March is Colorectal Cancer Awareness Month, providing adults with an added incentive to undergo a screening for colon cancer. The colonoscopy remains the gold standard of these tests, although there are various others available.
But before we get into that, why are colon cancer screenings so important? The answer can be found in the numbers. The American Cancer Society (ACS) estimates there will be 106,970 new cases of colon cancer, and 46,050 of rectal cancer, in the U.S. this year. Colorectal cancer is the second leading cause of cancer death for men and women combined in the U.S., trailing only lung cancer, according to the CDC.
And although the rate of people being diagnosed with colon or rectal cancer each year has dropped overall since the mid-1980s – largely due to more people getting screened, as well as changing their lifestyle-related risk factors – for people younger than 50, the rates have been going up 1-2% a year since the mid-1990s. For that reason, a number of organizations, including the ACS and the American College of Gastroenterology, have lowered the recommended starting age for colorectal cancer screening from 50 to 45 years old.
The goal of the colonoscopy is to find and remove polyps on the colon walls. By themselves, these are usually found to be benign; however, if left untreated, some could develop into cancer as time goes by. If there are no polyps found, and in the absence of such risk factors as a family history of colon cancer or irritable bowel syndrome, the patient can typically wait 10 years until another colonoscopy is recommended.
Even with all this knowledge at hand, some people are still hesitant to get a colonoscopy. Although a family history of colon or rectal cancer is the main risk factor, the majority of those diagnosed do not have a family history.
Concerns about cost, being under sedation, and even the unpleasant taste of the colonoscopy prep formula are also cited as reasons for why people skip colonoscopies. Colonoscopies are usually done for free; sedation unfortunately is a part of the equation; and the taste has improved over the years. (There are also various hints online on how to make the taste even less unpleasant, though the source of such recommendations should be considered; if in doubt, consult your gastroenterologist.)
As noted above, there are other options when it comes to colon cancer screenings. One, called a flexible sigmoidoscopy, does not require sedation. However, it only examines the rectum and about 30 centimeters of the colon, whereas a colonoscopy examines the entire colon (roughly 140 cm). These are rarely done at White Plains Hospital.
A CT (or virtual) colonography, done on an outpatient basis, uses CT scans to check the colon and rectum. The problem with both of these tests is that, should something suspicious or cancerous be detected, the patient will still need to have a colonoscopy.
There are also stool-based tests of colon cancer screening. With Cologuard, the company sends you a collection kit; once you’ve collected the sample, you send it back to them. The benefits here are that it’s easy to do, does not require sedation, taking time off from work, or ingesting the prep. The downside is that Cologuard’s response is limited to a “yes” or “no” answer, without explanation – meaning that if you receive a “yes,” you’ll have to get a colonoscopy.
Another option is the fecal immunochemical test (FIT), or stool DNA test, where again the patient collects the stool and sends it to a lab, which checks for altered DNA and the presence of blood. You collect an entire bowel movement and send it to a lab, where it is checked for altered DNA and for the presence of blood. While Cologuard is recommended every one to three years, and FIT on an annual basis, if the results are positive, the patient will – you guessed it – need to have a colonoscopy.
So do all roads lead to a colonoscopy? Not necessarily. But it does offer the only way to find and remove polyps in one exam, saving time and (usually) money. Isn’t that worth the prep?
Dr. Joseph Mermelstein is a gastroenterologist at Scarsdale Medical Group in Harrison. To make an appointment, call 914-723-8100.