As a primary care physician specializing in internal medicine, it is part of my daily patient conversation to discuss wellness and cancer prevention. When reviewing colon cancer prevention with my patients I always advise that a colonoscopy be conducted when appropriate based on their age and family history. Most people follow through with recommendations in order to be proactive. However, there are always a few who procrastinate stating that there is no one in their family with colon cancer or they are just too busy. I am hoping that my story changes this.
When I turned the age of 50, I scheduled my colonoscopy with my gastroenterologist. I agree that the liquid prep isn’t the most pleasant tasting but this is only for a few hours the night before the procedure. It is doable. I have no family history for colon cancer, yet to my surprise a precancerous colon polyp was removed. If I had procrastinated because of my busy schedule, I would have been diagnosed in the near future with colon cancer. As the polyp was removed, I successfully prevented colon cancer. This is exactly the purpose of a colonoscopy.
The statistics for colon cancer per the American Cancer Society are sobering. Colon cancer is the 3rd most common cancer for both men and women. They estimate a lifetime risk for colon cancer of 1 in 22 for men and 1 in 24 for women. Fortunately, the death rate has been decreasing. Reasons for this include more colonoscopies being conducted and better cancer treatments are now available.
Not all colon polyps are precancerous in nature. The adenomatous polyp is cancerous as opposed to a hyperplastic polyp which is benign and has no cancer potential. Most colon cancers are adenocarcinomas. Less common types of cancers in the colon include lymphomas, carcinoids and sarcomas.
Risk factors for colon cancer have been identified. They are broken down into risks that are adjustable, and those that are not. Examples of the latter include family history of colon cancer or precancerous polyps as well as if you already had precancerous polyps. Those who have inflammatory bowel disease such as ulcerative colitis also have an added risk. African Americans and Jews of European descent have higher risks as well.
Risks that are adjustable include obesity, heavy alcohol intake, smoking and being sedentary. Diets that are rich in meat and that are highly processed increase the chance as well. There are also possible increased risks seen for those that are night shift workers, men with prior testicular cancers as well as those men who were treated with radiation for prostate cancer. More research is needed however to confirm these possible risk categories.
Prevention, as I always state, is so important. It is essential that you speak to your primary care physician about your risks and when your screening is due. Although the previous standard was for the average risk person to start screening at 50, the ACS has now lowered the starting age to 45. The question is if health insurances will agree to this advised new age. It is recommended for those in the average risk to have a colonoscopy every 10 years between the ages of 45-75. From 76-85, the colonoscopy is based on risk. No further screening colonoscopies are routinely done above age 85 but may be done if an acute problem occurs such as significant rectal bleeding.
The start age for higher risk people is individualized and is repeated in frequency depending on the findings. The longest time between colonoscopies is usually 5 years. Another test available for those people that have no polyp or family history for colon cancer is a Cologuard stool test which is a specific DNA study for precancerous polyps, and it is done at 3 years intervals.
I encourage you to keep up with your annual wellness physicals with your primary care physician. Discuss when all of your prevention cancer screens are due and get them done. Work on your diet to make it low in fat and carbohydrates but rich in lean protein and fruits. Keep up with physical exercise 3 times per week. Avoid smoking and drink in moderation. I hope that you realize through my experience that procrastination is never good. Please get your colonoscopy done in a timely fashion. It may save your life.
