Help Us Win The Fight Against Colon Cancer This March
March heralds 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 colorectal cancers. Practicing in the Dallas-Fort Worth Metroplex, I am surrounded by many outstanding Primary Care Physicians (PCPs) – Internists, Family Physicians, OBGYN’s – who deliver continued excellence in medical care, acting as the front line for cancer screenings. The obstacle that many physicians face is one of time – how do you fit discussions about screening into a short follow up visit, or a new patient visit when the patient is being seen for other reasons? Enter this article – I hope it will start a conversation for you with your doctor about colorectal 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 it 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.
Ashkenazi Jewish patients carry the highest lifetime risk worldwide for the development of colorectal cancers. What can you do to mitigate the 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, in addition to taking advantage of screening programs.
There are a number of national societies who have published screening guidelines and strategies, which differ in some regards. However they all currently agree that the average-risk individual should begin screening at the age of 50. Who is not “average risk”? 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, evaluating 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.
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 person to discuss these options with you doctor to decide which strategy works best for you. If we share a common goal this Colon Cancer Awareness month to make screening a priority we can continue to win the fight against colorectal cancer.
References and More Information
MSTF for Colorectal Cancer Screening:
Dr. Stuart Akerman is a gastroenterologist and a partner in Digestive Health Associates of Texas, PA, practicing in Plano, TX. He and his wife currently reside in Dallas, TX with their 3 wonderful daughters. He has many clinical interests, not least of which is cancer screening, prevention, and education. You can learn more about Dr. Akerman and his practice at http://www.stuartakermanmd.com, and watch a video for more information on colonoscopy here
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