Dear Dr. Roach: I’m an 85-year-old woman. I took the Cologuard test a month ago, and it came back positive. My gastrointestinal doctor said that at my age, he wouldn’t perform a colonoscopy. I asked for other alternatives, and he said that there’s a virtual colonoscopy CT scan. I had soft tissue sarcoma a year ago and have been getting CT scans of my pelvic area and chest. My blood work is all good, as well as my tests. What are your feelings on the CT colon scans? — M.K.
Dear M.K.: I understand why you’re concerned. When a test like Cologuard is positive, there’s a significant risk of colon cancer. The best estimate of your risk of having an advanced polyp now is approximately 38%, and the likelihood that you have actual colon cancer is about 4%.
I do understand why your gastroenterologist is concerned about a colonoscopy. The risk of an adverse event in people who are in their 80s is significantly higher. Both the sarcoma and radiation treatment that you received might increase your specific risk even higher than other people. I will say for my other readers (especially my clinician readers), the person who’s ordering Cologuard should’ve thought carefully about what to do with a positive result before ordering it.
If you’re willing to live with a 4% risk of colon cancer, you can stop where you are. Since you’ve had many CT scans (called a virtual colonography) of your abdomen, including at least one recently, it’s reassuring that you probably don’t have advanced colon cancer. The blood tests likewise give a measure of reassurance but aren’t definitive.
I recommend caution with a virtual CT scan because they’re uncomfortable for many people. Also, if it’s positive, you’re still left unsure as to what to do about it. I’d ask the gastroenterologist whether he’d perform a colonoscopy if the virtual colonography showed a significant concern.
If the answer is still “no,” you should, again, consider no further evaluation; however, if he said that he’d do the colonoscopy with a positive CT scan, then you could decide to get it done. But you should recognize that this decision puts you on a path to a risk of a complication, which is about 1%.
The most-common complication is perforation of the colon, which requires a hospital stay. A 4% risk of cancer is still higher than a 1% risk of perforation. A colonoscopy remains the best way to evaluate for cancer and obtain a biopsy of any suspicious mass or polyp.
It’s also worth considering whether you’d accept surgery if necessary. If you wouldn’t consider surgery to remove colon cancer under any circumstances, then it may not make sense to continue the investigation. However, I’ve seen people with highly advanced cancer that’s incurable by surgery still get recommended for palliative surgery, because an acute obstruction of the bowel by cancer is a terrible outcome.
If you reach an impasse with your current gastroenterologist, meaning you want to proceed with a colonoscopy and he refuses, you have the right to seek a second opinion.Readers may email questions to ToYourGoodHealth@med.cornell.edu.

“It’s been a bit of a black box,” said Ana Anderson, a senior author and core faculty member of the Gene Lay Institute of Immunology and Inflammation at Brigham and Women’s Hospital. “Now we have a research direction. We have a path to follow and hopefully find something that’s really specific to this disease and that will be the basis for developing tailored therapies specifically for young-onset colon cancer.”
In the United States, rates of colorectal cancer among people younger than 50 rose nearly 3 percent each year from 2013 through 2022, according to the American Cancer Society. Colorectal cancer is now the leading cause of cancer death in that age group.
Researchers have sought explanations for the perplexing rise. A growing body of evidence has linked risk to diet and ultra-processed foods, among other lifestyle and environmental factors. But experts say it’s also important to understand what is happening inside the tumors and bodies of younger patients.
In the new study published in the peer-reviewed journal Nature Medicine, scientists examined 189 tumors from people in their 20s to 90s, including 54 patients who were diagnosed when they were younger than 50. They analyzed more than 850,000 cells. The researchers also looked for factors that changed with age, revealing subtle differences between the younger and older patients studied, said Dr. Kimmie Ng, a senior author and director of the Young-Onset Colorectal Cancer Center at Dana-Farber Cancer Institute.
Researchers observed that tumors in younger patients appeared to have a different composition of cells, namely a much higher proportion of connective and supporting cells, known as stromal cells. Studies of other types of solid cancer have linked stromal cells to chemotherapy resistance.
The study also found differences in how genes are expressed in the tumors of younger people — a finding that experts say could lead to new therapeutic targets.
The dataset is the largest to date for colorectal cancer and includes the highest number of young patients, Ng said.
“It gives a huge amount of hope,” she said. “It really serves as a guidepost to where we should direct our future research efforts.”
The new research gives scientists access to large quantities of detailed data, said Dr. John Paul Shen, an associate professor in the department of gastrointestinal medical oncology at the University of Texas MD Anderson Cancer Center.
“There’s some very clear experiments that we might do in our lab or other people would do in their labs around the world,” said Shen, who was not involved in the study. “That’s hugely valuable.”
But he and other experts noted that the dataset, while expansive in its cellular analysis, is drawn from a limited number of people. Ng said the study’s cohort aligns with what is generally known about young-onset colorectal cancer patients around the world.
Future research could build on the study by analyzing other groups of patients, said Dr. Christina Annunziata, senior vice president of extramural discovery science at the American Cancer Society.
While the new study holds promise for helping researchers discover better ways to prevent and treat colorectal cancer in young people, experts said many breakthroughs may still be a ways off.
Having the dataset, Annunziata said, is “an essential first step.”
“The research is necessary for us to understand why people are getting cancers early and what we can do about it,” she said.

GREENVILLE, S.C. —
Officials confirm one person and one pet were exposed to rabid bats in Greenville and York counties in South Carolina.
The South Carolina Department of Public Health reported that, in Greenville County, a bat was found near Bessie Road and North Flat Rock Road in Piedmont. The bat tested positive for rabies, and one person was exposed.
In York County, a bat was found near Pinewood Road and Belleview Road in Rock Hill, according to SCDPH.
Officials say the bats were submitted for testing Oct. 23 and were confirmed to have rabies on Monday.
“Rabid bats have been known to transmit the rabies virus,” said Terri McCollister, Rabies Program manager. “People don’t always realize they or a pet have been bitten since bat teeth are tiny and bites are easy to overlook.”
If you believe you, someone you know, or your pets have come in contact with either of these bats, or another animal that potentially has rabies, please call DPH’s rabies prevention program during normal business hours or after hours and on holidays at 888-847-0902.
In 2026, the Greenville County bat is the sixth animal to test positive for rabies in the county. There have been 97 cases of rabid animals in South Carolina this year.

Stuck at home sick? It’s probably not the flu, according to infectious disease specialist Dr. Emily Landon at UChicago Medicine, but it may be another rapidly spreading virus.
But what is that virus?
“You probably have rhino enterovirus, and probably not influenza. There is a pretty nasty round of rhino entero going around right now,” said Landon, the Executive Medical Director of Infection Prevention and Control at UChicago.
Flu season did start earlier than usual this year according to federal experts, and numbers are higher than what’s typical for October. However, data reflects cases are still considered low.
According to experts, Rhinovirus and Enterovirus are in the same virus family, which is why they’re often tested together on a lab panel. They are the primary cause of the common cold, but their initial symptoms can be very similar to the flu, leading to patients potentially thinking they’ve got influenza.
“When you first get sick, it can be really difficult to tell. Some people are going to have more severe illness with rhino enterovirus and might have a fever and a cough, but most people are going to have more of a runny nose and just feeling a little tired and maybe that head cold feel. Whereas influenza tends to cause more coughing and more severe illnesses with more fevers,” she said.
According to experts, flu season typically peaks in January in Chicago, and while Landon said no two flu seasons are precisely the same, it’s too early to consider the flu to be the primary health threat.
“Maybe that’ll be earlier this year than usual, but we are definitely not there yet with respect to flu,” said Landon.
Northwestern Medicine says flu and COVID cases are “slightly higher than usual” for this time of year. Rush University Medical Center said there is not one illness spiking but did confirm flu season started early.
Landon says there are some “waning cases from a late summer bump in COVID,” but that numbers are decreasing right now.
As for preventative measures like vaccinations, the flu vaccine takes about two weeks to take full effect, and doctors are urging people not to put off getting the shot.
“We don’t even start looking at whether or not the flu strains match the flu vaccine until the end of October, beginning of November,” said Landon.
“We know that what we’re seeing now are almost entirely H1N1 cases of influenza A,” she continued. “H1N1 influenza is often milder and not as dangerous as H3N2 influenza.”
Landon says regardless if it’s a perfect match, the vaccine is the best bet at protecting from serious illness.
“I would argue that it’s even more important because when the flu vaccine is less effective, then more people need to get it in order for it to have an effect. And you’re going to be exposed more in years where it’s not a good match. And so you want that protection from severe illness even more,” she said.

BOSTON —
A new surgical implant tested in Boston is giving hope to patients with macular telangiectasia, or MacTel, a rare eye disease that impairs central vision and makes it difficult to see details.
Heather Harris-Keddy, a patient living with MacTel, said the disease has affected her vision dramatically over time.
“If I close this eye, all I’m seeing is your hair and the walls around you,” said Heather Harris-Keddy, a patient living with the disease for more than 20 years. “I can’t see your face.”
She said she noticed changes in her right eye first, then later in her left.
“And I was always doing this — like, can I see today?” Harris-Keddy said, holding her hand over one eye.
MacTel affects the macula, which is a round area at the back of the eyeball, in the center of the retina.
“The macula is what’s responsible for fine, detailed vision — watching television, looking at faces, and especially reading,” said Dr. Dean Elliott, director emeritus for the retina service at Mass Eye and Ear.
He has treated several cases of MacTel, despite its rarity.
“It starts out by causing some blurry vision, a few little small blind spots right around the center of vision,” Elliott said.
Until recently, there was no treatment for the disease.
“People who had it were severely debilitated,” Elliott said. “I mean, they had significant problems with their central vision, and most progressed to a point where they couldn’t read. They had extreme difficulty watching television and seeing faces.”
Harris-Keddy adapted to the changes as best she could.
“I have magnifying glasses around the house to make sure that I can read directions on boxes and stuff like that,” she said.
But Harris-Keddy worried about the day her central vision would be gone for good.
“And you know, I won’t be able to see again or drive again,” she said. “My whole life will change. My husband’s life will change because I will be more of a burden.”
Her hope came in the form of a tiny implant called ENCELTO, which is the size of a single grain of rice.
Inserted into the eye, the implant generates and delivers proteins that the macula needs to function properly.
“The implant is like science fiction,” Elliott said. “It is actually really hard to believe that this was developed.”
Elliott participated in the clinical trials, which showed that while the implant cannot restore lost vision, it can significantly slow or even stop the gradual loss of central vision.
Last year, the Food and Drug Administration approved the device for patients like Harris-Keddy, who became the first person to receive it at Mass Eye and Ear.
“It’s a very expensive device,” Elliott said. “It’s about $250,000, but it protects someone’s eyesight for life.”
Harris-Keddy said she is grateful — and relieved — to have it now while she still has some vision.
“At least we were able to stop it,” she said.