Healthy Living is a weekly television news segment seen on WABI-TV5. Local physicians from Eastern Maine Medical Center and The Acadia Hospital give opinions on the latest research, highlight concerns, and eliminate fear. They focus on important health issues that concern you and your family.Watch the segment each Tuesday on Channel 5's First News at five!.
March is Colorectal Cancer Screening Month
Healthy Living - March 4, 2014
Joan Pellegrini, MD
Colorectal cancer is one of the more common cancers. It is estimated that each of us has a six percent chance of being diagnosed with colon cancer in our lives. The most important thing that we can do is try to prevent colon cancer with a healthy diet, high fiber intake, exercise, and not smoking. The second most important thing we can do is follow screening guidelines. Currently, less than two-thirds of people over age 50 years old get screened. In some areas of the country it is even worse. Screening is particularly problematic for the uninsured or under-insured.
There are two ways to screen for colon cancer: stool tests and structural tests. The old stool tests had some problems with not being sensitive enough and also needed some dietary changes before they could be done. As such, they have fallen out of favor. More recently there is a much more sensitive type of stool test call FIT (fecal immunochemical testing). This test does not require any dietary changes, is covered by most insurances, and is quite sensitive for picking up cancer if done every year.
The most commonly recommended screening test is colonoscopy. The reason this has become so recommended is because it can see polyps and remove them. It is felt that colon cancer first starts out as a polyp and so by removing polyps we can actually prevent colon cancer. FIT does not generally detect polyps and of course it cannot do anything to prevent a cancer.
But there is a problem with colonoscopy. First, many people will not get one done because of the bowel prep and the fear of the procedure. If you have a job, getting a colonoscopy usually requires you to take a day off work and you must have someone drive you home and stay with you because you have been given anesthesia. Although colonoscopy is an excellent screening tool, it is not perfect. There is a risk of about 3 in 1000 patients having a serious complication. Also, some cancers are missed. Sometimes the whole colon cannot be seen and so another test may be ordered. Colonoscopy is very expensive and basically unaffordable if you are uninsured.
There are not enough doctors in the US to be able to do a colonoscopy on every eligible patient. In some areas where there are not enough doctors, some patients with serious gastrointestinal illness must go on a waiting list to be seen because the doctors are too busy doing screening colonoscopies. In fact most screening colonoscopies are completely normal. Even when polyps are found and removed, it is thought that only 6% of those polyps would have gone on to develop into a cancer.
So here is the baseline message: get screened if you are over 50 or earlier if you have a strong family history of colon cancer. Colonoscopy is not the only screening option available. Although most doctors will recommend colonoscopy, FIT may be a better option for you. If your doctor is not familiar with FIT, the Maine CDC has some excellent information (links provided).