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Stop stalling: Screening can spot colorectal cancer before itís too late

March 14, 2016

Just a few weeks after she turned 17, Danielle Burgess was diagnosed with colon cancer.

Burgess had been noticing blood in her stool for several years, but she shrugged it off after consulting Dr. Google and self-diagnosing hemorrhoids.

By the time she went to the doctor to have a colonoscopy, she was diagnosed with Stage 3 colon cancer.

"It wasnít great but they gave me a lot of treatment options," said Burgess of Kansas City, Mo.

Six months later she was cancer-free. Doctors continued to monitor her colon (large intestine) every three years. In 2009, when she was 25, a growth on her colon once again tested positive for cancer.

"Luckily, they caught it early," said Burgess, now 32.

Colorectal cancer, a malignancy that occurs in the colon or rectum, is a leading cause of cancer deaths. This year, itís expected to claim the lives of nearly 50,000 people in the United States.

Itís also largely preventable. Screening tests can detect and remove abnormalities before they have a chance to turn cancerous ó or spot problems in the early stages, when the disease is more responsive to treatment.

The American Cancer Society and other groups say that screening for most men and women should begin at age 50. Even so, many choose to ignore this advice. Roughly one-third of the countryís eligible adults havenít been screened for colorectal cancer as recommended by the U.S. Preventive Services Task Force, according to the Centers for Disease Control and Prevention.

The CDC estimates that if everyone age 50 and up had regular testing, at least 60 percent of deaths from this cancer could be avoided.

"In nearly every case, colon cancer begins with a small growth called a polyp, which over time turns into a large polyp, and eventually turns into cancer," said Dr. David Greenwald, director of clinical gastroenterology and endoscopy at Mount Sinai Hospital in New York. "This process takes many years to occur; if polyps are removed when they are small or even when they are big, but before they turn into cancer, colon cancer is prevented."

If found in its earliest stages and if the cancer hasnít spread, the survival rate beyond 5 years is 90 percent, said Durado Brooks, managing director of cancer control intervention for the American Cancer Society. If it has already spread, the survival rate drops to 12 percent beyond 5 years.

"Our treatments are much, much more effective at the early stage," Brooks said.

There are numerous ways to screen for colorectal cancer, and several organizations have issued their own guidelines.

The U.S. Preventive Services Task Force recommends screening using high-sensitivity fecal occult blood testing, sigmoidoscopy or colonoscopy beginning at age 50 and continuing until age 75, at which point the decision to continue screening should be made on an individual basis depending on the personís overall health and screening history.

The tests the task force recommends:

ó High-sensitivity fecal occult blood test (FOBT) or fecal immunochemical test (FIT) to detect blood in the stool, a possible sign of cancer. People get a kit and collect small samples of stool that are sent to a lab. This test should be done annually.

ó Flexible sigmoidoscopy, where doctors use a thin, flexible, lighted tube called a sigmoidoscope to examine the interior walls of the rectum and the lower third of the colon. Should be done every five years in conjunction with FOBT/FIT every three years.

ó Colonoscopy, similar to a sigmoidoscopy but uses a longer colonoscope tube to look at the inside walls of the rectum and the entire colon. Should be done every 10 years. During the procedure, tissue samples may be collected for further testing or polyps may be removed. Colonoscopies are often performed as a follow-up if abnormalities are picked up by other screening methods.

Doctors say theyíve heard a plethora of excuses from patients whoíve put off screening.

"Some excuses for not undergoing screening include a fear of being diagnosed with cancer," said Dr. Andrew Chan, associate professor of medicine at Harvard Medical School and gastroenterologist at Massachusetts General Hospital. "Other patients do not want to undergo endoscopic screening tests because they are afraid of pain or discomfort. For these patients, I explain that the vast majority of patients do not experience discomfort since they are given sedatives and pain medicines during the procedures."

The American Cancer Societyís recommendations include additional screening options, such as an X-ray of the colon and rectum called a double-contrast barium enema, and a CT colonography (virtual colonoscopy), where X-rays and computers create images of the entire colon. Both require that the colon is completely empty before testing, so patients need to do a colon-cleansing prep, same as they would with a standard colonoscopy.

The society also recommends a stool DNA test every three years that entails sending a bowel movement to a lab to be checked for cancer cells.

"They (stool tests) may not be as sensitive as colonoscopy, and some patients also worry about having to manipulate fecal matter," Chan said. "However, any screening is better than no screening exam."

While most adults can wait until 50 to start routine screening, tests should begin earlier and be done more frequently for those at higher risk, such as people with inflammatory bowel disease or a strong family history of colorectal cancer or polyps.

People also need to be vigilant about symptoms ó no matter what their age.

Just before Susan Cohanís 40th birthday in 2002, Cohan experienced stomach pain and rectal bleeding. She saw several doctors who prescribed laxatives rather than referring her to a gastroenterologist.

Cohan ended up in the emergency room in incredible pain. She was diagnosed with advanced stage colon cancer and told she had a couple of months to live, said her father, David Cohan, president of the Baltimore-based Susan Cohan Colon Cancer Foundation.

"Susan died two years later after a heroic battle," her father said. "We urge anyone regardless of age with symptoms such as abdominal pain, bleeding or continuous constipation to get screened for colon cancer."

 

 


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