We all hear horror stories from our friends and families about colonoscopies and the dreaded “prep”. Why are we doing this to ourselves? How can we reduce the number of times we need to do this test in our lifetime? Is there a way to avoid it completely?
First let’s talk about prevention as this is what really saves lives. In the US, colorectal cancer is the second deadliest cancer. Men have a 4.7% chance and women a 4.4% chance of being diagnosed with it.
There are risk factors you can’t change, like living longer than 50 years, having a family member with colon cancer or other cancer syndromes, polyps, Crohn’s or ulcerative colitis, having diabetes, or being in certain racial or ethnic groups (African American and Ashkenazi Jewish).
But there are risk factors that we can control- like alcohol consumption, smoking, sedentary lifestyle, obesity, and poor diet. Make sure to talk with your primary care provider about when to start screening if you have a family history of polyps, colon cancer, or a high number of other cancers. Hint: you need to be screened earlier- up to 10 years earlier even without symptoms depending on the situation.
We now have genetic tests to identify familial disorders that link many types of cancers, such as Lynch syndrome (this causes ovarian, uterine, pancreatic, kidney, brain, ureter and bile duct cancers). So we can test people for a genetic predisposition and make sure they are vigilant about screenings. But what if you have no risk factors? What are the screening rules in that case? Our federal government, as the USPSTF (US Preventive Services Task Force- they will be a recurring character in this blog) recommends screening all Americans between 50 and 75 years old. How often during that 25 year span depends on what is found during the screening. If you are minimizing your risk factors and have a normal colonoscopy you can avoid one for up 10 years at a time. That means a lifetime total of 3 at ages 50, 60 and 70. The upside? It’s a day off from work and maybe you even lose a stubborn pound or two with the clear diet leading up to the procedure. But is it possible to avoid the colonoscopy completely? Well the USPSTF and the AAFP (American Academy of Family Physicians) agree that the only methods that we can count on are colonoscopy, sigmoidoscopy (similar to colonoscopy but not as thorough), and stool testing that looks for blood. There are other newer tests such as a stool test that looks for cancer DNA rather than blood (Cologuard) and CT scans specifically for the colon/rectum. But these newer tests have not had time to prove themselves effective in a way that outweighs the risks- like an incorrect result or exposure to radiation.
If you use one of the stool tests or sigmoidoscopy and there is any uncertainty about being cancer-free, then you’ll need to follow up with a colonoscopy. Honestly, other than our skin, we can’t look at an organ directly to look for changes in the cells. Colonoscopy allows us to use a camera, equipped with tools, to look for and take samples of cells to analyze under a microscope. If you want to use the stool tests, you should repeat them yearly. Otherwise follow up frequency for colonoscopy depends on what was seen inside and under the microscope-usually 3-10 years.
Bottom line (pun intended), the same rules for healthy living apply to colon health as for the rest of our body. Don’t smoke, get exercise, eat lots of veggies, fruits, and whole grains, keep alcohol to a max of 1 drink daily for women or 2 for men, and stay at a healthy weight (BMI/ body mass index <25). And make sure to see your primary care provider to discuss your personal and family health history and come up with an individualized plan for your health each year. Call us or visit us at any of our Kelly Goodman Group locations to set up a visit.