Whenever they inquire about colorectal cancer screening, doctors are accustomed to hearing excuses. “Not right now,” the patient may say. Or “I’ll think about it.”
These patients may be anxious about the embarrassment or perceived pain or discomfort that they associate with colonoscopy. They may think they are at low risk because they have had no symptoms.
Yet colorectal cancer is the second leading cause of cancer deaths (after lung cancer), and screening is particularly effective at detecting cancer at an early treatable stage–even preventing it in some cases.
Most medical groups recommend screening starting at age 50 for anyone with an average risk of colorectal cancer. Persons with inflammatory bowel disease or a family history may need to start screening at an earlier age and have screening more frequently.
There is really no excuse for not being screened since some options are simple, easy, inexpensive, non-invasive and cause neither pain nor discomfort.
FECAL OCCULT BLOOD TESTING (FOBT) is one of those simple options. It requires only a kit that you use in the privacy of your bathroom. You smear a small amount of stool, from three consecutive bowel movements, on appropriate squares of a test sheet and then mail in the kit for laboratory testing. It’s all very private.
Some foods and drugs can affect results so you may have to make minor changes in your diet, such as avoiding red meat, right before the test.
The idea is to see if there are small amounts of blood hidden in the stool. Pre-cancerous polyps and cancerous growths have a tendency to bleed but usually not enough to make your bowel movement noticeably bloody. (Bright red blood in the stool is usually another problem such as diverticulitis.)
FIT, or fecal immunochemical test, is now recognized as a good alternative test to detect occult blood in the stool. This test reacts to part of the human hemoglobin protein that is found in red blood cells. The process of collecting the samples is similar to that for FOBT, but there are no drug or dietary restrictions ahead of time.
If results show hidden blood, a followup colonoscopy must be performed for diagnosis and treatment.
COLONOSCOPY is widely recommended as one of the most effective screening tests. It reduces colorectal cancer deaths by 60 to 70 percent, according to studies. And it has the advantage of being able to remove any abnormalities that are found during the same procedure.
When test results are negative, colonoscopy may be needed only once every 10 years for a person at average risk.
A flexible lighted tube, or scope, is inserted through the anus into the rectum and threaded through the entire length of the colon so the doctor can examine it through images displayed on a monitor. Air is pumped into the colon to expand it and make viewing easier.
Since the patient is given sedation, the whole procedure is less uncomfortable than the description suggests. Many patients, nevertheless, are apparently squeamish.
Even more disagreeable, to some patients, is the need to clear the bowels in preparation. You need to quit eating solid foods a day ahead, then take a substance that triggers a powerful bowel-clearing diarrhea.
SIGMOIDOSCOPY is a similar test, with similar effectiveness, using the scope to examine only the lower or sigmoid part of the colon. Bowel preparation, while still necessary, is less extensive since only part of the colon is involved.
As a mixed blessing, sigmoidoscopy requires little if any anesthesia. There is no pain, but there is a sensation of the tube traveling through your bowels. As a result, some persons are not comfortable having the procedure. And it’s usually recommended every five rather than every 10 years.
With either procedure, there is a slight risk that the scope will tear or damage the lining of the colon.
The above three screening tests are recommended by the U.S. Preventive Services Task Force and other groups: FBOT or FIT plus either colonoscopy or sigmoidoscopy. Actually, many medical facilities today have moved toward using colonoscopy as the default test, and sigmoidoscopy is no longer widely available.
DOUBLE CONTRAST BARIUM ENEMA (also known as a lower GI series) was widely used between 1985 and 1992 but, like sigmoidoscopy, has been replaced by colonoscopy in many areas.
As with colonoscopy and sigmoidoscopy, the bowels must be empty and clean, requiring a restricted diet for a couple of days and laxatives and/or enemas in the hours leading up to the procedure.
Usually without anesthesia, a small, flexible tube is inserted through the rectum. Barium sulfate, then air is pumped into the colon so that x-ray images can be produced.
At least in part to make screening more acceptable, other options have emerged in the past few years.
VIRTUAL COLONOSCOPY is a term that is bound to attract attention among those anxious about invasive screening procedures. It involves examining the inner bowels using a CT scan rather than a tube inserted into the bowels. It does not require sedation and takes only about 10 minutes.
All that sounds great, but wait a minute. The bowels have to be emptied and prepared just as they are for a colonoscopy. For some, that is the most disagreeable part.
Any abnormality detected requires a colonoscopy to biopsy or remove. So virtual colonoscopy is still a work in progress. When it comes to preventing, detecting and treating colorectal cancer, no excuses are acceptable. There are numerous alternatives to answer your objections...and save you from a potentially deadly cancer.
EDITED AND APPROVED BY Frank A. Thorngren, M.D. Family Medicine OF WEST RIVER HEALTH SERVICES
REFERENCES:
American Cancer Society, “Colorectal cancer screening tests,”last medical review, October 15, 2014.
Michelle Andrews, “Government streamlining Medicare coverage for cancer test,” Kaiser Health News, August 18, 2014.
“At-home cancer screening test available at Meriter,” Channel3000.com, October 29, 2014.
Centers for Disease Control, “Colorectal cancer screening tests,” last updated April 2, 2014.
Zosia Chustecka, “Dramatic decline in CRC in US attributed to colonoscopy,” Medscape Medical News, March 20, 2014 (CA Cancer J Clin, March 17, 2014).
“Colon cancer screening,” MedlinePlus.
Kathryn Doyle, “For older colon cancer survivors, colonoscopy is risky: study,” Reuters Health, August 13, 2014.
Caroline Helwick, “Stool DNA test sensitive for large sessile serrated polyps,” Medscape, May 12, 2014.
David A.Johnson, et al, “Optimizing adequacy of bowel cleansing for colonoscopy,” American Journal of Gastroenterology, 2014;109(10):1528-1545.
David A. Johnson, M.D., “Colon cancer screening: a win for quality and technology,” Medscape Gastroenterology, May 27, 2014.
S. Karasick, et al, “Trends in use of barium enema examination, colonoscopy, and sigmoidoscopy: is use commensurate with risk of disease?” Radiology, June, 1995.
Fran Lowry, “Novel stool DNA test may enhance colon cancer screening,” Medscape Medical News, March 18, 2014 (NEJM, March 19, 2014).
K. McCaffery, et al, “Declining the offer of flexible sigmoidoscopy screening for bowel cancer: a qualitative investigation of the decision-making process,” Soc Sci Med, September, 2001.
National Cancer Institute, “Tests to detect colorectal cancer and polyps.”
Roxanne Nelson, “FDA approves Cologuard for colorectal cancer screening,” Medscape Medical News, August 11, 2014.
Marcus Plescia, M.D., MPH, “Colorectal cancer screening: the best test is the one that gets done,” CDC Medscape, February 12, 2014.
Colleen M. Schmitt, M.D., MHS, “Fighting colorectal cancer with advances in colonoscopy,” Medscape Gastroenterology, May 27, 2014.
Y.-X Yang, et al, “Minimal benefit of earlier-than-recommended repeat colonoscopy among US Medicare enrolees following a negative colonoscopy,” Alimentary Pharmacological Therapeutics, 2014;40(7):8435-853.
01/21/2015
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