You may not want to put these statistics out there the next time you’re at a cocktail party, but chew on them regardless. Colon cancer is the leading cause of deaths among non-smokers in the United States. A colonoscopy can usually prevent colon cancer – also called colorectal cancer – and the procedure is often covered by Medicare.
In fact, Obamacare will pay for colonoscopy when performed as a screening method in most cases. A good thing too: colon cancer kills roughly 50,000 folks in this country each year, yet roughly one-third of adults between 50 and 75 have never done any form of colon cancer screening. Lack of health insurance is a major reason for that, along with the fact that having a colonoscopy is, well, rather unpleasant.
Colon cancer ain’t going away. The disease killed 608,000 people worldwide in 2008. Perhaps more disturbing is the rise in new cases among young people. Between 1992 and 2005, colon cancer increased among people in their twenties by more than five percent each year, and with often fatal results: colon cancer patients under 40 were 30% more likely to die of the disease compared to patients over 60.
Do you eat red meat? You should get screened. Do you smoke, drink, have a history of inflammatory bowel disease or a family history of precancerous polyps or breast cancer? You should get screened.
Look closer at the following risk factors for colon cancer and you’ll see they affect many, if not most of adults in the developed world, including Canada, Australia, the UK and the USA.
Even if you don’t fall into these categories, you should get screened anyway. The Center for Disease Control recommends that adults between 50 and 75 screen for colon cancer, and even at 40 for patients with genetic history of it. You’re on even higher alert if you display symptoms of colon cancer, which include:
Changes in bowel movements
Persistent diarrhea or constipation
Bloody or stool with dark patches
Bloating or stomach pain
Unexplained fatigue, loss of appetite
Pelvic pain (a sign the disease has progressed)
Like most kinds of cancer, prognosis for colon cancer hinges on early detection and prevention. The American Cancer Society says the five year survival rate for stage I colorectal cancer is 74%.
While colon cancer is more common in adults over 50, it is a growing problem in younger adults. And according to a new study, colon cancer patients under 40 have a worse prognosis than middle-aged patients if the disease has metastasized.
Researchers found this after analyzing health records from over 20,000 patients who participated in 24 phase three clinical trials for colorectal cancer. Patients younger than 40 were 30% more likely to die than 57 year old patients and 28% more likely to succumb to the disease if a patient was 67.
Older patients didn’t fare well either, with a 72% higher risk of death and a 19% increased risk the disease would spread compared to patients between 57 and 61.
Colon cancer patients under 40 were 30% more likely to die of the disease compared to patients over 60.
Colon cancer increased in adults between 20 and 40 by roughly 1.5% each year between 1992 and 2005, with the highest increase in new cases at rates similiar between men and women aged 20 to 29. Researchers can’t explain this trend, but speculate that genetics, environmental factors, fewer early detections and/or a combination of these factors might be at work.
The study, conducted by researchers at the University of Colorado and presented to the 2013 European Cancer Congress, offers preliminary findings. More research is required before we can conclusively say that colon cancer is more dangerous in young patients than those in their fifties.
Still, it’s an intriguing, if not disturbing observation. And it highlights the need to understand your risk of colon cancer with both lifestyle and genes, starting in young adulthood, to watch for symptoms and screen for colon cancer in the thirties or even twenties if your risk is higher.
There are three basic ways to screen for colon cancer. They’re improving each year, and a study published in the Sept. 29 issue of the New England Journal of Medicine reveals they can all lower risk of death from colon cancer – assuming you follow the recommended guidelines.
The least intrusive method is a fecal occult blood test. Performed at home, it’s a stool swipe done on a disposable pad, in which you’ll note the results and send to your health care provider, who will analyze the sample for traces of blood.
Higher up the unpleasantry scale, but with a more thorough exam of the colon’s interior, a flexible sigmoidoscopy involves a small tube fitted with a tiny camera inserted up the rectum and into the colon. This allows doctors to see what’s inside and take samples of tissue for further examination.
Finally, the best-known and most comprehensive screening tool is the colonoscopy. Performed under anesethesia, the procedure is a more intrusive version of the sigmoidoscopy, done with a longer tube and with more preparation required. It’s rather unpleasant, to say the least, but it gives doctors the best chance to look for precancerous growths, called polyps, including in the right side of the colon, for which a sigmoidoscopy may be unsuitable.
You wouldn’t be inaccurate if you ranked preparation for a colonoscopy up there with having a root canal, but the procedure is clearly effective. A study published in the Annals of Internal Medicine found that having a colonoscopy may reduce death from advanced colon cancer by up to 70%.
However, depending on your age and risk factors, you may not require a colonoscopy if you pursue a sidmoidoscopy or even just a fecal occult blood test if you follow the Center For Disease Control’s guidelines for colon cancer screening. Beginning at 50 – or earlier for patients at high risk of colon cancer – these include:
Fecal occult blood test: Performed once a year
Flexible sigmoidoscopy: Every five years with a fecal blood test every three years
Colonoscopy: Every ten years
Note that you may need a colonoscopy to remove precancerous polyps if your health care provider detects them at any point during your annual screening.
Each method works. The New England Journal of Medicine study documents that colonoscopy shows the best results, with a 56% reduced risk of death from colon cancer, but flexible sigmoidoscopy and fecal blood testing fared well too, with a 40% and 32% decrease respectively.
Fecal blood testing does not require preparation like a colonoscopy does. That alone makes this method a more suitable option for many clients, and may be the difference between screening or not.
Fecal blood testing has improved too, since the timeframe of the cases reviewed during the study, from 1976 to 1982 and again from 1986 to 1992. According to Dr. Theodore Levin of the University of California at San Francisco, patients who pursue this screening tool would most likely experience even greater accuracy and detection than patients in previous years.
As well, fecal blood testing does not require preparation like a colonoscopy does. That alone makes this method a more suitable option for many clients, and may be the difference between screening or not. Many patients avoid getting a colonoscopy because of the intense and unpleasant preparation involved.
Also worth mentioning, some doctors miss precancerous polyps during colonoscopy because some clients don’t prepare for the procedure as directed. Preparation for a colonoscopy typically requires fasting from solids and use of laxatives for several days leading up to the procedure. Failure to do so may hamper the doctor’s ability to detect dangerous polyps and smaller lesions.
If you’re looking for the comprehensive screening linked to colonoscopy without the unpleasantries of emptying your bowel, you might also consider a virtual colonoscopy.
This is a relatively new development, yet it shows promise. The procedure creates a 3D view of the colon’s interior using computurized tomography. Also called CT colonography, proponent Dr. Michael Zalis of Harvard University says the technique picked up close to 90% of precancerous polyps that were 10mm (four inches) or bigger.
There is still preparation involved with a virtual colonoscopy. Patients are required to stick to a low fiber diet several days leading up to the procedure and consume small amounts of a contrast agent to label fecal matter in the colon. Doctors then use software programs to identify precancerous or abnormal growths, with roughly 15% of virtual colonoscopies requiring a follow up with a conventional procedure to remove polyps.
Zalis conducted a study in which patients underwent both a virtual colonoscopy and the real thing. Not rocket science here – they prefered the virtual procedure over the more intrusive and laxative-heavy elements of a real colonoscopy. While the latter picked up more advanced polyps, a higher number of patients in a Dutch study conducted in January 2012 found that more patients volunteered for CT colonography.
That’s a good thing – the U.S. government estimates that roughly four out of ten Americans between 50 and 75 don’t meet screening recommendations. The expense and unpleasantry of a colonoscopy may have something to do with that.
Virtual colonoscopy is not yet widely practiced. Medicare does not always cover the procedure, and since private insurers tend to follow the public sector’s lead, relatively few doctors have learned how to perform it.
Just the same, it’s a promising development. The American Cancer Society liked it enough to recommend virtual colonoscopy performed every five years as an acceptable screening method. The best colon cancer screening test is the one that gets done – not the one avoided until it’s too late. If you’re in that camp, it’s time to take action.
Click here to learn more about virtual colonoscopy and if it’s right for you.