Follow your instincts and get screened

Fifty. For me, it’s just across the corner, as much as I hate to confess it, and it is time to schedule my first colonoscopy. It’s actually not something anyone really looks forward to, but it surely is an important cancer screening tool that shouldn’t be avoided or delayed. According to the American Cancer Society (ACS), colorectal cancer (CRC) is the second leading reason for cancer death within the United States for men and ladies combined (American Cancer Society, 2021). Each yr, CRC affects roughly 150,000 people, of whom one third won’t survive.

I had the chance to talk with Dr. Aparna Mele, a board-certified gastroenterologist and CEO and founding father of the corporate My Instinct, Inc., a nonprofit health and wellness organization dedicated to increasing awareness of preventable diseases that impact community health. “At least 85% of CRC cases are sporadic and occur in people with no family history of colon cancer, and the risk of colon cancer increases with each decade of life,” Dr. Mele said. The early stages of colorectal cancer (CRC) are frequently asymptomatic and subsequently often go undetected. However, Dr. Mele indicated that some patients may experience symptoms similar to change in bowel habits, diarrhea, constipation, bleeding, anemia, weight reduction, or pain (A. Mele, personal communication, March 23, 2021). Early screening for CRC is crucial and might detect cancer when it’s small, has not spread and will be easier to treat. “CRC remains one of the most preventable diseases in the U.S. because almost all colorectal cancers start as a small growth called a polyp, which over time becomes cancer. So if you have polyps, they can be removed before they turn into cancer” (A. Mele, 2021).

“With the widespread use of colonoscopy, the incidence and mortality of this disease is decreasing among people over 50 years of age, but increasing in younger people for whom screening is limited and key symptoms may go unrecognized,” says Dr. Mele. In 2018, the ACS published guidelines with a professional suggestion to lower the age of initiation of CRC screening from 50 to 45 years within the average-risk adult population. Other vital organizations are beginning to follow suit. The latest colorectal cancer screening guidelines published by the American College of Gastroenterology [ACG] this month included a conditional suggestion to initiate CRC screening in average-risk individuals aged 45 to 49 years to scale back the incidence of advanced adenoma, CRC, and CRC-related mortality (Shaukat et al., 2021). Additionally, the U.S. Preventive Services Task Force (USPSTF) issued a draft suggestion in October 2020 to lower the starting age to 45 years for adults at average risk for asymptomatic colon cancer. The task force is an independent panel of experts convened by the Department of Health and Human Services’ Agency for Healthcare Research and Quality, a corporation that has significant influence on policymakers (Holt, 2021). These initial recommendations are expected to be finalized this yr and would require insurance coverage under the Affordable Care Act to cover screening.

Screening recommendations

The ACS (2021) suggests the next screening recommendations for people at average risk for colorectal cancer:

• People at average risk should start regular screening at age 45.
• People who’re in good health and expect to live at the least one other 10 years should proceed regular screening until age 75.
• People aged 76 to 85 should discuss ongoing screening with their doctor, bearing in mind personal preferences, previous screening results, overall health and life expectancy.
• People over the age of 85 should not be screened for colorectal cancer.

For people at increased risk of developing colorectal cancer, it could be vital to begin screening before the age of 45. They should seek advice from their doctor about the precise time to begin screening, what test is correct for them and the way often to get tested. People at increased risk of colorectal cancer include individuals with (ACS, 2021):

• A private history or strong family history of colon cancer or certain kinds of polyps
• personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease)
• A family history of an inherited syndrome similar to familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer syndrome (Lynch syndrome)
• History of radiation to the abdomen or pelvis to treat previous cancer

Screening for colorectal cancer is offered in two forms: stool testing and visual screening.
Stool-based tests include (Centers for Disease Control and Prevention [CDC]2021):

• The highly sensitive fecal immunochemical test (FIT) uses antibodies to detect blood in stool; this test is carried out yearly.
• The highly sensitive guaiac-based fecal occult blood test (gFOBT) uses the chemical guaiac to detect blood in stools; this test is carried out yearly.
• Multitargeted stool DNA (MT-sDNA) or FIT-DNA (Cologuard®) combines FIT with a test that detects altered DNA in stool; this examination is carried out every 3 years.

Visual Research (CDC, 2021):

• Colonoscopy is used to examine the presence of polyps or tumors within the rectum and whole colon, this procedure is performed every 10 years (for individuals who should not have an increased risk of developing colorectal cancer).
• Computed tomography (CT) colonography, also called virtual colonoscopy, uses X-rays and computers to create images of the complete colon, that are displayed on a pc screen for evaluation. this procedure is performed every 5 years.
• Flexible sigmoidoscopy (FSIG) is used to examine for polyps or cancer within the rectum and lower third of the colon; this treatment is performed every 5 years or every 10 years with FIT yearly.

ACG recommends colonoscopy and FIT as the first screening methods for CRC. Dr. Mele notes that “all roads lead to colonoscopy,” meaning that an abnormality in some other screening test will end in the necessity for a diagnostic colonoscopy. It reiterates that “the best preventive strategy is colonoscopy to detect and remove polyps, and that colonoscopy is the only screening test that also removes precancerous polyps before they develop into colon cancer.” Some private insurance firms may not yet cover this procedure for patients under 50 years of age. For those unable or unwilling to undergo colonoscopy or FIT, flexible sigmoidoscopy, multitarget stool DNA testing, CT colonography, or colonic pouch are suggested (Shaukat et al.). , 2021). Dr. Mele emphasizes that “ultimately, the most important message is that SOME form of CRC screening is better than none.”

Dr. Mele also recommends “a healthy diet, high in fiber and low in fat, rich in fruits, vegetables, whole grains and legumes, as the main preventive measure against colorectal cancer. Tobacco in any form and quantity can increase the risk of polyps and colon cancer. Daily exercise and maintaining an ideal weight will independently and collectively reduce the risk of many cancers, including CRC. She encourages us to “start the conversation, spread the word, wear the blue ribbon, support awareness and schedule colonoscopies for yourself and your family members.”

March is Colorectal Cancer Awareness Month – follow your instincts and get screened!

American Cancer Society (2021, February 4). When must you start screening for colorectal cancer? https://www.cancer.org/latest-news/american-cancer-society-updates-colorectal-cancer-screening-guideline.html

Centers for Disease Control and Prevention (2021, February 8). Screening for colorectal cancer. https://www.cdc.gov/cancer/colorectal/basic_info/screening/tests.htm

Holt, C. (2021). Advocates of earlier screening for colorectal cancer gain a very important ally. , 43 section 1, 9–10.

Shaukat, A., Kahi, C. J., Burke, C. A., Rabenkeck, L., Sauer, B. G., & Rex, D. K. (2021). ACG Clinical Guidelines: Colorectal Cancer Screening 2021. 116 sec. 3, 458-479. https://doi.org/10.14309/ajg.0000000000001122