More than 53,000 Americans are projected to die from colorectal cancer this year. Although colorectal cancer is the second-most common cause of cancer deaths in the United States, it can be cured if caught early. Detecting a tumor as soon as possible can help you get treatment as soon as possible, giving you the best chance for survival.

In my work as a gastroenterologist, I treat patients from every background and walk of life. Uniting them are a growing number of insurance barriers threatening access to timely care. All too often, payers take a long time to make coverage determinations, or they even deny them outright.

With the alarming rise of colorectal cancer diagnoses among Americans under 50, it is more important than ever for people to know their cancer risk and when to get screened.

Here are common questions I and other gastroenterologists get from patients about colorectal cancer:

What is my colorectal cancer risk?

Anybody at any age can develop colorectal cancer. However, some people may be more likely to get the disease than others.

For example, people with a family history of colorectal cancer or a personal history of polyps, which are abnormal growths in the tissue of the colon or rectum, may have a higher risk.

Inflammatory bowel diseases like Crohn’s and ulcerative colitis can also increase your risk of developing colorectal cancer. This is because the chronic inflammation associated with these diseases can promote the development of abnormal growths.

Race and ethnicity may also affect colon cancer risk. Black and Indigenous Americans are significantly more likely to develop – and die from – colorectal cancer. While genetics does play a role in disease development, much of the risk of colorectal cancer is linked to environmental factors. These include a person’s income level, types of food and groceries available in the neighborhood, access to primary care providers and specialists, and a wide variety of other social determinants of health.

Lifestyle factors like smoking, not exercising regularly and poor diet can also increase your colon cancer risk. Researchers have shown that red meat releases chemicals that can cause inflammation, while high-fiber foods and vegetables can help lower inflammation. Similarly, a sedentary lifestyle can also increase inflammation. Smoking can lead to harmful genetic changes in colon cells.

What are my screening options?

People with colorectal cancer usually don’t exhibit symptoms until the disease progresses to a later stage. That is why early and regular screening is critical.

The U.S. Preventive Services Task Force recommends Americans begin regular screenings at age 45. Recognizing that the incidence of colorectal cancer has grown among younger adults, the task force lowered the age from 50 in 2021. Screening may start earlier and occur more frequently for people who have an increased risk of colon cancer.

There are various screening methods, and your medical provider can recommend procedures based on your risk factors.

Many people choose to get a colonoscopy, which is a screening test that can also prevent cancer by removing precancerous polyps. It involves using a long, flexible tube with a light and a camera on the end to visually inspect the colon for signs of cancer, abnormalities in the colon lining, or growths such as polyps. Ultimately, colonoscopy screening can significantly reduce the incidence and mortality of colorectal cancer.

Other screening strategies include noninvasive stool testing, imaging scans and a combination of endoscopic visualization with stool-based testing.

Your doctor can help you select a test that aligns with your preferences, values and risk factors. Suggested screening approaches in people with an average colon cancer risk include a colonoscopy every 10 years, stool-based testing every one to three years, or CT scans every five years for those who are unable to have a colonoscopy as an initial screening test. A positive test result for these alternative approaches should be followed by a colonoscopy.

With routine screening, one out of every three colorectal cancer deaths can be avoided.

Why won’t my health insurance pay for my colonoscopy?

While colorectal cancer screening is free as a preventive service under the Affordable Care Act, some insurers are making it harder for people to get care.

For example, Blue Cross Blue Shield of Massachusetts proposed a 2024 policy that would have deemed the use of anesthesia in endoscopies, colonoscopies and other vital procedure as medically unnecessary. This meant patients would have had to pay out of pocket to cover the anesthesia needed for colorectal cancer screenings, potentially creating major cost barriers. The insurance company only reversed course after an outcry from physicians and patients.

Another troubling trend is expanded use of prior authorization, a process some health insurers use to determine if they will cover the cost of a medical procedure, service or medication. Insurers can delay or deny coverage of medically necessary care that physicians and medical guidelines recommend because they deem certain health care services unnecessary for a patient or too expensive to cover.

In 2023, UnitedHealthcare proposed a policy that would have required the 27 million people under their plan to obtain insurance approval before they could get diagnostic or follow-up colonoscopies. After protests from physicians and patients, the insurer put the policy on hold.

UnitedHealthcare has also made plans to introduce a program in 2024 that could involve prior authorization for colonoscopies. The insurer has released little information about why it feels such requirements are necessary, what services would require prior authorization and how it would protect patients from unnecessary delays and denials.

How can I lower my risk of colorectal cancer?

If you haven’t already, look into getting screened for colorectal cancer. Talk with your doctor’s office and check with your insurance company to understand what will be covered before your procedure. If you’re 45 or older, a colonoscopy can screen for and prevent colorectal cancer.

Younger adults can take steps to reduce their risk of colon cancer by adopting healthy eating and lifestyle behaviors. Being aware of personal risk factors and seeking medical attention for symptoms – such as changes in bowel habits, rectal bleeding, abdominal pain or unexplained weight loss – can help you discuss screening options with your health care provider.

If you have already had a colonoscopy and had polyps removed, make sure you know when you are due to return for a follow-up colonoscopy. It could save your life.

Andrea Shin, Associate Professor of Medicine, University of California, Los Angeles

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Part 5 —Male Menopause: Speaking Out About the Unspeakable Passage

This is the 5^th in a series of articles on the Future of Men’s Mental Health. In Part 1, I addressed the questions, “Men and Mental Health, What Are We Missing?” Part 2 focused on the way that “Mental Health Crises Are Putting Everyone at Risk.” In Part 3, I explored Gender-Specific Healing and Man Therapy. In Part 4, I shared Recent Research From Leading Neuroscientists.

            The title of the first chapter of my book, Male Menopause, was titled, “Putting the Men Back in Menopause.” I detailed my initial explorations this way:

“When I began researching this book, I was skeptical about the concept of ‘male menopause.’ I had been a therapist for over thirty years and had worked with thousands of midlife men and women. Is there really a change of life that men go through?”

            I went on to describe my encounter with one of the earliest proponents of male menopause, the writer Gail Sheehy.

“While browsing through my local bookstore, I was drawn to a copy of Vanity Fair magazine. Well, to be absolutely honest, I was drawn to the cover photo of  Sharon Stone, nude to the waist, with her hands cupping, but only partially covering, her breasts. Sharon was staring seductively into the eyes of the reader, with two-inch letters emblazoned across her bare midriff proclaiming, ‘WILD THING!’ I was sure there was something important Sharon had to tell me.”

            I went on to say,

“However, I never read the article to find out, because just to the left of Sharon’s blond hair, right below the April 1993 dateline, were the words that grabbed me by the throat (actually a bit farther south than my throat)—‘Male Menopause: The Unspeakable Passage by Gail Sheehy.’ Those words spoke in a quiet but insistent voice.”

            Male Menopause was published in 1997 and soon became an international best-seller. It has since been translated into more than fifteen foreign languages. My follow up book, Surviving Male Menopause: A Guide for Women and Men, was published in 2000. There continues to be a great deal of confusion and controversy surrounding the whole concept of what goes on at mid-life for men. As Sheehy recognized in the 1993 article,

“If menopause is the silent passage, ‘male menopause’ is the unspeakable passage. It is fraught with secrecy, shame, and denial. It is much more fundamental than the ending of the fertile period of a woman’s life, because it strikes at the core of what it is to be a man.”

            I was one of the early researchers who was speaking out about Male Menopause (also called Andropause or Manopause). Here are a few of the important things I’ve learned over the years and have shared in my books and articles.

What is Male Menopause?

            Male Menopause begins with hormonal, physiological, and chemical changes that occur in all men generally between the ages of forty and fifty-five, though it can occur as early as thirty-five or as late as sixty-five. These changes affect all aspects of a man’s life. Male Menopause is, thus, a physical condition with psychological, interpersonal, social, and spiritual dimensions.

What is The Purpose of Male Menopause?

            “The purpose of Male Menopause is to signal the end of the first part of a man’s life and prepare him for the second half. Male Menopause is not the beginning of the end, as many fear, but the end of the beginning. It is the passage to the most passionate, powerful, productive, and purposeful time of a man’s life.”

What Are The Most Common Symptoms of Male Menopause?

• Loss of libido and sexual desire, particularly with the partner you are with.
• Increased fantasy about having sex with others.
• Difficulty developing and maintaining erections.
• Increased irritability and anger.
• Taking longer to recover from injuries and illness.
• Having less endurance for physical activity.
• Increased anxiety and worry.
• Loss of self-confidence and joy.

What Are Common Life Changes Associated with Male Menopause?

• Hormone levels are dropping, particularly testosterone.
• Sexual vigor is diminishing.
• Children are leaving.
• Parents are dying.
• Job horizons are narrowing.
• Friends are dying or getting serious illnesses.
• Martha Weinman Lear, writing in the New York Times Magazine summed it up this way.

“The past floods by in a fog of hopes unrealized, opportunities not grasped, women not bedded, potentials not fulfilled, and the future is a confrontation with one’s own mortality.”

            Over the years, I have found two common extreme views: (1) Male Menopause doesn’t exist.            Only women go through a hormonally driven change of life. (2) If men do go through a change, it is only a hormonal change, and can be “cured” by giving  men supplemental testosterone.

            I’ve learned that neither of these views are true. Men do experience a change of life, whether we call it Male Menopause, Andropause, or Manopause. I called it Male Menopause because I believe there are more similarities than differences between what women and men experience. I also believe, as does, Gail Sheehy, that it is much more complex than simply a loss of hormones and

“It is much more fundamental than the ending of the fertile period of a woman’s life, because it strikes at the core of what it is to be a man.”

Surviving Male Menopause Together. How Can Couples Navigate the Change of Life?

            After Male Menopause was published and become an international best-seller with 15 foreign editions, I received letters from women all over the world asking questions about the relational aspects of what men go through. I wrote the book Surviving Male Menopause: A Guide for Women and Men to answer questions including the following:

• How does male menopause differ from the midlife crisis?
• Why do men have affairs at this time of life?
• What are the best methods for treating erectile dysfunction?
• Why do menopausal men act so much like adolescent boys?
• What can a woman do to help a man get through male menopause?

Is There Anything Good About Male Menopause?

            Like so many complex aspects of life, when we try to oversimplify things, we lose the very essence of what we are trying to study. When we deny the reality of a “male change of life” and reduce it to a “midlife crisis” or simply see the change in medical terms, we give men few options.

            For most of human existence our lifespan was quite limited to around forty years. Men and women rarely lived long enough to experience a “change of life.” Life was a climb up a mountain and we reached the peak when we were in our 20s and had produced children to keep our species going. Then, it was a quick decline down the mountain once the children were old enough to survive.

            But now humans can live into our 80s, 90s, and beyond. Now there is another mountain to climb and what we call Male Menopause is simply the transition to the second mountain. If top of the first mountain is called “Adulthood,” the peak of the second mountain, is “Super-Adulthood” or “Elderhood.” That is why I say that

“Male Menopause is not the beginning of the end, as many fear, but the end of the beginning.”

Too Many Men Are Dying Before Their Time

            These are confusing and challenging times for most people, but particularly for men. It has been said that “Old age is not for sissies.” While many men are embracing the later years, too many are losing hope and giving up. The suicide rate for men is much higher than the rate for women and gets even worse the older we get.

            Take a look at this chart from the Centers for Disease Control (CDC):

Suicide rate among adults age 55 and older, by age group and sex: United States, 2021

We see the men’s death rates on the left and women’s on the right for four different age groups. It is clear that death by suicide is a huge problem for men as we age. The male/female ratio for ages between 55 and 85+ are almost 5 times higher for males. This is a tragedy and a crisis. Clearly older men are feeling pressures that women do not experience and are losing hope for a better future. This needs to change.  

Welcome to the Second Mountain and an Expanded Understanding of Midlife and Aging

            My friend and colleague, Chip Conley, is transforming our understanding of midlife and what we can look forward to as we prepare for and climb the second mountain of life. Says Conley, “The midlife crisis is the butt of many jokes, but this long-derided life stage has an upside.” In his new book, Learning to Love Midlife: 12 Reasons Why Life Gets Better with Age, he expands our vision.

“What if we could reframe our thinking about the natural transition of midlife not as a crisis, but as a chrysalis: a time when something profound awakens in us, as we shed our skin, spread our wings, and pollinate the world with our wisdom?“

            We know midlife and aging is not all sweetness and light. It isn’t easy letting go of old ways that no longer work for us. We all know what happens to the caterpillar. As Conley reminds us,

“When it is fully grown, it uses a button of silk to fasten its body to a twig and then forms a chrysalis. Within this protective chrysalis, the transformational magic of metamorphosis occurs. While it’s a bit dark, gooey, and solitary, it’s a transition, not a crisis. And, of course, on the other side is a beautiful, winged butterfly.”

            You can learn more about Chip’s work and his book on his website, https://chipconley.com/

Learning About Men’s Health, Male Menopause, and How to Live Well in the Second Half of Life

            There is a lot we need to learn about life in the second half. Chip Conley suggest that there are three stages of midlife:

• Early midlife (Age 35-50)

            During early midlife we tend to experience some of the challenging physical and emotional transitions—a bit like an adult puberty. We realize we are no longer young, but not yet old.

• The second stage of midlife (50-59)

            This is the core of midlife in our fifties when we’ve settled into this new era and are seeing some of the upside. We begin to see opportunities for growth and finding passions we never knew we had.

            We are still young enough to see and plan for what’s next, our senior years. Says Chip,

“At 63, I am just getting acquainted with this third stage, but I do know it’s also when our body reminds us it doesn’t want to be forgotten.”

            I turned 80 last December and am well into the stage of Eldership. It’s a time where we are called to share what we know and have learned over our lifespan. Three years ago I started the MenAlive Academy for Gender-Specific Healthcare. The Academy offer programs for both men and women who want to learn about the unique mental, emotional, and relational issues that men face. It also offers programs for healthcare providers who are working with men and their families.

            As my colleague Marianne J. Legato, M.D., Founder of the Foundation for Gender-Specific Medicine says,

“Everywhere we look, the two sexes are startingly and unexpectedly different not only in their normal function but in the ways they experience illness.”

            If you would like more information about the MenAlive Academy for Gender-Specific Healthcare, drop me a note to Jed@MenAlive.com and put “MenAlive Academy” in the subject line. If you’d like to read more articles like these, I invite you to subscribe to our free weekly newsletter.

First off, this guide is not just about lifespan. These tips can improve your energy, happiness, productivity, and much more than just how long you live.This cheat sheet is designed to be short and jam-packed with science-based tips to improve your longevity. Guava Health will focus exclusively on results of modern science. For each tip in the guide, a reasonable longevity improvement is identified that an average person might be able to attain, ranging from 7% to 66%. The percentage benefit is derived from the hazard ratios in the studies, and the corresponding Scientific Rigor score was subjectively determined by Guava Health’s statistician and medical officer.Disclaimer: The studies below are mostly correlations, not guaranteed causations, and are based on averages of many people. This means that your personal health may react differently than in the studies. Before taking action, you should talk to your doctor about your specific situation.

#1: Do not smoke cigarettes

• Benefit: +66%
• Scientific Rigor: 3/3

The most boring and yet most effective recommendation on the list shouldn’t surprise anyone. Don’t light toxic stuff on fire and then inhale it. Never-smokers vs. lifelong smokers have a whopping 66% reduction in mortality by age 79, and quitting after a long time of smoking can also retain much of this benefit.

#2: Take 8,000 to 12,000 steps per day

• Benefit: +51%
• Scientific Rigor: 2/3

There’s a reason fitness trackers target 10,000 steps per day: It’s the magic number that gets you most of the possible improvement. Increasing step count from 4,000 to 8,000 per day was associated with a staggering 51% reduction in death from all causes (all-cause mortality). Additionally, the intensity of the steps, like running vs. walking, didn’t matter at all. So 25 minutes on the elliptical might save you time in obtaining your step goal, but each step will benefit your longevity the same as a normal walk.

#3: Get sufficient sunlight

• Benefit: +50%
• Scientific Rigor: 1/3

This was higher up the list than expected, but it turns out that totally hiding from the sun might really hurt you. A study of 29,518 Swedish women found a 2X decrease in mortality associated with the highest amount of sun exposure. Note that we only gave this study a scientific rigor score of 1/3 because it was only women and took place in a northern climate. The correlation with sunbathing was seen in a country with a very low UV index, which should be interpreted with caution. However, many other studies have found that adequate sunlight is important for longevity, often related to Vitamin D and melatonin.

It’s obvious, but worth stating anyway: Too much sun can kill you. So don’t take this as advice to sit in the sun all day or to get sunburnt.

#4: Consider dry sauna a few times per week

• Benefit: +40%
• Scientific Rigor: 1/3

The study showcasing sauna benefits is from Finland, as many sauna aficionados might have guessed. The study only includes men and they’re all from Finland, but it’s the best study Guava Health found and it shows a substantial 40% reduction in all-cause mortality for those who used a sauna 4-7 times per week compared with once per week. Normally the study would include comparisons with zero saunas per week, but apparently that is unheard of in the sauna capital of the world. Keep in mind this is for dry saunas at around 175 degrees F, so does not necessarily apply to cooler saunas, infrared saunas, or steam rooms. However, a study linking infrared sauna with coronary improvements was found.

#5: Brush and floss your teeth nightly

• Benefit: +37%
• Scientific Rigor: 2/3

In addition to not aggravating the people within smelling distance, brushing and flossing each independently help you live longer, according to Guava Health’s chosen study on dental behaviors, conducted on adults 52 and older. Brushing and flossing every day compared to not every day was associated with a mighty 37% reduction in death during the study period. Yep, it wasn’t just something your parents bugged you about; it might actually kill you. A curious discovery in the article was that nightly brushing was most important, and was even better than morning and daytime combined. Flossing every day was best, but don’t worry if you’re lazy sometimes, there was still a noticeable benefit in flossing “sometimes,” just not as much.

#6: Minimize your stress levels

• Benefit: +34%
• Scientific Rigor: 2/3

Another commonly mentioned factor of faster aging, reduction of perceived stress, landed on the list with thorough scientific evidence. There is an entire industry around stress reduction, but if you’re looking to improve, you should first consider all the other health improvements on this list since many can reduce stress. Then, perhaps consider meditation or massage, which both have scientific evidence of stress reduction.

#7: If you drink alcohol, stay below 7 standard drinks per week

• Benefit: +31%
• Scientific Rigor: 3/3

A small amount of alcohol appears to give you slight protection from a few causes of death, notably myocardial infarction, but it’s still detrimental to overall longevity. For amounts below 100 grams (~7 drinks) per week, this study of 599,912 people found negligible effects on mortality. But, as you can see in the chart, those negative effects increased steeply above 7 drinks per week. Cutting down from 3 drinks per day to 1 drink could reduce your risk of death by 31%.

Keep in mind that if you don’t currently drink, it’s not recommended you start, since alcohol is known to be addictive and moderating your consumption might be difficult.

#8: Consider intermittent fasting

• Benefit: +26%
• Scientific Rigor: 1/3

Caloric restriction is one of the most effective and persistent methods of extending life across every species of life ever studied. Humans, however, have not been equally proven to live longer simply by reducing calories. There are some studies showing probable positive effects, such as the people who eat less in the Japanese islands of Okinawa, and across studies of fasting, which is a little different from calorie restriction. The best study Guava Health found wasn’t as thorough as hoped because it studied only 2,714 people and they were all recovering from a surgical procedure. But, it did show a very substantial reduction in mortality for those who routinely fasted for 5+ years compared with those who didn’t fast.

#9: Don’t consume too much sugar

• Benefit: +23%
• Scientific Rigor: 2/3

This study found that consuming only 10% of your daily calories as sugars compared with 20% or more offered a 23% reduction in mortality. The authors also found that it was more helpful to reduce sugar in beverages than it was in solid foods. Similar to avoiding excess sugar, avoiding high glycemic index foods can also be helpful to your longevity. Basically, eat more of the stuff like nuts and vegetables that don’t give you an instant dump of energy.

#10: Minimize processed meat

• Benefit: +19%
• Scientific Rigor: 3/3

Of all the meats you can eat, fish is one of the best for longevity, while red meat and processed meat are among the worst. That’s a generalization, of course — some fish are much healthier to eat than others (wild salmon is great), and the quality of red meats can vary significantly. The study Guava Health chose shows the biggest offender to be processed meat by far, but also indicates red meat is slightly harmful on average. So the official recommendation here is to avoid processed meat when you can, and either avoid red meat or be sure it’s high quality.

#11: Avoid bad air quality

• Benefit: +17%
• Scientific Rigor: 3/3

Bad air can come from many sources, including polluted cities, factories, forest fires, and high-heat cooking. Basically, it’s not healthy to burn stuff and then breathe it in. A massive study on U.S. cities found that each 10 µg/m3 decrease in PM2.5, a common measure of air pollution, reduces your mortality by 17%. This amount of reduction or more could be achieved by moving from a polluted city or factory to the suburbs. You can easily find your neighborhood’s current PM2.5 measurement online. If you’re in one of the world’s most polluted cities, your potential benefit could be much higher than 17%. And if you don’t plan on moving, you can also use an air purifier in your home and office, and use a car with HEPA filters to help minimize your exposure.

#12: Consider drinking coffee — even decaf

• Benefit: +15%
• Scientific Rigor: 3/3

Before modern science began adjusting for confounding factors, researchers used to think that coffee increased death rates. In reality, coffee drinkers were just more likely to also smoke cigarettes. After adjusting for this, recent studies show a non-trivial reduction in mortality for moderate coffee drinking of 2-4 cups per day. Furthermore, the improvement appears to remain even if you’re a slow metabolizer of caffeine, which is something you can test for with popular genetic test kits. Note that it’s coffee studied here, not caffeine. Decaffeinated coffee has shown similar results.

Remember, caffeine is a drug and is often addictive. It can be beneficial, but can also cause serious effects on your body, particularly at high amounts, so consult your doctor if you’re unsure.

#13: Eat 5 servings of fruits and vegetables per day

• Benefit: +13%
• Scientific Rigor: 2/3

More servings of fruits and veggies were associated with lower mortality, plateauing around ~5 servings. Notably, this does not include starchy veggies like corn, peas, and potatoes, nor does it include fruit juices. Increasing from 2 to 5 servings per day is what showed the 13% benefit being highlighted.

#14: Sleep 7-9 hours per night

• Benefit: +11%
• Scientific Rigor: 3/3

Many studies, including this meta-study, show increased mortality if you sleep too little. One difficulty is they had to combine different definitions of “short sleep” ranging from 4 to 7 hours, but the overall result was that staying above ~7 hours reduced mortality. A curious result of their study was that long sleep was even worse than short sleep. Somewhere in the range of 7-9 hours looked optimal for most studies, and although the studies were based on survey answers and couldn’t measure it, it’s common to recommend 7 hours of time actually asleep and not just laying in bed.

#15: Consider metformin

• Benefit: +7%
• Scientific Rigor: 3/3

Normally a drug targeting a specific disease would not be included in a longevity cheat sheet built for everyone, but metformin is a notable exception. In studies meant to understand its effectiveness at improving diabetes, the researchers were surprised to find that metformin reduced death from all causes for diabetics, even beyond non-diabetics, by 7%. This suggests that non-diabetics could benefit by even more than 7% by taking it. However, metformin is a prescription drug in the U.S., so Guava Health only recommends considering it through talking with your doctor, or other legitimate pathways if you live outside the U.S.

Bonus: Drinking more water doesn’t seem to help

• Benefit: +0%
• Scientific Rigor: 1/3

Strangely, no correlation was found between the amount of liquids consumed in a day and mortality. We all know that you’ll die within days if you stop drinking water, but perhaps the negative effects only appear with extreme dehydration, whereas all the study participants had full access to water.

 

This story was produced by Guava Health and reviewed and distributed by Stacker Media.