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Colorectal Screening

Friday, March 25, 2016

True confessions time – I am over 50 and have not had colorectal screening yet. Like many, I have a lengthy list of excuses…”I feel fine,” “I don’t have time,” “You are going to put that thing where?!,” and “Oh, but that prep” were rationalizations that came out my mouth.   I finally made my appointment this month after the sobering news that the president of my alma mater passed away from colon cancer at the age of 52.  While some of you are screaming TMI (too much information), others of you realize the validity and benefits of colorectal screening.  Indeed, colorectal screening is critical and should start at age 50 and continue until age 75 for most men and women. The single biggest risk factor for colorectal cancer is age and there is no escaping that!

According to the National Center for Chronic Disease Prevention and Health Promotion, colorectal cancer is the number two cause of cancer deaths in the U.S.  In the same breath, the five-year survival rate is 90% if cancer is found at the local (early) stage. But sadly, only 39% of colorectal cancers are diagnosed at an early stage, partly due to low testing rates.  Screening is important because it can find polyps (abnormal growths).  Those growths can then be removed before turning into cancer.  Currently, 28 million Americans are not up-to-date on screening.  In New York alone, an estimated 1.2 million have never been tested.  Approximately, 51,000 people in the U.S. die from colorectal cancer each year and recommended screening could prevent at least 60% of these deaths!  Understanding the screening options and leading a healthy lifestyle can substantially lower your risk.

There are several colorectal cancer screening choices for average-risk men and women ages 50-75:

  • High-sensitivity fecal occult blood test (FOBT) – This at-home test should be done once a year.  The patient sends a stool sample to a doctor’s office or lab. It looks for hidden blood in stool.  Positive results should be followed up by a colonoscopy.   OR

  • Flexible sigmoidoscopy – The doctor looks for polyps or cancer in the rectum and lower third of the colon.  This should be done every 5 years with a high-sensitivity FOBT or every 3 years by itself.   OR

  • Colonoscopy – The doctor looks for polyps or cancer in the rectum and the entire colon and removes polyps during the same procedure.  This should be done every 10 years.  

High-sensitivity fecal occult blood test (FOBT) – This at-home test should be done once a year.  The patient sends a stool sample to a doctor’s office or lab. It looks for hidden blood in stool.  Positive results should be followed up by a colonoscopy.   OR

Flexible sigmoidoscopy – The doctor looks for polyps or cancer in the rectum and lower third of the colon.  This should be done every 5 years with a high-sensitivity FOBT or every 3 years by itself.   OR

Colonoscopy – The doctor looks for polyps or cancer in the rectum and the entire colon and removes polyps during the same procedure.  This should be done every 10 years.  

Which screening is best for you?  Robert Smith, MD with the American Cancer Society recently commented, “We have a saying, the best test for colorectal cancer screening is the one that gets done.”  Discuss the options with your physician to determine what makes the most sense for you.  If you or a close relative have: inflammatory bowel disease, Crohn’s disease, or ulcerative colitis; a personal or family history of colorectal cancer or colorectal polyps; a genetic syndrome such as familial adenomatous polyposis (FAP) or hereditary non-polyposis colorectal cancer (Lynch syndrome), contact your physician.  You may need to start screening before age 50 and be tested more often than other people.  

In addition to screening, a healthy lifestyle lowers your risk not only for colorectal cancer but for other cancers and chronic diseases as well.  The American Cancer Society suggests the following management strategies.

DO:

Eat a diet rich in whole grains, fruits, veggies, dairy, and lean proteins.

Manage your weight.  A healthy Body Mass Index (weight to height proportion) is 18-25.  (to calculate your BMI, go to:  http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html

Stay active.  Walk, exercise, and play on a daily basis.

Stop smoking.  

LIMIT:

  • Processed foods, junk foods, fatty meats, and refined sugar products like cookies, candy, and cake.

  • Screen and couch time.  According to a new Nielsen report, Americans spend almost 8 hours per day with some kind of screen device.   Limiting screen time may improve physical and psychological health.

  • Alcohol and soda.

Processed foods, junk foods, fatty meats, and refined sugar products like cookies, candy, and cake.

Screen and couch time.  According to a new Nielsen report, Americans spend almost 8 hours per day with some kind of screen device.   Limiting screen time may improve physical and psychological health.

Alcohol and soda.

Colorectal screening is now on my calendar.  The benefits far outweigh any time issues, embarrassment, or mild discomfort.  If you would like more information about screening, go to: New York State’s Department of Health website at https://www.health.ny.gov/diseases/cancer/colorectal/ or locally, call the Cancer Services Program of Livingston and Wyoming Counties at 800-588-8670.  If you are uninsured, the Cancer Services Program can also assist you with free screenings as well as insurance information.  

Lorraine Wichtowski is a community health educator at Noyes Health in Dansville.  If you have questions or suggestions for future articles she can be reached at lwichtowski@noyeshealth.org or 585-335-4327.  

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