TAKE YOUR OUNCE OF PREVENTION
Colon cancer rates soar due to pandemic postponed screenings
IF you put off your screening colonoscopy during the height of the pandemic, you’re not alone. Colonoscopies — where a lighted scope is passed into the rectum and beyond to look for precancerous polyps (abnormal growths) and irregularities — dropped by an alarming 90% during the three-month pandemic pause between March and June 2020, which translates to a staggering 3.8 million colorectal cancer diagnoses that may have been missed, according to data from JAMA Oncology.
Perhaps you wanted to get screened but couldn’t due to shutdowns at hospitals nationwide, all the while feeling concerned about such worrisome symptoms as bleeding in your stool, changes in your bowel habits or abdominal pain.
The result: Health care providers are now seeing patients with much laterstage cancers and a 10% to 15% increase in higherstage polyps.
Fact is, colorectal cancer almost always develops from polyps.
“These are polyps that would have been small if a colonoscopy was done sooner and are now being detected at a larger size,” said Dr. David Greenwald, a professor of gastroenterology at the Icahn School of Medicine at Mount Sinai. He’s also director of clinical gastroenterology and endoscopy at Mount Sinai Hospital on the Upper East Side.
In addition, the number of people being diagnosed with colorectal cancer under the age of 50 continues to rise, despite the fact that the Centers for Disease Control and Prevention lowered the age of initial screenings for colorectal cancer from 50 to 45 in 2021.
“There are several things about these delayed colonoscopies that are concerning,” said Dr. Fiyinfolu Balogun, an oncologist at Memorial Sloan Kettering Cancer Center who specializes in gastrointestinal cancers. “After all, the sooner we catch these cancers, the more chance for a cure. What we’re seeing now are more advanced and more metastatic cancers.”
This is especially due to the widely reported disparities in terms of access to care based on socioeconomic status, race and ethnicity, Balogun (inset) said.
“The delays caused by the pandemic further widened this disparity,” he said. “That’s something that’s very worrisome to those of us in the field.”
However, it’s not as if experts in the cancer field haven’t previously sounded the alarm. In June 2020, the National Cancer Institute predicted tens of thousands of excess cancer deaths through 2030 due to missed screenings and delays.
Greenwald worries that the damage of the delay in care might not be undone.
“We’ve been promoting regular colorectal screenings for so long, [which] has had the effect of dropping colorectal cancer rates in the US over the past 20 years,” Greenwald said. “Now, because people had to put off screening for what’s often an asymptomatic disease, we will have an increase in case numbers with attendant bad outcomes. People who might have been cured of colorectal cancer in the past will come in with advanced cancers and won’t be able to be cured.”
No one has ever said a colonoscopy is pleasant, especially because the day prior involves fasting and the use of laxatives to clear out the colon, but it’s the gold standard to find a polyp and treat it before colon cancer
can emerge or spread.
That said, here are some new screening tools that might be added to your cancer-prevention arsenal if your health care provider gives you the green light.
Stool-based tests
What it is: With these at-home fecal immunochemical tests such as Cologuard, you simply request a kit, follow the instructions and mail back a stool sample to a lab for testing. Your health care provider will call you with the results.
Pros: You won’t need an in-person appointment with a provider beforehand, and the tests are cost-effective and involve zero prep.
Cons: If you receive a positive result, you’ll need a diagnostic colonoscopy, which could incur insurance costs, unlike a screening colonoscopy. This test needs to be repeated annually. (A colonoscopy with zero polyps will generally be performed every 10 years, Balogun said.)
CT colonography
What it is: Using a scanner, your health care provider will be able to see 2and 3-dimensional images of your large bowel (colon and rectum). During this minimally invasive procedure, gas is used to inflate the bowel through a thin flexible tube placed in your rectum.
Pros: Also known as virtual colonoscopy, it doesn’t require sedation or the insertion of a camera into the colon, and it’s quicker than a colonoscopy.
Cons: This still involves considerable prep — you won’t be allowed to eat solid food the day before the procedure and will be required to drink 8 ounces of clear liquid every hour. And, if polyps are found, you’ll need to book a colonoscopy.
Video capsule
What it is: Also known as PillCam, you’ll swallow a pill the size of a multivitamin with a camera function that takes images of your GI tract.
Pros: You won’t need to be sedated.
Cons: This is generally recommended only for patients who can’t complete a routine colonoscopy due to a history of abdominal surgery, diverticular disease or other colon conditions.
Blood-based tumor markers
What it is: These blood tests — the most common one is the carcinoembryonic antigen, or CEA, test — can detect issues suggestive of colorectal cancer, but they can’t be used alone.
Pros: Some tests are showing good results in detecting cancer, but they’re nowhere as good in detecting polyps, Greenwald said. “And detecting polyps is a way better way to prevent colon cancer.”
Cons: Aside from not detecting polyps well, these aren’t generally available to most patients right now.