Good Health Starts with You - Colorectal Cancer Awareness Month

Good Health Starts with You - Colorectal Cancer Awareness Month

Colorectal cancer can often be prevented through regular screening, which can find polyps (abnormal growths) before they become cancerous.

Talking with your doctor about screening should begin based on your age and family history of the disease. People with average risk should begin screening at age 50.

The American Cancer Society has recommended starting screening at age 45 because of the increase in studies of colorectal cancer in younger people. Also, African Americans should start receiving screening at age of 45 or earlier because they are more often diagnosed at a younger age.

Colorectal cancer does not always cause symptoms until the disease is advanced, it is important for people to talk with their doctor about the pros and cons of these screening tests and how often each test should be given.

Under the guidelines below, people should begin colorectal cancer screening earlier and/or undergo screening more often if they have any of the following colorectal cancer risk factors.

  1. Personal history of colorectal cancer or adenomatous polyps.
  2. Strong family history of colorectal cancer or polyps in a first degree relative younger than 60 or in two first degree relatives of any age.
  3. Personal history of chronic inflammatory bowel disease such as Crohn's or ulcerative colitis.
  4. Family history of any hereditary colorectal cancer syndrome, such as FAP, Lynch syndrome and any other syndromes.

The preferred test for colorectal cancer screening is a colonoscopy. The colonoscopy allows the doctor to look inside the entire rectum and colon while the patient is sedated. A flexible, lighted tube called a colonoscope is inserted into the rectum and the entire colon to look for polyps or cancer. During this procedure, a doctor can remove polyps or other tissue for examination and diagnosis. The removal of a polyp can prevent colorectal cancer. Colonoscopy should be initiated at the age of 50 and can be repeated every ten years if normal.

Other screening tests include computed tomography colonography and sigmoidoscopy. CT colpography sometimes called virtual colonoscopy, is a screening method being studied in some centers. It requires interpretation by a skilled radiologist to provide the best results. A radiologist is a doctor who specializes in obtaining and interpreting medical images. However, a CT colpography may be an alternative for you if you cannot have a standard coloscopy due to the risk of anesthesia, which is medications to block the awareness of pain, or if a person has a blockage in the colon that prevents a full examination.

A sigmoidoscopy using a flexible, lighted tube that is inserted into the rectum and lower colon to check for polyps, cancer, and other abnormalities. With this procedure, the doctor can remove polyps or other tissues for later examination. The doctor cannot check the upper parts of the colon with this test. This screening test allows for removal of polyps, which can also prevent colorectal cancer. If polyps or cancer are found using this test, a colonoscopy to view the entire colon is still recommended.

Other screening modalities include stool-based studies such as fecal occult blood test (FOBT), stool DNA test (Cologuard) and fecal immunochemistry test (FIT).

A fecal occult blood test is used to find blood in the feces, or stool, which can be a sign of polyps or cancer. Positive test, being that blood is found in the feces, can be from causes other than a polyp or cancer, including bleeding into the stomach or upper GI tract and even eating raw meat or other foods.

Polyps and cancers do not bleed continually, so FOBT must be done on several stool samples each year and should be repeated every year. Even then the screening test provides a fairly small reduction in deaths from colorectal cancer if done yearly.

Stool DNA test analyses the DNA from a person's stool sample to look for cancer. Looking for a change in the DNA that occur in polyps and cancers to find out if a colonoscopy should be done. Cologuard as this test is called has significant promise, it should be done every three years, it is my personal opinion that it is not ready for mainstream yet but it is very promising. If the patient has a positive Cologuard test, they still need a colonoscopy.

Different organizations have made different recommendations for colorectal cancer screening. There are two sets of recommendations based on a person's health history and personal colorectal cancer risks.

The American Society of Clinical Oncology (ASCO) has developed guidelines for colorectal cancer screening to help prevent cancer in people with average risks. Beginning at the age of 50, both men and women with an average risk of colorectal cancer should follow one of the testing schedules.

The following tests detect both polyps and cancers:

  1. Flexible sigmoidoscopy every five years or every ten years with FIT or FOBT every year.
  2. Colonoscopy every ten years.
  3. Upper contrast barium enema every five years.
  4. CT colpography as often as your doctor recommends.
  5. Guaiac-based fecal occult blood test, FIT, should be done yearly.
  6. Cologuard or stool DNA testing should be done at least every three years or as recommended by your doctor.

The U.S. Preventive Services Task Force recommend that people between the ages of 50 and 75 should receive regular screening. The USPSTF recommend that people between the ages of 76 and 85 should talk to their doctors to see if screening is right for them.

Screening options are available to most of our patients in the surrounding areas based on recommendations from their primary care physicians. All the above mentioned options are available through Regional Medical Center including screening colonoscopies.

If you have any questions about screening for colorectal cancer, options available to you as an individual, you should call your primary care physician. If you do not have a primary care physician, visit trmchealth.org/primary care to find a provider close to home.

About the author: Michael Hill, MD, FACS is a general surgeon with Orangeburg Surgical Associates.