Colonoscopy worth unpleasantness, time
March is Colorectal Cancer Awareness Month. According to the Centers for Disease Control and Prevention, colorectal cancer is the second leading cause of cancer deaths in men and women.
The disease is slightly more common in men, affecting 55 per 100,000, compared with 41 per 100,000 women. Of these, 20.7 per 100,000 men and 14.5 per 100,000 women die from the disease. The lifetime risk of developing colon cancer is 5.1 percent.
If the cancer is diagnosed while it’s localized to the colon, survival rates are 95 percent. If it has spread to regional lymph nodes, the chance of survival drops to 69 percent, and if it has spread more distantly, the survival rate is less than 11 percent.
The key to survival is early detection. Yet, despite the prevalence of this illness, screening tests for colorectal cancers are done far too infrequently. I guess we all find the idea of a day and a half of bowel cleansing followed by a visit to a gastroenterologist, sedation and examination just too darn embarrassing.
So I will say this as strongly as I possibly can: Screening for colorectal cancer saves more lives than any other cancerscreening program. Thank goodness, the message is getting through. According to the CDC, the number of Americans being adequately screened for colon cancer has increased from 52 percent in 2002 to 65 percent in 2010.
Screening involves annual testing for microscopic amounts of blood in the stool. This involves placing a small amount of stool on a card and mailing it back to your physician for testing. Although an early feature of cancer and conditions that lead to cancer, bleeding from the bowel also can occur from hemorrhoids, diverticulosis and malformations of blood vessels in the colon.
Anyone who has blood in his or her stool that is either visible or present in microscopic amounts must have further testing to exclude the presence of cancer or polyps that have the potential of becoming cancerous.
For most people, a colonoscopy to screen for colon cancer should be done initially at age 50. I had my first colonoscopy at age 40 because colorectal cancer is very common on both sides of my family. Relatives of colon cancer victims are at much greater risk of developing the disease. Many families, such as ours, have genes that predict a high risk. Furthermore, the cancer tends to occur, on average, 10 years earlier than expected, and consequently, screening should commence at a younger age.
The goal is to find and recognize polyps before they become malignant. A study published in the New England Journal of Medicine showed that identifying and removing polyps reduces the risk of death from colorectal cancer by more than 50 percent. It takes three to five years for a polyp to develop and another five years to become malignant.
If a colonoscopy is done and polyps are identified and removed, the procedure should be repeated after three years. If the colonoscopy is normal, it should be repeated every five years. Most polyps that are identified during the colonoscopy can be removed immediately and sent to the laboratory for microscopic testing. Suspicious-looking lesions also can be biopsied and an early cancer diagnosed. In some cases, surgery will be needed to remove the cancer.
The worst part of the colonoscopy is the preparation. I have tried them all, and they are no fun. Some recommend the use of Fleet’s Phospho-soda preparation. This involves a liquid diet for two days and then taking a few ounces of a liquid that causes diarrhea. The following morning, you are supposed to use a Fleet’s enema.
Today, this approach is not used as much because of a slight risk of kidney failure. Most gastroenterologists recommend drinking a liter of Golytely that, rest assured, cleans your bowel completely.
Many put off having colonoscopies because of its unpleasant nature. Don’t put it off! Colon cancer is a killer, and a colonoscopy can save your life.