When should you begin colon cancer screenings?
After a bit of footdragging in the wake of my 50th birthday, I recently had a colonoscopy.
My physician found and removed a pair of small polyps during the procedure.
One was innocuous, while the other was a bit more troubling — not cancerous, but, I’m told, capable of becoming cancerous had it continued to grow.
Not surprisingly, my situation also has prompted my girlfriend to think about colorectal cancer. Mary just turned 45.
Is it too early for her to begin screening through colonoscopy or other methods?
Dr. Prescott prescribes
Let’s start with a scary statistic: After lung cancer, colorectal is the leading cause of cancer deaths in the U.S.
That said, colon cancer almost always can be prevented through early detection and removal of its precursor polyps, known as adenomas. That’s what you had — and what your doctor removed.
Going forward, you’ll need to remain vigilant about regular screenings.
But finding an adenoma is no reason to panic: Between 20 and 50 percent of Americans are estimated to have these polyps.
Still, it’s a good thing you followed standard recommendations, which call for people without a family history or symptoms to begin screening at age 50.
That guidance is based on the fact that about 85 percent of colon cancers develop after age 50.
Over the past 25 years or so, for reasons that are not known, there’s been a significant increase in the incidence of colon and rectal cancers in people under 50. Of those cases, nearly half were in adults age 45 to 49.
As a result, in May, the American Cancer Society for the first time recommended that Americans begin colon cancer screenings at age 45. This recommendation puts the Cancer Society at odds with other national organizations, which continue to recommend starting routine screenings at 50.
Colonoscopy does carry some risks, most notably the possibility of a perforated bowel. Balancing the risks of this procedure against the possibility of catching additional cases of colorectal cancer is a close call and, obviously, one that has divided medical experts.
As with so many medical decisions, insurance also may play a role. If Mary is inclined to follow the Cancer Society’s recommendation and opt for screening at age 45, she should check with her insurer first, as many will not cover the procedure until age 50.
Other, less invasive options for screening do exist.
The leading one is called Cologuard, and it involves collecting a single fecal sample and mailing it to a lab. Unlike colonoscopy, it doesn’t require any special preparation or dietary changes.
While colonoscopy is typically repeated every 10 years if nothing unusual is found, Cologuard should be done every year. If the test is positive, a follow-up colonoscopy is then needed to find the reason.
As with colonoscopy, insurers may not cover Cologuard until age 50.
The decision to begin colorectal cancer screenings at 45 or 50 is a personal one and something that Mary should discuss with her physician.
Whenever she does opt to begin, though, she’ll also have to choose a screening method.
Most physicians continue to recommend colonoscopy, which appears to be more effective at finding precancerous growths.
But, for most people, the best screening method is the one they’ll do as frequently as recommended.
Prescott, a physician and medical researcher, is president of the Oklahoma Medical Research Foundation. Cohen is a marathoner and OMRF’s senior vice president and general counsel.