A few weeks ago I saw a 50-year-old woman for her first screening colonoscopy. She was in good health and had no symptoms. During the examination a large polyp containing cancer was removed. The cancer was caught early and cured simply with polyp removal. She was fortunate because most colon cancers are advanced when detected and usually require further treatment with surgery and chemotherapy.
March is Colon Cancer Awareness Month and the message remains the same: colon cancer can be prevented or caught early with routine screening.
Most colon cancers begin as a benign growth called a polyp or adenoma, which usually grow slowly. Removing these polyps during screening colonoscopy prevents the polyp from progressing to cancer.
Colon cancer is common, affecting 1 in 20 Americans, and is currently the second leading cause of cancer death in the United States. Ninety percent of new cases and 95 percent of deaths from colon cancer occur in people 50 or older. Although recent disturbing statistics report an increasing number of younger patients being diagnosed with colon cancer. Colon cancer treatment costs exceed $14 billion in the U.S. annually.
Prevention of colon cancer with screening colonoscopy is a major medical success story. Screening has decreased the incidence of colon cancer by more than 20 percent over the past 15 years largely due to increased awareness and acceptance of colonoscopy as the best screening method. Unfortunately screening rates have leveled off and only half of persons in the U.S. needing routine screening are being screened. Awareness needs to be reignited.
Even though the overall incidence of colon cancer has decreased, right-sided colon cancers have not decreased significantly. More than half of colon cancers occur on the right side of the colon far from the reach of a rectal examination or sigmoidoscope. Right-sided colon cancers frequently arise from flat or sessile polyps. Common polyps protrude outward from the lining of the colon like a mushroom, making them easy to detect. Flat or sessile polyps grow like a carpet on the surface and are more difficult to identify and remove, especially if a colonoscopy is not performed carefully or the colon is not adequately cleaned out. Careful examination of the entire colon and removal of all polyps identified during a complete colonoscopy is currently the gold standard for colon cancer screening.
When undergoing colonoscopy, choose a physician trained in gastroenterology who does hundreds of colonoscopies each year. A gastroenterologist is a specialist with extra training in safely and effectively performing colonoscopies. Most gastroenterologists use newer advanced techniques and are generally more adept at detecting and removing flat polyps.
Risk factors for colon cancer include age over 50, family history of colon cancer or colon polyps, personal history of colon polyps, chronic inflammation of the colon (ulcerative colitis and Crohns disease), cigarette smoking and obesity.
A colonoscopy is recommended for anyone 50 or older. Additionally, anyone with a family history of colon cancer or polyps in close relatives or anyone with symptoms which might suggest colon cancer such as a change in bowel habits, diarrhea, constipation, blood in stool, weight loss, bloating, abdominal pain or anemia might need earlier screening.
Remember: Colon cancer is preventable and easily cured if caught early. Ask your health care provider about colonoscopy and colon cancer screening. Get the test. Get the polyp. Get the cure. Then ask your loved ones and friends to do it. You will be glad you did.
John T. Witte, M.D., FACG, is a partner at Idaho Gastroenterology Associates.