March 15th, 2022
By: Ravikant Varanasi, MD, AGAF, Pinehurst Medical Clinic Gastroenterology
If you had about a 5% chance of developing a potentially fatal disease, wouldn’t you want to do something about it?
Colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer-related death in the United States, with over 50,000 people losing their lives annually. Though screening could prevent approximately 60% of these deaths, about one out of every three Americans is not up to date with colon cancer screening.
We often hear the news of someone famous being diagnosed with colon cancer. President Ronald Reagan and baseball great Darryl Strawberry both survived colon cancer. But many celebrities, including cartoonist Charles M. Schulz, actress Elizabeth Montgomery, and the talented actor Chadwick Boseman, have succumbed to the disease.
Over the last several years, celebrities like Katie Couric and Will Smith have advocated for colon cancer screening and the importance of screening colonoscopy. Multitarget stool DNA testing is also more common, and it is now unusual to watch television without seeing a commercial featuring a talking Cologuard® box with arms and legs sitting on a toilet. Yet, despite increased awareness, many people would still rather avoid the subject of colon cancer prevention.
Since 2000, March has been designated as National Colorectal Cancer Awareness Month, which means there is no better time to talk about the importance of colon cancer screening.
The good news is that colon cancer can be prevented. Most colon cancers begin as polyps, small growths on the inside surface of the colon. Polyps come in different shapes and sizes and have different microscopic characteristics. Certain polyps, such as adenomas and serrated polyps, have the potential to turn into cancer over several years.
The growth of polyps and transformation into cancer is often silent, as colon polyps seldom cause any symptoms. So even though one may feel well and be in good health, a colon polyp could be growing and surreptitiously transforming into a life-threatening malignancy.
Fortunately, getting screened can significantly reduce your risk of getting colon cancer. Because a polyp usually takes several years to turn into cancer, colonoscopy with polypectomy (polyp removal) can effectively prevent the disease. Additionally, timely diagnosis of colon cancer is essential, as treatment of early-stage colon cancer offers a greater than 90% chance of survival five years after the diagnosis.
No one will argue that getting a colonoscopy is enjoyable, and the doctor’s office is everyone’s least favorite place to visit. But after the twenty-minute exam is over, most people marvel about how easy the procedure was and how they should have never worried about it in the first place.
The day before the procedure, a clear liquid diet is consumed, culminating with drinking a laxative the evening before and morning of the examination. While this is usually the most disagreeable part of the process, it is also the most important. The cleaner your bowel preparation is the better your colon examination. There are several different bowel preparations available, and you can discuss the options with your doctor. Do not allow fear or dread of the cleansing process to increase your risk of dying from a preventable disease. Since the procedure is done while you are sedated, the exam itself is painless and basically feels like a short nap.
In addition to the cleanliness of your colon, another critically important factor that determines the quality of your colon examination is your doctor. All doctors who perform colonoscopy should be aware of their ADR or adenoma detection rate. This doctor’s “report card” is the rate at which one or more precancerous polyps are found during a screening colonoscopy in patients 50 years and older. Current standards suggest a minimum ADR of 30% for male patients and 20% for female patients, but you can expect higher rates from your doctor. Don’t be afraid to ask your doctor what his or her ADR is. Wouldn’t you want your house inspected by someone who is likely to find a preventable problem so you don’t have to make costly repairs later? Your colon health should be no different. Studies have shown that for every 1% increase in a physician’s ADR, the risk of colon cancer decreases by 3% for the patient over the next year. So if you are getting a screening colonoscopy, it is important that it be done well.
The American Cancer Society recommends that all individuals age 45 and older get screened for colon cancer. However, you might need a screening exam at a younger age if you have a family history of colon polyps or cancer, a personal history of inflammatory bowel disease, or other medical conditions. Your personal medical and family history will determine when and which type of colon cancer screening test is best for you. Screening tests for colon cancer are covered by insurance.
There are many resourceful websites where you can get additional information, including the American Cancer Society (www.cancer.org) and the American Society for Gastrointestinal Endoscopy colorectal cancer awareness website (www.screen4coloncancer.org).
If you have not done so already, talk to your doctor about getting screened for colorectal cancer. Screening colonoscopy is an easy, safe, and proven way of reducing your chance of dying from a common but preventable disease. Having a colonoscopy will give you peace of mind. And it may just save your life.
Dr. Varanasi is a Fellow of the American Gastroenterological Association and accepts new patients at his office locations in Pittsboro, Sanford, and Pinehurst. To make an appointment, please call (919) 292-6110.
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