I decided to address Screening for diseases such as cancer with this blog post. This is a topic I find to be very important in my practice, and the topic of much discussion.
Often the hardest people to speak to about screenings are those that are healthy. If it's not broken, why fix it - right?
Who benefits from screenings?
Actually, healthy people are the ideal target audience for medical screenings. The idea is that we want to find potential issues before the symptoms arise, and ideally we want to look for diseases or syndromes that can affect large different groups of people, and those that if found we can take care of and alter the course of the disease.
One of the more common diseases that gastroenterologists screen for is colon cancer. Data from the National Cancer Institute estimate that over 135,000 new cases of colon cancer will be diagnosed in 2017 (https://seer.cancer.gov/statfacts/html/colorect.html). While this is a large number, the NCI estimates that over the last 10 years rates of new diagnoses have fallen ~2.7% annually. Why is that? There are likely many factors at play, but more widespread adoption of screenings by patients are a large part of the story.
How does a doctor decide who is a good patient to recommend screening for?
Screening guidelines are published by a number of professional societies, but there are national medical guidelines published by the U.S. Preventive Services Task Force. In regard to colon cancer screening, they recommended with an "A" grade (substantial benefit to the population) that all patients between the ages of 50 and 75 be offered screening.
I should note that this is referring to any "average risk" patient without a family history of colon cancer or colon polyps. If you do have a family history of either of those, you are still offered screening, but the recommendations change as you are considered "high risk" screening.
Continuing with average risk colon cancer screening as our example, the idea behind screening is not to find colon cancer - it is to find polyps, the growths that if left to their own devices may become a colon cancer given time. The goal of the screening test is to identify the person with polyps, so that they can then undergo intervention to remove them and hopefully avoid the cancer entirely. This is an opportunity for us to find healthy individuals and keep them healthy; if someone already has symptoms such as bleeding, weight loss, etc, the evaluation is no longer a screening but rather diagnostic to find the cause of the symptoms.
So what are some options for colon cancer screening?
There are a few different ways you can get screened for colon cancer/polyps including stool based testing, sigmoidoscopy, colonoscopy, and imaging, each with its own benefits and limitations. I encourage patients who are approaching the screening age (or older if they have not had one done) to schedule and appointment with their primary care doctor or a gastroenterologist like myself to answer any questions and discuss the options in detail.
I hope that this post helps to answer some questions regarding screening, and help people start the discussion with their doctors. I will be posting in the future regarding screening for other types of GI cancers, that may focus on more specific patient populations.
DISCLAIMER: Please note that this blog is intended for Informational Use only and is not intended to replace personal evaluation and treatment by a medical provider. The information provided on this website is not intended as substitute for medical advice or treatment. Please consult your doctor for any information related to your personal care.