Springtime! It is time to clean out the garage, work on the flower beds, take daily walks and schedule your colorectal cancer screening exam.
What was that last comment? Now, don’t make me think about that. I will do that later; it is so inconvenient. I really do not have any symptoms.
When asked to write a short article about colorectal cancer screening, I immediately wanted to make a childish quip about getting the scoop on the poop. After reviewing the statistical data, the seriousness of the task was more evident.
Why you should care
The estimated incidence rate of new cases of colorectal cancer was 150,000 last year. Every year there are about 50,000 deaths due to this disease. Colon cancer is the third most common cancer and the second leading cause of cancer death in the U.S.
The lifetime risk for men and women combined is 5.29 percent or 1 in 19 people. Despite these new numbers only about 50 percent of people who need screening actually get it.
Early screening is critically important to make an impact on this disease survival. Effective screening has been shown to decrease incidence because most colorectal cancers derive from small growths called adenomatous polyps. These can be removed during a procedure called a colonoscopy. Unfortunately, presentation of symptoms of colorectal cancer can be variable. Some patients have rectal bleeding, altered bowel patterns, anemia or even no symptoms at all. With an earlier cancer state at the time of diagnosis, the prognosis is better. Only 40 percent of colon and rectal cancer cases are diagnosed while in a local (less advanced) stage when there is a 90 percent, five-year survival. Nineteen percent of the colon cancers are diagnosed when the cancer is an advanced state and five-year survival is only 10 percent. A big delay can have significant consequences.
The newest recommendations for screening were released by the U.S. Preventive Service Task Force in 2008. The American College of Gastroenterology, the American Society of Gastroenterology Endoscopy and the American Cancer Society have members in this U.S. multispecialty task force. Their recommendations included initial screening beginning at age 50 until age 75. Ninety percent of colon cancers are diagnosed after age 50. Clearly there may be indications for earlier or later screening based upon an individual’s personal or family history. The USPSTF does not feel potential benefit outweighs risk of screening after age 85. These screening age guidelines do not apply if a patient has had colon cancer, colon polyps or other symptoms that warrant diagnostic evaluation.
Three types of screening
The USPSTF guidelines recommend one of three screening modalities. These include annual high sensitivity fecal occult blood tests, sigmoidoscopy every five years and FOBT every three years, or colonoscopy every 10 years. Sigmoidoscopy and colonoscopy are invasive procedures that involve direct visualization of the colon.
The American College of Gastroenterology and American Society of Gastrointestinal Endoscopy both support the colonoscopy is the preferred method of screening because of potential for intervention. The USPSTF concluded that there was insufficient evidence to assess benefit and harm of CT colonography and fecal DNA as screening modalities. The American College of Radiology and the U.S. Multitask Force on Colorectal Cancer include double contrast barium enemas or CT colonography every five years in addition to those modalities mentioned above.
Other comments of the USPSTF guidelines included the recommendation against the use of aspirin or nonsteroidal anti-inflammatory medication for the primary prevention of colorectal cancer.
Dietary measures such as avoidance of red meat and alcohol, increasing dietary fiber have been associated with decreased incidence of colorectal adenomas.
In conclusion, I urge everyone within these age guidelines to not delay in some form of screening for this deadly disease. Your physician can assist you in deciding the most appropriate method for screening.
Dr. Noel Hunt is a gastroentrologist with Digestive Health Specialists in Tupelo. Further information may be obtained at www.ahrg.gov/clinic/uspstf/ 8uspscolo.htm.