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 106,590 new cases of colon cancer and 46,220 of rectal cancer in the U.S. this year. Colorectal cancer is the third-leading cause of cancer deaths for men and fourth-leading cause of cancer deaths for women in the U.S., according to the CDC – but it's the second most common cause of cancer deaths when numbers for men and women are combined.
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 and changing their lifestyle-related risk factors, the rates have been going up 1-2% a year since the mid-1990s for people younger than 50. For that reason, a number of organizations, including the ACS and the American College of Gastroenterology, recommend 45 as the starting age for colorectal cancer screening.
The goal of the colonoscopy is to find and remove polyps on the colon walls. Isolated polyps are usually benign; however, if left untreated, some could develop into cancer over time. If no polyps are found, and in the absence of risk factors like 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. Patients are often surprised to learn that screening colonoscopies are free and that there are new options for prep, including a pill-based prep that has no taste at all. Sedation is unfortunately unavoidable.
Other Options
As noted above, there are other options when it comes to colon cancer screenings. A CT (or virtual) colonography, done on an outpatient basis, uses CT scans to check the colon and rectum. The problem with this test is that there are suspicious findings, such as a polyp, the patient will still require 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 stool is tested for blood and abnormal DNA. The benefits here are that it’s easy to do and does not require sedation, time off from work, or prep ingestion. 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. This test also needs to be repeated every one to three years.
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.