colorectal cancer. If you have a mother, a father, a brother, or a sister who've had colon or rectal cancer, then you also have a higher risk of getting the disease.
What are the symptoms of colorectal cancer?
Unfortunately, most colorectal cancer is asymptomatic. And that's why screening is so important. A large majority of people will walk around with this cancer, sometimes for years, and not know that they have it.
But if they do develop symptoms, the most common is blood in the stool. People can also have a change in their stool pattern, meaning that they can move toward being constipated all the time or having diarrhea all the time, for months on end. And when colorectal cancer becomes very advanced, we also see weight loss and abdominal pain.
Is colorectal cancer treatable?
Absolutely. But it’s important to understand that the cure rate depends on the stage when you are diagnosed. For people who have stage one disease - early cancer - the cure rate is over 90%. Unfortunately, if the cancer has progressed to stage four, which is late-stage cancer, the cure rate drops to less than 15%. So this really emphasizes the importance of early diagnosis.
How can I prevent colorectal cancer or lower my risks?
The number one way to prevent it or to lower your risk is to get screened as recommended by our . And that guidance is that unless you have a family history, you should start screening at age 45. And if you do have a family history, you start screening at age 40. Screening is our number one tool for prevention and early detection.
The second tool is lifestyle modification. We know that if we increase our fiber, we lower our risk. We know that if we reduce the amount of red meat and processed meat, we reduce our risk. Other things that can be helpful are to avoid tobacco and minimize alcohol, increase your exercise and make sure that you're getting plenty of vitamin D and calcium.
What is a colorectal screening?
There's a big misconception that colonoscopy is the only screening test. You can screen with a colonoscopy, which is a procedure that is performed by a gastroenterologist. It's usually done in a hospital or a medical procedure unit, and it requires the individual to take a colon prep to clear out the colon the night before.
At least 75% of screening in the United States is done by colonoscopy. But it's important to know that there are many barriers to colonoscopy. Some people have a hard time finding a gastroenterologist or lack access to medical care in general. Some people are terrified of medical procedures. Fortunately, we have other screening methods.
The second most common are stool-based screening tests you can do at home. The kit comes with instructions on how to collect a stool sample, which you then send to a lab where they test for blood. If that test is positive, you will need a colonoscopy to see if there is a polyp or a cancer.
Beyond the stool-based test, there's also a CT colonography. And then, most recently, we are starting to see some blood tests that can show markers for colorectal cancer.
Who should be screened and how often?
Everyone who is at average risk and has no family history should start screening at age 45. How often you are screened is going to depend on the test you're using and the results of that test. For colonoscopy, if it’s clear, you can wait ten years for your next one. But if the colonoscopy detects high-risk polyps or pre-cancerous polyps, then you'll need to have a colonoscopy sooner than that. The stool-based tests are usually performed every three years or every year, depending on the test. If you have a family history of colorectal cancer, you should have a first screening test at age 40 – and it should be a colonoscopy.
Dr. May is an associate professor of medicine at the David Geffen School of Medicine at UCLA , a research collaborator at the and associate director at the UCLA Kaiser Permanente Center for Health Equity. Her research focuses on eliminating patient, provider and health system-level barriers to colorectal cancer screening among low-income individuals, racial/ethnic minorities, and Veterans.
To set up an interview, contact Simi Singer at [email protected] or 310.435.9435
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