Colon cancer deaths could be cut in half by regular screening
By Jason Bratcher, M.D. 

If you knew you could save your life by taking a relatively simple, painless, routine screening test, would you do it? 

While the answer may be obvious to most, one out of every three Americans over the age of 50 are needlessly risking their lives, choosing never to undergo any type of colorectal cancer screening test. It’s   the easiest form of cancer to prevent through screening, yet remains the second most common cause of cancer death in men and the third most common in women. More than 50,000 die from colon cancer every year in the U.S. – but what’s sadder, between 50 and 60 percent of those deaths could have been prevented through screening. 

So why do so many refuse?  For some, it’s embarrassment or squeamishness; they can’t handle the idea of anyone examining them there. For many, the issue isn’t the procedure itself, but the bowel preparation the night before. Even though the preparation is far easier, requiring far less liquid intake than just a few years ago, they can’t get beyond those old stories or memories of how it used to be. 

As we age, it’s very common for small tissue growths called polyps to appear along the colon wall. By age 50, between 25 and 30 percent of people have polyps. By age 70, more than 50 percent do. Polyps are almost always benign, but can grow into cancer. Doctors can easily remove polyps during a colonoscopy and test them for cancer. 

RECOMMENDED GUIDELINES
Men and women with none of the risk factors listed below should begin routine colon screening at age 50 (age 45 for African Americans) and continue through age 75. Frequency of screening depends on the type of test and what’s found.  People with increased risk based on the variables below may require screening at an earlier age and have to be screened more frequently. You are at higher-risk if you have:

- A personal history of colorectal cancer or colon polyps
- A family history of colorectal cancer or genetic syndrome predisposing to an increased risk
- Inflammatory bowel disease 

The three main options for colorectal screening today: 

COLONOSCOPY
By far the most strongly recommended option, this procedure has the patient self-administer a two-step bowel cleansing preparation – usually consuming two small bottles of a prescription liquid, plus some additional water – the night before and morning of the procedure.  With the patient comfortably asleep under anesthesia, a long, narrow flexible tube with a miniaturized video camera is fed through the large intestine, searching for polyps. Viewing the process on high-definition screen, doctors remove any polyps they find for testing. From start to finish, including anesthesia recovery, the process takes a little over an hour. 

STOOL-BASED SCREENING
For these tests you receive a kit from your doctor. At home, you use a stick or brush to obtain a small amount of stool. You return the kit to the doctor or lab, where the samples are checked for blood. One version of the test also checks for altered DNA. If blood or any other issue is detected, a colonoscopy is recommended. If no issues are found, these tests are recommended every one to three years. 

VIRTUAL COLONOSCOPY
A computerized tomography (CT) scan produces images of the entire colon, displayed on a computer screen for the doctor to analyze. This test has similar accuracy in detecting colon polyps and if seen, a traditional colonoscopy would be recommended. 

Again, a standard colonoscopy is the preferred option among doctors because it lets us remove polyps during screening – an ideal form of preventive maintenance. What’s most important is that people get screened in some way. It can save your life.

Jason Bratcher, M.D., is Chief of the Division of Gastroenterology at Berkshire Medical Center.