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March 11, 2012 at 10:04 PMComments: 0 Faves: 0

Colon Cancer: Should I Be Screened?

By Jeffrey VanWingen M.D. More Blogs by This Author

March means a lot of different things, depending on who you are. To mid-westerners, it's means the transition to warm weather, to sports fans it means college basketball, to those of Irish decent, it means St. Patrick's day and to us in the health field, it means colon cancer awareness month.
To me, though, every day in my office is about colon cancer awareness- and for good reason. For the most part, colon cancer is preventable, yet people still get colon cancer. 
This blog will explore colon cancer to raise awareness and help you determine when you should consider screening.

Colon Cancer Prevalence

Colon cancer (or more completely colorectal cancer) emerges from the lining of the large intestine and rectum.  From normal tissue, a polyp emerges in the pre-cancerous stages.  From there the polyp develops further into a tumor, growing deep into the colon eventually to metastasize to other organs.  According to the American Cancer Society's most recent estimates around 143,000 new cases of colorectal cancer are diagnosed per year.  When men and women are considered together, it is the second most common cancer. The lifetime prevalence of colorectal cancer without screening is one in 20. 

Colon Cancer Risk factors

Colon cancer is more prevalent with some genetic conditions and with bowel diseases such as ulcerative colitis.  There is also a hereditary component with raised prevalence if a family member has had colon cancer. Certain factors in our lifestyle and health have been shown to affect colon cancer risk.  Smoking, increased alcohol use and obesity are known to increase risk. Regarding the foods we eat, a diet high in fat and red meat has been shown to increase risk of colon cancer. Most cases, however, are found in those with normal risk.

What about burnt marshmallows or charred meat?

Charred food does contain chemicals like aromatic hydrocarbons and acrylamide that have been shown to be carcinogens. Despite this however, no definite link has been made to show if or how much of these chemicals are bad for us. While a well-done burger or some black on your toast won't kill you, it's probably best to use the guideline that less is better. 

Preventing Colon Cancer

Again, colon cancer is, for the most part, preventable. Colonoscopy (a fiberoptic scope that visually examines the extent of the colon) is generally considered the best way to evaluate for colon abnormalities. If a polyp is found during the procedure, it is removed and sent for analysis.
Basically, there are benign polyps (called hyperplastic) and those with the potential to become cancer (adenomatous). The formula for determining when colonoscopy should be performed is quite simple. If a family member has had colon cancer, subtract 10 years from when they were diagnosed. If no risk factors are known, screening should begin at 50. If the scope is normal without other risk factors, a repeat scope should be performed in 10 years. If polyps are found, this gap is shortened to 1, 3 or 5 years depending on the type of polyps found.
Why is there such a long gap if the first scope is normal?  It takes years for the normal colon to evolve into polyps and then a tumor.  As such colonoscopy is not needed so frequently as other screening tests like mammograms.

Colonoscopy - It's Worth It!

Most people agree that colonoscopy helps save lives. Often, though, I find myself selling the procedure and listening to a lot of hemming and hawing: "Maybe next year," "I'll talk to my wife and get back to you.
Admittedly, colonoscopy is not a fun process.  Pre-scope, a couple days of preparation to clean the colon out are required. This involves frequent trips to the restroom. The scope procedure itself may take as little as 20 minutes or a bit longer if polyps need to be removed. Generally, people are sedated for the procedure. In a perfect world, the most difficult thing about colonoscopy would be the colon clean-out.  Unfortunately, the wallet can be cleaned out in the process as well. With costs approaching $1000 many people would choose to pay their bills first if insurance does not pick up the tab. 
Other methods of screening are out there but colonoscopy is the present standard of care. Stool testing for blood and a shorter scope called a sigmoidoscope are helpful but not as thorough as colonoscopy. Small pill-sized cameras that are swallowed may show promise for the future of colorectal cancer screening. 

My Own Experience

Because of a positive family history and some gastrointestinal issues, I have had a colonoscopy. Overall, it was not nearly as bad as I thought it would be (I tend to get worked up about things according to my stoic wife). I dutifully drank my Gatorade as my family ate dinner the day before. I usually have a hearty appetite and this was perhaps the most difficult part of the whole deal. I did manage to work a bit on the day of the colonoscopy which was late in the afternoon--  preparing but not out of the game. In general, the preparation did not cause significant discomfort. At the colonoscopy suite, the procedure was described and an IV was started. I remember a song from REO Speedwagen playing on the radio and the next thing I knew I was being wheeled out from the procedure.  Things looked good and I got a, "See you in 10 years," from the gastroenterologist. My wife drove me home and I took it easy the rest of the day.

In Conclusion

Colorectal cancer is one of the most common cancers.  With the help of colonoscopy, this cancer is considered preventable.  If you are over 50 or have risks warranting earlier screening, I urge you to get colonoscopy.  Ask your loved ones if they have been screened and advocate if they have not.  In doing so, you may save a life.

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