Is 2018 the year we collectively turn the tide against Colon Cancer?
Technology and options for screening continue to evolve - but are you informed regarding all of your choices?
(Please note that a version of this blog post appears on www.sharsheret.org)
March announces the arrival of Colon Cancer Awareness Month. The medical and mainstream media have done an excellent job of education and engagement within our communities to raise awareness about colon cancer. Ribbons, videos, articles, and screening programs have all been utilized to stir the collective consciousness. In the midst of all of it I find myself asking “how can I best impact this month, how best can I help get the word out?” I decided that by writing this article I can hopefully enlighten and inform, as well as start the conversation on a topic that is important to us all.
Practicing in the Metroplex, I am surrounded by many outstanding Primary Care Physicians (PCPs) - Internists, Family Physicians, OBGYN’s - who deliver continued excellence in medical care. They are the front line for cancer screenings. Patients rely on their PCP’s to remain current regarding medical guidelines, and to direct on the timeliness and execution of screenings. The obstacle that many physicians face is one of time - how do you treat a patient for the ailments they currently suffer, while at the same time manage to screen for the diseases that may not affect the patent for some time? Enter this article - I hope it will start a conversation for you with your doctor about colon cancer screening, or even provide the push to make an appointment with a gastroenterologist.
First let’s review the statistics. The American Cancer Society estimates that there will be over 140,000 new cases of colorectal cancers diagnosed this year, making them the third most common cancer diagnosed in the United States. It’s not all bad news though - the incidence of colorectal cancer has declined by 35.7% since 1975. In addition to better screening methods and more screenings performed, newer treatments have allowed the 5 year survival to increase from 49.8% in 1975 to 66.3% in 2013 (per the SEER Cancer statistics database). That is a 33% increase in 5 year survival! This is a fantastic start, but there is work yet to be done.
Now there are many risk factors involved in the development of colon cancers, some of which are modifiable (i.e. obesity, alcohol/smoking, low fiber diets) and some of which are not (i.e. genetic syndromes, family history of polyps/cancers, inflammatory bowel disease, and racial/ethnic backgrounds). Patients of African American descent are the population at highest risk in the United States, and Ashkenazi Jewish patients carry the highest lifetime risk worldwide of the development of colorectal cancers.
So what can you do to mitigate this risk? Unfortunately you can’t change your genetics, but you can be proactive in other ways. Increasing dietary fiber intake, maintaining healthy weight goals, and avoiding significant alcohol or smoking all help, and working with your doctor on screening strategies should give you the strongest advantage towards early detection or avoidance of colorectal cancer entirely.
There are a number of national societies who have published screening guidelines and strategies, and they do differ in some regards. However they all currently agree that the average-risk individual should begin screening at the age of 50. If you have a family history of colorectal cancer or polyps (growths which can turn into cancers over time), or a family history of a genetic syndrome related to colon cancer you should be screened earlier, and should speak with your doctor about tailoring a strategy that is specific to your circumstance.
What are the screening options for “average risk” individuals?
Stool-based testing such as checking for microscopic blood in the stool or in combination with fecal DNA being shed from a polyp or cancer (the most common commercially available test is called Cologuard)
CT Colonography - also known as a Virtual Colonoscopy
Flexible Sigmoidoscopy - similar to colonoscopy, but limited only to the left side of the colon
Each of the options listed above carry their own risks and benefits. Typically, the more likely a test is to miss an important finding, the more frequently you need to retest the patient. Using stool-based testing as an example, testing for a polyp or cancer that is large enough to cause microscopic blood in the stool should be done annually since it may catch a polyp when it is more advanced. Similarly, Stool DNA testing is currently recommended to be repeated every 3 years for a negative exam.
Virtual Colonoscopy is an enticing option to many individuals, but you still need to cleanse the colon prior to the exam similar to a colonoscopy, and it is limited in finding flat polyps or polyps less than 1cm in size. An additional consideration is cost - it is often not a screening procedure initially covered by many insurance plans .
Colonoscopy has been considered the gold standard for screening in the US for some time. It allows for direct visualization of the colon wall, and potentially for removal and/or biopsy of any concerning growths at the time of the exam. Colonoscopy is typically performed under anesthesia, so you will be sleeping and comfortable throughout the exam. A good clean colon without polyps in an average risk individual currently buys you a recommendation for a repeat exam in 10 years’ time. You can learn more about the colonoscopy procedure in my video blog post.
We have seen a significant decline in overall incidence of colorectal cancers over the last 40 years, coupled with rising 5 year survival rates. It is great to have all of these options available to patients for screening, and I encourage each and every patient to discuss these options with their doctor to decide which strategy works best for them. If we share a common mission this Colon Cancer Awareness month to make screening a priority we can continue to win the fight against colorectal cancer.
References and More Information