Proper Colon Cancer Screening Saves Lives

Despite Katie Couric’s best efforts, we don’t much talk about colon cancer, especially not in polite company.  It makes us uncomfortable for many reasons.  For one thing, we don’t like to even think about cancer happening to anyone we know (especially ourselves).  Likewise, the screening process generally involves, well, sticking a long slender video camera in a certain orifice in our body.  And then, the signs and symptoms of the need for screening outside the recommended age guidelines are also things we don’t want to talk about, like blood in our stools (there, I said it).  However, not talking about colon cancer may lead to far worse outcomes and people who don’t receive proper screening may just end up with the very thing they didn’t want to talk about.

You may be asking yourself, “Why is a lawyer talking about colon cancer screening?”  Well, the answer is that I’ve seen that good screening can save a life (my own, in fact).  And, I’ve unfortunately seen what happens with little to no screening and the heartbreak that can cause.

First of all, colorectal cancer is one of the most common and most preventable cancers in America.  Each year, roughly 51,000 peopledie as a result of colorectal cancer. Many thousands more live the rest of their lives with portions of their large intestines removed and/or with colostomy bags.  My personal experience has been that I’ve been properly screened for colon cancer and I know others who have too.  It’s not a big deal to go through, but it can save your life.  In fact, my gastroenterologist once showed me a photo of the polyp he removed and said, “You know, you dodged a bullet.”

I’ve also known people who did not know they needed to be screened, or who were not properly screened due to medical malpractice on the part of their medical provider(s).  I’ve seen the outcome that comes with no screening.  The bottom line is that in today’s world, we all need to take the initiative and know something about guidelines for colon cancer screening, so that we can be pro-active about it and ask the right questions when talking with our medical providers.  We cannot assume that our primary care physician will talk with us about colon cancer screening because, quite frankly, sometimes they’re too busy and miss it.  We need to bring the subject up with them.  There are some very important guidelines that everyone needs to be aware of as you approach your 40’s and 50’s.

As stated by the AmericanCancerSociety (“ACS”), the goal of screening for colorectal cancer is both the detection of early-stage adenocarcinomas and the detection and removal of adenomatous polyps, for which there is general acceptance of their precursor role in the development of colorectal cancer. Screeningreduces colorectal morbidity and mortality by both diagnosing occult disease at a more favorable stage and preventing disease by removing precursor lesions.

So, as promised, here are some very specific guidelines you need to know:

In 1997, the American Cancer issued its GuidelinesforScreeningandSurveillanceforEarlyDetectionofColorectalPolypsandCancerUpdate.  The guidelines for all people 50 years of age or older who were at average risk for colorectal cancer required (1) FecalOccultBloodTesting (“FOBT”) plus FlexibleSigmoidoscopy or (2) Total Colon Examination every five years. (Ex. N, Cancer J Clin 1997; 47:3).

According to the guidelines, FOBT referred to the implementation of the protocol of collecting and testing six samples from three consecutive stools of a patient following a specified diet.  Flexible sigmoidoscopy referred to the direct visual examination of the lower third to half of the colorectum by a trained examiner using a flexible 60-cm endoscope after satisfactory cleansing of the descending and sigmoid colon. Total colon examination referred to either of two procedures carried out by a trained examiner after a satisfactory cleansing of the entire colorectum. One procedure is colonoscopy, direct visual examination of the entire colorectum (to the cecum) using a colonoscope. The other procedure is doublecontrastbariumenema, radiologic examination of the entire colorectum by instilling both barium and air to define the contours of the colorectal mucosa.  A positive finding on any of the recommended screening procedures required a follow-up colonoscopy.

In 2005, the ACS continued to recommend that average-risk adults should begin colorectal cancer screening at age 50, utilizing one of the following five options for screening: (1) annual FOBT or fecal immunochemical test (FIT); (2) flexible sigmoidoscopy every 5 years; (3) annual FOBT or fecal immunochemical test plus flexible sigmoidoscopy every 5 years; (4) colonoscopy every 10 years; or (5) double contrast barium enema every 5 years. These recommendations are nearly identical to guidelines for average-risk individuals issued in 2002 by the USPreventiveServicesTaskForce (USPSTF) and identical to guidelines for average-risk individuals issued in 2003 by the Multi-Society Task Force, which includes representative gastrointestinal specialty societies as well as representatives from primary care. (Ex. T, 2005, Cancer J Clin 2005; 55:31-44).

There have been various other updates and “tweaks” over the years, but today, 2011, the screening guidelines include those identified in 2005, with screening colonoscopies occurring every 7 to 10 years beginning at age 50, along with a new screening process called a virtualcolonoscopy.

Virtual colonoscopy is a new technique that uses CT to construct virtual images of the colon that are similar to the views of the colon obtained at colonoscopy. The virtual colonoscopic images are produced by computerized manipulation of two-dimensional images obtained by a CT scanner rather than direct observation through the colonoscope. The colon is cleaned-out using laxatives the day prior to the virtual colonoscopy examination. A tube then is inserted into the anus and is used to inject air into the colon. The CT scans then are performed, and the scans are analyzed and manipulated to form a virtual image of the colon.  There are a couple downsides to the virtual colonoscopy.  The primary downside is that a traditional colonoscopy can remove a polyp immediately when detected because the instrument is already inside the colon.  Not so with virtual colonoscopy.  Therefore, the virtual colonoscopy has not taken the place of the traditional colonoscopy.

There are two other tests that are also currently recognized.  The American Cancer society also recognizes yearly fecal immunochemical test (FIT), if done every year.  Also, a person could have a stool DNA test (sDNA) done, but the interval for testing is uncertain.  These tests are only good for identifying cancer, and if positive, the patient should still have a colonoscopy performed.

Essentially, the whole purpose of proper screening is to identify precancerouspolyps before they become cancer, and remove them.  Most pre-cancerous polyps take a couple of years to grow into a cancerous mass.  That is why early detection is so important.  Often times, there may be no signs of polyps, but one very common sign is blood in a person’s stool.  If you are experiencing anysigns, see your doctor and talk about it. Ask about a colonoscopy, and follow through with the procedure.  It just might save your life.  It did mine.

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