Beat Colon Cancer, Get Screened

Contributed By Dr. Shannon Scholl and Dr. Michael Brody, of Cary Gastroenterology

John Redmon stands ready to battle the weeds in his yard, glad that a screening colonoscopy he reluctantly underwent saved him from having to do battle with the far more daunting foe of colon cancer. Redmon is not alone. He did not run to a gastroenterologist for a colonoscopy when he hit 50, but his wife’s persistence finally pushed him to set up an appointment to be screened.

That decision saved his life.

Redmon was one of hundreds of thousands of Americans with polyps in his colon. Polyps are growths in the colon that are generally precancerous. Unlike most people, Redmon’s polyps contained cancer. His gastroenterologist was able to completely remove the polyps, and Redmon is now cancer-free. If not for the screening colonoscopy, his cancerous polyps would have continued growing and turned into a well-developed colon cancer mass. Redmon now actively urges everyone he knows to get proper colon cancer screening.

According to the American Cancer Society, colon cancer is now the third most common cancer in men and women in the United States, and the second leading cause of cancer deaths. The lifetime risk for developing colon cancer is about 1 in 20, or 5 percent, and is slightly higher for men. The death rate for colorectal cancer has been declining steadily over the last 20 years, likely because screening colonoscopy removes polyps (which can be considered potential cancers) and because it catches cancers at an earlier, more treatable stage. Colon cancer affects men and women from all racial and ethnic groups, though African-Americans present with more advanced polyps and cancers at an earlier age. Smokers and obese people are also at higher risk for developing polyps and cancer, having 1.5–3 times the risk of non-smokers and average-weight people.

The good news is that colorectal cancer is preventable. Regular screening detects precancerous polyps that can be removed at the time of colonoscopy before they become cancer. The goal of screening is to catch polyps before they develop into cancer; however sometimes screening detects early stage colon cancer before it becomes symptomatic. Thanks largely to greater awareness of the need for regular screening and the use of colonoscopy, the rate of colon cancer has dropped in recent years.

Current recommendations call for all men and women age 50 and older to begin colorectal cancer screening. If you have a family history of colon cancer or polyps you should consult with your physician to determine the appropriate age for you to begin colorectal cancer screening, which may be earlier than age 50. One of the national GI Societies, the American College of Gastroenterology, recommends screening for African-Americans at age 45.

Current screening tests include: annual fecal occult blood testing, flexible sigmoidoscopy, barium enema or colonoscopy. A positive result on any of the first three tests requires further evaluation with a colonoscopy. Therefore most medical societies (like the American College of Gastroenterology and The American Gastroenterology Association) recommend a colonoscopy as the preferred method of screening. Other tests that have been developed but are not currently recommended include CT colonography and fecal DNA screening. CT colonography is unlikely to become a recommended screening test because of issues of radiation exposure and difficulty determining a polyp from fecal matter. Fecal DNA screening may be a useful tool in the future in select cases but it is not currently available to the public.

Why do some people avoid colorectal cancer screening? Common reasons people use to avoid colonoscopy are the difficulty involved with the preparations the day before the procedure, the discomfort people anticipate feeling before and after the procedure, and the fear of what the colonoscopy may uncover. Some people are also embarrassed by the modesty-challenging nature of the test. Some think colon cancer and colon polyps cause symptoms, but the truth is that colon polyps and early colon cancers do not cause symptoms.

There are multiple different colonic cleansing methods (commonly referred to as bowel preps) that your doctor may prescribe when you schedule your colonoscopy. The purpose of all these preps is to thoroughly clean out your colon so your doctor can get a good look at the colon’s lining. Some of the newer preps are much easier to tolerate that the ones our parents suffered through. While you definitely need to plan to spend the evening before your colonoscopy at home near your restroom, generally speaking you will only need to miss one day of work.

The vast majority of patients experience minimal or no discomfort, especially with new sedation medications that are available at many endoscopy centers. Almost all patients don’t recall having the procedure done. During the colonoscopy your colon is filled with air, so when it is finished, you will pass that air, which may produce mild cramps. Virtually all patients return to work the next day.

Early detection and prevention saves lives. Don’t allow yourself to become one of the 160,000-plus new cases of colorectal cancers that are diagnosed each year. If you are age 50 or older (or 45 and African-American) or have a family history of colon cancer or polyps, be sure to discuss colon cancer screening with your physician.

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