Your lifetime risk of colon cancer is about one in 20, on average. Arkansas has the sixth highest rate of death due to colorectal cancer (CRC) in the nation. It is the second biggest cancer killer in the Natural State.
The good news is: CRC is preventable and treatable. Treatment is most effective if it’s discovered at an early, precancerous stage. The five-year survival rate for CRC is over 90 percent if found early, before it can spread to other parts of the body. The survival rate drops to only 10 percent if the cancer has moved to other areas (metastasized).
Increasing among young adults
For people over age 50, the CRC death rate has been declining for the past 20 years. The American Cancer Society (ACS) says this is partly because people are getting screened. But, there is a new and alarming trend among adults younger than age 50. There has been a dramatic increase in CRC rates for millennials and generation X adults, or people born between the mid-1960s and 2000. About 30 percent of CRC diagnoses are now occurring among those younger than age 55. The ACS reported this month that people born in 1990 have double the risk of colon cancer and four times the risk of rectal cancer when compared to people born around 1950.
Researchers think the reasons for this increase among young people is related to the obesity epidemic, lack of regular exercise and a high-fat, low-fiber diet. The ACS is now recommending that screening should start at age 40 for those with a family history of CRC. A major concern is that CRC cases in younger adults will not be diagnosed until the cancer is advanced. This will cause more deaths, and more invasive, expensive treatment.
Who is at risk?
Patients at higher risk for CRC:
- Smoke tobacco
- Eat a high-fat, low-fiber diet
- Drink alcohol
- Are overweight or obese
- Are 60 years of age or older
- Do not regularly exercise
- Are African-American, Native American, Alaskan native, Ashkenazi Jew or Eastern European
- Have a history of cancer of the ovary, endometrium, breast or CRC; inflammatory bowel disease; or family history of polyps
Importance of screening
Screening is so important because there are rarely any signs or symptoms of early CRC. Most cases of CRC start with polyps – small tumor-like growths that project from the inside wall of your colon. Twenty-five percent of men and 15 percent of women, of average risk and over age 50, will have one or more polyps detected by a routine screening colonoscopy.
Prevention starts with lifestyle choices and a regular screening test. Almost a third of Americans over age 50 have never had any type of CRC screening test. Another third are not up-to-date with their screening tests.
While CRC symptoms are rare, always report any of the following to your doctor: changes in bowel habits, rectal bleeding or seeing blood in the toilet bowl, stomach pain that doesn’t go away or unexplained weight loss.
When to screen
If you are like many adults, this is an uncomfortable subject you’d rather ignore. People who avoid CRC screening say the reason is because they are afraid, too embarrassed, don’t have time, or don’t want to endure the discomfort of colon preparation. But, CRC screening can save your life. Surely that’s worth your time and a little discomfort. You’ll gain the peace of mind of knowing where you stand.
- If you are older than age 50, ask your doctor what CRC screening test is best for you.
- If you are younger than age 50, (but have a family history of cancer, are overweight, don’t get regular exercise and eat a high-fat, low-fiber diet) ask if you need an annual FOBT or FIT test.
Ask if you need a colonoscopy or would a less invasive screening test be adequate for you at this time? Remember, the best screening test for you is the one you will actually do. You have four good options for screening.
The American College of Physicians’ (ACP) guidelines for CRC screening recommend one of these four options:
- Fecal occult blood testing (FOBT) or fecal immunochemical tests (FIT) –needed every year
- Sigmoidoscopy – every five years
- Combined high-sensitivity FOBT or FIT every three years, plus sigmoidoscopy every five years
- Optical colonoscopy – every 10 years in average-risk adults ages 50-75 years
ACP says do not screen more frequently than recommended. Do not screen average-risk adults younger than age 50 or older than 75, or those with an estimated life expectancy of less than 10 years.
Colonoscopy is the gold standard for screening. It is the most effective method at finding polyps and reducing deaths from CRC. It allows the doctor (endoscopist) to visually inspect the insides of the colon and remove any cancerous or precancerous growths or polyps. If positive results are found from any of the other screening methods, you will need a colonoscopy to verify the results and remove any polyps.
For patients at average risk, colonoscopy screening should begin at age 50 and be repeated every 10 years if no polyps are found. If one to two small polyps are found, repeat every five to 10 years. Repeat every three years if three to 10 polyps are found, or one large one is found. Repeat in less than three years if more than 10 are found.
Sigmoidoscopy can only inspect the lower portion of the colon. Very few doctors use sigmoidoscopy anymore, preferring to use colonoscopy because it is more effective and thorough.
FOBT requires that a sample of your stool be placed in a sealed container and either mailed to the lab for testing or returned to your doctor’s office. No preparation is required and it can be done in the privacy of your own bathroom. Insurance usually covers all the cost. Ask your doctor for either a high-sensitivity guaiac-based FOBT (Hemacult Sensa has better sensitivity) or an immunochemical FIT test. FIT is a newer type of screening test that detects hidden blood in the stool, often a sign of colon cancer. FITs are done at home and are easier for people to use than FOBT tests. FITs do not require diet or medication restrictions before the test and the results are not affected by the food you’ve eaten. Researchers say FIT detects CRC about 80 percent of the time; accuracy exceeds 90 percent.
Importance of good preparation
If your doctor says you need a colonoscopy, be sure you get a good-quality one. Here’s how: first, find an experienced doctor. Ask your primary doctor for a referral. Studies have found that the best doctor to choose for your colonoscopy (called an endoscopist) is one who meets specific benchmarks. Ask him or her these questions:
- What is your polyp-detection rate? Experts say good-quality doctors should have a detection rate for finding polyps of 20 percent or higher.
- What is your average withdrawal time of the endoscope? A withdrawal time of six minutes or more is needed to carefully check all areas of the colon for polyps.
The second step to a good-quality colonoscopy is good preparation on your part. Preparation to clear the bowel is now easier, gentler, faster and causes less discomfort. It no longer requires suppositories, enemas or harsh laxatives. The recommended prep is PEG with electrolyte replacement (MOVIprep or Miralax with Gatorade). You are responsible for completing the entire prep the day before your colonoscopy. Be sure you understand exactly how your doctor wants you to do the prep. Good prep insures that the doctor can clearly see the inside of your colon and find all polyps during the procedure. There are also fewer complications when you complete the prep exactly as instructed. Failure to have a clean colon could result in missed polyps and you’ll need another colonoscopy in one year.
The cost of over-the-counter prep medications is less than $10. Medicare requires a $50 co-pay for prescription prep medications. Private insurance does not cover prep medications.