Florida resident Sue M. wishes her mother had paid attention to the recommendation that she have a screening colonoscopy every 5 years after the age of 50.
Caught at the earliest stage, colon cancer is very curable.
Unfortunately, by the time Sue’s mother, who was then 56 years old, developed abdominal pain, her colon cancer had already spread to distant organs, shortening her life.
Colorectal cancer is still the number 2 cancer killer in the US.
March is Colorectal Cancer Awareness Month, so it's a good time for Floridians to review the latest recommendations for prevention.
Although colorectal cancer is most common after age 50 and the risk increases with age, it can occur in younger individuals. Those at highest risk include:
-People with family histories of the disease
-A personal history of colorectal polyps, which are abnormal growths in the colon (75 to 90 percent of colorectal cancers can be avoided by removing pre-cancerous polyps)
-Inherited forms of colorectal cancer or polyps
-An underlying inflammatory gastrointestinal disease such as Crohn's or ulcerative colitis
How often to have screening tests recommendations vary depending on individual risk factors, but the American College of Gastroenterology (ACOG) developed the following 2009 guidelines for prevention screening for those with no specific risk factors other than age:
- Colonoscopy every 10 years beginning at age 45 for African-Americans and age 50 for all other ethnic groups (African-Americans have a higher incidence of colorectal cancer and a greater prevalence of right-sided polyps and cancer).
-Alternatively, flexible sigmoidoscopy every 5 to 10 years
-Alternatively, a CT colonoscopy every 5 to 10 years
NOTE: CT colonoscopy is an X-ray and brings the added risk of radiation. If polyps are detected, a regular colonoscopy must be performed to remove them.
The value of colonoscopies was confirmed last year in a study that followed patients for as long as 20 years. Published in the New England Journal, researchers reported a 53 percent reduction in colorectal cancer deaths in those patients who had colonoscopies and whose precancerous polyps were removed.
ACOG also developed the following guidelines for colorectal detection:
-Annual Fecal Immunochemical Test (FIT)
-Alternatively, Fecal DNA testing (FIT) every 3 years or annual Hemoccult Sensa
All of these tests detect hidden blood in the stool.
If the results are positive, a colonoscopy is performed.
Most early colorectal cancers produce no symptoms, which is why screening is so critical. However, if you experience a new onset of abdominal pain, blood in or on the stool or a change in stool shape or caliber or a change in your usual bowel habits, constipation or diarrhea, check with your personal physician.
What is new this year is more information about when colon cancer screening should stop.
In 2008 the United States Preventive Services Task Force reviewed years of research and recommended against routine screening for colorectal cancer in adults over age 75 and against any screening in those over 85.
In 2011, using a 5 percent national sample of Medicare beneficiaries, Dr. James Goodwin, a geriatrician at the University of Texas Medical Branch in Galveston and his team showed that older people underwent colonoscopies too often.
This month, Dr. Goodwin published a new study in the journal JAMA Internal Medicine in which he found that 23 percent of colonoscopies in Medicare aged patients were “potentially inappropriate” because these patients were over age 75 or because they had a repeat screening too soon after the last one for no clear medical reason.
Dr. Goodwin concluded that the inappropriate use of colonoscopy involves unnecessary risk for these older patients and consumes resources that could be used more effectively
As another study in last week’s JAMA Internal Medicine shows, older adults have more trouble stopping screening once they’ve begun a routine than continuing.
Bottom line: If you are under age 75, continue following the colonoscopy screening guidelines. For those age 75 and above, sit down and talk with your doctor about the pros and cons.
For more information: about colorectal cancer and screening