These are the biggest hurdles to slowing the spread of one of the most common forms of cancer in the United States: colorectal cancer.
The most accurate way to look for this disease is a colonoscopy, but there’s resistance to it, acknowledged Ben Kieff, MD, a gastroenterologist with Spectrum Health Medical Group.
Much of this resistance is because of the test’s less-than-pleasant preparation, which requires a liquid diet (Jell-O anyone?) and more than a few trips to the bathroom.
Patients also are anxious about the sedation.
“They’re afraid of saying or doing something embarrassing,” Dr. Kieff said. But “that’s an overblown myth.”
In truth, the process is usually uneventful–almost dull, Dr. Kieff said, because patients remain sleepy for the whole event. He often hears “that’s all there was to it?” comments from them after the procedure.
That’s because most colonoscopies are performed using intravenous sedation, also called twilight sedation. Patients are very drowsy, but comfortable and still breathing on their own. This type of sedation also has a mild amnesiac effect, so many may not even remember the procedure.
Save the shyness
There’s much value to facing fear and overcoming embarrassment about having a colonoscopy: It could save your life.
Most cases of colorectal cancer begin with precancerous polyps, or small tumors, in the colon or rectum. If not removed, many will eventually become cancerous.
Dr. Kieff said he finds precancerous polyps during a colonoscopy in 20 to 25 percent of his male patients, and 15 to 20 percent of his female patients. These powerful statistics demonstrate the effectiveness of the procedure.
In fact, colonoscopies are distinctive among cancer screening tests. Unlike with mammograms or prostate exams, the potentially cancerous tissue, or polyp, can be removed right then and there.
“That’s what’s unique about a colonoscopy,” he said. “Every day I catch what we call an ‘advanced polyp’ and by removing it, can remove the chance of it becoming cancer. I like to refer to colonoscopy as a ‘cancer prevention’ test.”
The American College of Gastroenterology recommends colon cancer examinations for people beginning at age 50, repeated every 10 years.
Additionally, African Americans males are more prone to colorectal cancer at a younger age than other ethnic groups and should begin screening by age 45.
The symptoms of colorectal cancer often don’t appear until the cancer has spread–another reason to get tested regularly. If found and treated in the earliest stage, colorectal cancer has a survival rate of greater than 90 percent.
DIY @ home?
What if you had other screening option—one you could do at home with minimal prep?
That’s the idea behind the Cologuard test, approved by the FDA in 2014. According to the manufacturer, it can detect signs of colorectal cancer with more than 90 percent accuracy by extracting DNA from a person’s stool sample and analyzing it for abnormalities that occur as a result of cancer.
Medicare Part B covers this test once every three years for people between 50 and 85 years of age with an average risk for colorectal cancer and no symptoms.
Spectrum Health’s gastroenterologist are encouraging primary care doctors to make patients aware of this option, Dr. Kieff noted. While this at-home test does not replace colonoscopies, it could reduce the number of people who need them.
“While Cologuard is the best non-invasive screening option available today, it doesn’t prevent cancer or detect all cancers, and it does a poor job of detecting advanced polyps that might ultimately become cancer,” Dr. Kieff said. “It’s also not clear yet how protective a single negative Cologuard test result is or the frequency with which the test should be repeated.”
Other testing options include:
- A CT scan of the colon, known as a virtual colonoscopy. No sedation is required, but the test isn’t as precise as a colonoscopy in detecting small polyps.
- A flexible sigmoidoscopy also doesn’t require as much sedation or as much preparation as a colonoscopy. However, it also doesn’t examine the full colon.
- A barium enema involves coating the lower part of the intestine with a special liquid before X-rays are taken. This test, too, is less precise and not as thorough as a colonoscopy.
Spectrum Health also offers a free testing kit that can detect the presence of blood in the stool, a sign of colorectal cancer.
It’s important to re-emphasize that all of these options are less precise than a colonoscopy, so they must take place more frequently. And, a positive result with any one of them will require a follow-up colonoscopy.
Spread the secret of survival
Although colorectal cancer took the lives of more than 50,000 Americans in 2014, the survival rate has gone up as more people are coming in for testing.
“So the good news is that the general public is becoming more aware and accepting of colonoscopy,” Dr. Kieff said.
Still, more than half of those 50,000 lives could have been saved with proper screening. In fact, it’s estimated that 1 in 3 American adults are not screened for colorectal cancer as recommended.
Dr. Kieff does more than 2,000 colonoscopies a year at Spectrum Health, so to him, it’s all routine.
“I’ve had one,” said Dr. Kieff, who practices what he preaches. “I’m not looking forward to my next one, but do I fear it? No.”
“My big message to people,” Dr. Kieff concluded, “is that the vast majority of people who get a colonoscopy have an uncomplicated experience that may even be surprisingly simple.”
Watch Dr. Kieff on Fox 17 and see what a colonoscopy and polyp removal looks like from the inside: