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Screening for Colorectal Cancers

January 15, 2018

Colon cancer knows no boundaries. It does not discriminate based on gender, age or ethnicity. In fact, the American Cancer Society estimates that more than 130,000 new cases of colorectal cancer will be diagnosed in the United States this year. After lung cancer, colorectal cancer is the second-leading cause of cancer deaths in America.

“We are starting to see a younger trend,” says Donna Seidman, RN, BSN, CHPN, gastrointestinal nurse navigator for Overlook Medical Center. “The majority of patients we see range in age from mid- 40s and up. However, we’re starting to see individuals in their late 20s to early 30s. No matter your age, have a conversation with your physician. Evaluation is critical if symptoms are present.”

The news is not all grim, however. “Most colorectal cancers are preventable through screening,” says Bertram Chinn, MD, chief of colon and rectal surgery for Overlook Medical Center who practices at Associated Colon & Rectal Surgeons in Edison, NJ. “Most cancers begin as benign polyps. With colonoscopy, these polyps can be removed before a cancer develops. If we can’t prevent the cancer, then with screening, the cancers are generally found earlier and can be cured following surgery without the need of a colostomy.”

Who, What, When

Dr. Chinn points out that everyone is at risk for colorectal cancer (in fact, one in 17 people will develop colorectal cancer) and therefore, everyone should be screened. But when to be screened – and which screening modality is best for you – should be determined by your physician. For asymptomatic adults at average risk for developing colorectal cancer, the recommendation is to begin screening at age 50. Those with a family history of the disease are encouraged to begin testing at age 40, or 10 years prior to the age at which a physician diagnosed the youngest family member. Other factors like a known family history of a hereditary predisposition generally require screening at an earlier age with more frequent follow-up exams.

Colonoscopy remains the gold standard for detecting colorectal cancer. Usually performed under sedation, the procedure enables direct visualization of the colon with a scope. “If we see something, we can do something,” says Dr. Chinn, citing the on-the-spot removal of polyps – abnormal growths of tissue – that may be malignant or may develop into cancer over time.

Other options include radiologic exams with a barium enema, or virtual colonoscopy with CT to create 3-D images of the colon. These studies are best utilized by patients with an anatomical narrowing or scarring of the colon, or those for whom sedation is not ideal. Still, Dr. Chinn cautions against the downside of these studies: If an exam visualizes a polyp, a physician cannot remove it at the time of screening; subsequent colonoscopy or surgery would then be necessary.

In recent years, at-home screening tests have been gaining in popularity for those who have no symptoms of, or risk factors for, colorectal cancer. These tests require a prescription from a physician. Patients collect a stool sample at home; the sample is sent to a lab, where it is evaluated. “Not everyone with an abnormal at-home study will have a cancer,” Dr. Chinn says, “but further evaluation with a colonoscopy would be required.”

Regardless of which modality is used, the first step is to begin a dialogue with your physician. “We can’t do anything about family history, but we can try to prevent colorectal cancers through lifestyle choices,” says Dr. Chinn. This includes eating a healthy diet, engaging regularly in moderate exercise and getting screened as recommended. Says Dr. Chinn, “Everyone can take steps to minimize their chance of developing these cancers.”

Contact your physician if you are over 50, have a family history of colon cancer or if you have a family history of cancer as some may increase your risk for colon cancer.