Daniel Connell, Jr. MD

Preventing Colon Cancer: Know your risks and options

Preventing Colon Cancer: Know your risks and options | Originally posted on LGH Cancer Institute Blog here on 4/3/2014

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Dr. Daniel Connell, Jr

If you’re between 50 and 75 years old, you’re either among the two-thirds of Americans who’ve been screened for colon cancer—or among the one third who have not. And that’s a screening you should not miss because detecting colon cancer early saves lives.

The Centers for Disease Control and Prevention says about 23 million Americans—28 percent of people who should be screened—have never had a test. Another 7 million have been tested—but haven’t kept up to date.

Colon cancer is the second-leading cancer killer for men and women behind lung cancer. For nonsmokers, it’s the leading cancer killer, claiming about 50,000 lives a year.

If you’re at average risk, you should begin screening at age 50, earlier if you have a family history of the disease. There are several tests available, which your doctor may use alone, or in combination. They include:

Stool test. The fecal occult blood test (FOBT) or the newer fecal immunochemical test (FIT) is recommended annually. You can take the stool sample yourself, using a kit. The inexpensive test identifies blood in the stool, which can be a sign of cancer. A study in the Annals of Internal Medicine indicates a screening with a single FIT detected 79 percent of colorectal cancers.

Flexible sigmoidoscopy. Your doctor uses a lighted tube to examine the rectum and part of the colon to check for and remove any abnormal growths for analysis. The test is recommended every five years in conjunction with home fecal tests done every three years.

Colonoscopy. Your doctor examines the inside of your colon with a lighted scope to find precancerous polyps early so they can be removed. The test is recommended every 10 years and finds more than 95 percent of colorectal cancers. You’ll need to prepare the day before by cleansing your colon, considered the most difficult part of the exam.

CT colonography. Known as “virtual colonoscpy,” this test is fairly new and uses a CT scanner to produce pictures of your colon and rectum from outside the body that a computer assembles into images capable of showing polyps and other abnormalities. Although the accuracy of virtual colonoscopy is similar to standard colonoscopy, the National Cancer Institute says it’s not yet known whether virtual colonoscopy can help reduce colorectal cancer deaths and more studies are needed.
Double-contrast barium enema. This test also visualizes the colon from outside the body via a series of X-ray images of the colon and rectum after you’ve had an enema with a barium solution to help outline the colon and rectum on the images. People who can’t undergo standard colonoscopy may be candidates for this test.

Don’t let your anxiety about being tested, particularly with colonoscopy, deter you. The CDC says about two of every three adults who have never been tested actually have a doctor and health insurance that could pay for the test. The federal government is also expanding insurance coverage of the recommended tests at no cost to the patient through the Affordable Care Act.

Work with your doctor to decide which test you should have. For example, colonoscopy may be the best option if you have a strong family history of colon cancer, an intestinal condition such as inflammatory bowel disease, or if you’ve had polyps removed in the past.

In the end, says the CDC, the best test is the one you get.