Important Updates to Colonoscopy Guidelines
If you were offered the chance to keep from developing the third most common cancer and to cure it if you have it, wouldn’t you be first in line to snatch up that gift?
But close to one-third of all people who fall into the age range and have risk factors for needing a colonoscopy — a procedure which essentially eliminates the incidence of colon cancer — don’t have one, according to the Centers for Disease Control and Prevention (CDC).
“Colon cancer is one of the most preventable cancers,” says Viralkumar Patel, M.D., a gastroenterologist and physician on the medical staff at Texas Health Dallas and at Digestive Health Associates of Texas. “While there are exceptions, I feel that if you’re getting appropriately screened, the odds are much higher of catching it early or preventing it.”
But people do get it. This year, the American Cancer Society predicts 104,610 new cases of colon cancer will be diagnosed. Also this year, colon and rectal cancer combined are expected to take the lives of 53,200 people.
But, Patel stresses, that number should be much lower.
“Colonoscopy is the best test known to prevent cancer,” he says. “The sooner you get screened, the sooner you’ll find colon cancer, which is one of the few cancers that can be cured. Stage one can be 100 percent cured with surgery. With stage 2, you have a greater than 90 percent survival rate. Stage 3 has an 85 percent survival rate at five years, which is still good.”
Traditionally, the recommended age for a colonoscopy has been 50 years of age. Two years ago, though, based on modeling analysis studies showing people decades younger were getting colon cancer, the American Cancer Society lowered its recommendation to age 45 under doctor’s orders.
“They went back and looked at the incidence of colon cancer in younger people who were getting colonoscopies for other reasons,” Patel says. “They found younger and younger people getting colon cancer which, when found, was at a more advanced stage.”
The American Gastrological Association and the American College of Gastroenterology have kept 50 as the recommended age except for high-risk populations, a stance Patel mostly follows.
“For my routine patients, I say to stick to age 50,” he says. “For those with higher risk, though, I tell them, ‘Let’s go ahead and get you to do a screening at an earlier age.’”
African Americans have a higher incidence of colon cancer diagnosis and mortality than any other race. Other risks include obesity and smoking, especially for people smoking more than a pack of cigarettes a day over 25 years.
Another risk factor is having a first-degree relative — parent or sibling — who has been diagnosed with colon cancer. If that’s you, Patel offers this formula to determine when you should be screened: “The recommendation is to start screening at age 40 or 10 years before the youngest first-degree relative’s diagnosis, whichever comes first.
For instance, if your mother was diagnosed at age 55, Patel would recommend you come in at age 45. If she was diagnosed at 49, you’d come in at 39.
With all this knowledge about colon cancer, and all these statistics supporting colonoscopy as a lifesaving procedure, you’d think people would be lining up to be screened. But Patel says that’s not always the case. According to the CDC, in 2016, only about 60 percent of respondents in the Metroplex who were 50 to 75 years old reported receiving a colon cancer screening. That number declined, in many cases, in more rural communities.
While you might think the main reason would be the procedure itself, and especially the colon-cleansing preparation the day before, Patel discounted that.
“Cost and access to care primarily holds people back,” he says. “A lot of people don’t have health insurance.”
Additionally, unless their primary care doctor tells them about it, they may have never heard about the importance of having a colonoscopy, or even about the procedure itself.
“Others don’t want to be put to sleep,” he says. “Or they say, ‘You’re not putting anything up there.’”
Which, he says, brings us to the preparation, which he called “much more bothersome than the actual procedure.”
But there is good news: “It has gotten significantly better,” Patel says. “Now we do a low-volume kind: Two 8-ounce cups to drink, and they’re split into two doses. One is taken the evening before and the other the morning of the procedure.”
Another prep method even includes eating a granola-type bar instead of just drinking fluid.
“It’s important to discuss all bowel cleansing options with your provider to make it the best fit and most comfortable for you,” Patel says.
At this point, you may be remembering a commercial you’ve seen for a product called Cologuard. Billed as “noninvasive at-home screening,” the prescription-only product allows people age 45 and older at average risk to get a sample of their stool and send it in.
“It’s essentially very good at finding colon cancer,” Patel says. “The problem is that it’s only looking for cancer. Its success in finding polyps, which is what a colonoscopy does, drops dramatically: It only picks up 42 percent of advanced polyps, which are those a centimeter or bigger with advanced features that will turn into cancer. A colonoscopy can find polyps as little as two or three millimeters.”
Cologuard “is better than nothing,” he says. “At least it will find your cancer. But if it does come back negative, it’s important to repeat it every three years.”
A colonoscopy, on the other hand “is diagnostic and preventative. You can find cancer and prevent it by cutting out polyps.”
He offers other ways to lower your risk of developing colon cancer: namely, eat healthily.
“The best diet, according to a 2015 study in the Journal of the American Medical Association is pescovegetarian: plant-based, whole foods, some fish,” Patel says. “The second best is vegetarian. The worst diet is that which has a very high intake of red meat — three to four times a week.”
Over the years, he says, aspirin and folate supplements have been touted as helping prevent the disease. But he says, “nothing has borne out as well as those high in fruits, vegetables, fiber. Even fiber supplements aren’t as good as eating fruits and vegetables.”
So snack on the good stuff. And please, get screened. What gift could possibly be better than this — the one that saves your life.
To find a physician to speak with about digestive health or colon cancer screenings, visit TexasHealth.org/FindaPhysician