What do President Ronald Reagan, Pope John Paul II and Charles Schultz
(creator of the Peanuts cartoon strip) all have in common? They were all
diagnosed with colon cancer.
Colorectal cancer is a common and lethal cancer in the country. Worldwide,
colorectal cancer is the second most common cancer in women and the third
most common in men. Approximately 1 in 3 people who get the disease will
not survive. That is why early detection and treatment is critical.
As with most cancers, routine screening is the best way to identify potential
issues early. Not only does screening offer peace of mind, colorectal
screening is unique in that it also provides the benefit of the removal
of precancerous polyps (growths on the lining of the large intestine)
during the procedure, which can prevent colorectal cancer and even death
from the disease.
The gold standard for the detection and removal of precancerous polyps
and early colon cancer is the colonoscopy. The rationale behind getting
a colonoscopy screening is simply that most colorectal cancers arise from
adenomatous (pre-cancerous) polyps that progress, growing larger and turning
cancerous, over the course of 7 to 15 years. That’s why it’s
so important to remove the polyp before it becomes cancerous.
How common colorectal cancer? The lifetime incidence for a patient at average
risk for the disease is a little more than 4%, with 90% of those cases
occurring after the age of 50. For African American patients, the incidence
is higher, but overall, rates have declined by 3 to4% per year over the
last 15 yrs. And although mortality is also higher in the African American
population, it has declined progressively since 1985 due to earlier detection
and more effective treatments.
When should I start getting screened for colorectal cancer?
Without a family history of colorectal cancer, all guidelines recommend
screening begin at age 50, with the American College of Gastroenterologists
has recommending age 45 for the African American population. If there
is a family history, the following rules apply: Patients with one first
degree relative (mother, father, brother, sister) diagnosed under the
age of 60, or two first degree relatives of any age, screening should
start at age 40 or 10 years younger than the youngest relative was diagnosed,
with follow-up colonoscopies every five years thereafter. For a first
over 60 years old or two-second 2nd-degree relatives of any age, begin screening
between 40 and 50 years old, then every 5 to 10 years.
When should I stop getting screened?
Age 75 is the accepted standard for patients who are of average risk. Patients
between the ages of 75 to 85 who have never been screened would likely
benefit from a single screening colonoscopy. However, screening exams
are not recommended for patients over 85, as the cost and health risks
increase. Most guidelines would recommend that screening stop when life
expectancy is less than 10 years.
Are there other screening options? ?
Not many people know there are at least five ways an individual may be
screened, but not all have the same effectiveness in detecting early colorectal cancer.
1. Stool Testing: Performed yearly, this test detects blood in the stool,
which could suggest an issue. 2. Stool DNA Testing: Performed every one
to three years, this test looks for center genes that are sometimes found
in colon cancer cells.
3. Flexible Sigmoidoscopy: Performed every five years, this procedure uses
a thin, flexible tube equipped with a small light and camera to view the
rectum and lower colon.
4. CT colonography: Performed every five years, this screening, also known
as a virtual colonoscopy, uses low dose radiation CT scan to provide an
interior view of the colon.
5. Colonoscopy: As mentioned above, colonoscopies, with the use of a thin
tube equipped with a light and camera, are generally performed every 10 years.
The idea of colonrectal screening can make some people uncomfortable, but
with the help of medication and technology, there’s no reason to
dread these procedures.
Who is at risk for developing colorectal cancer?
Risk factors for developing colorectal cancer are typically environmental
and genetic factors. Lack of physical activity, red meat consumption,
obesity, cigarette smoking and alcohol abuse can increase your risk. In
addition, certain hereditary/genetic conditions, a personal medical history
of colon polyps, and either Ulcerative Colitis or Crohn's Disease
can lead to an increased risk, as well.
What can I do to decrease my risk?
Being physically active and maintaining a healthy weight, taking vitamins
with folic acid, consuming a diet low in saturated fat and high in fiber,
and not smoking are all ways to decrease your risk of developing colorectal
cancer. And if you’re 50 years old or meet the parameters for being
high risk, then getting your regular screening colonoscopy is important!
It’s important to be proactive and raise the issue with your family
doctor to determine if you are a candidate for screening. You may also
call our office at [insert phone number] to schedule your screening colonoscopy today.
Dr. William Caddick is Medical Director for gastroenterology and hepatology
at CaroMont Health. He practices at CaroMont Gastroenterology & Hepatology
and CaroMont Regional Medical Center in Gastonia and the CaroMont Endoscopy
Center in Belmont.
The data for this article has been extracted from guidelines set forth
by The American College of Gastroenterology, the US Preventive Services
Task Force, and the American Gastroenterologic Association.