What doctors wish patients knew about colon cancer screening


Colorectal cancer – which refers to cancer of the colon or rectum – is the second leading cause of cancer death in the United States. And there doesn’t seem to be any signs of slowing down – colorectal cancer rates are rising in adults aged 20-49. year. Yet about 30% of eligible patients in the United States have still not been screened for colorectal cancer.

The AMA’s What Doctors Wish Patients Knew™ series gives doctors a platform to share what they want patients to understand about today’s healthcare headlines.

In this article, two doctors took the time to discuss what patients need to know about colorectal cancer. They are:

  • Jill Jin, MD, internist at Northwestern Memorial Hospital and clinical assistant professor of medicine at Northwestern Feinberg School of Medicine in Chicago. She is also Senior Medical Advisor for the AMA and Associate Editor for JAMA®.
  • Walter Park, MD, gastroenterologist at Stanford University Medical Center and associate professor of gastroenterology and hepatology at Stanford University School of Medicine. He is also an AMA delegate for the American Society for Gastrointestinal Endoscopy.

“Colorectal cancer, or colon cancer, is cancer of the colon or rectum, which is the last segment of your large intestine,” Dr. Park said, noting that it is “a fairly common cancer among Americans”.

“And when we specifically refer to the word cancer, we are referring to a specific type of cancer called adenocarcinoma,” he added. “It’s acknowledging that there are technically other types of colon cancers, but they’re less common.”

“Colon cancer is more common than rectal cancer, but they are often combined,” Dr. Park said. “But the reason they are treated separately is that they have different therapeutic implications.”

“Traditionally, we thought adults 50 or older were most at risk, which is still the case – most cases are diagnosed in adults over 50,” Dr Jin said. “However, we are seeing more people being diagnosed at younger ages,” she added. “It is currently estimated that around 10% of new diagnoses are in people under 50. This number is growing, which is interesting because no one really knows why.”

“We don’t know where the trigger comes from, whether it’s food or not,” Dr. Jin said. “So we think everyone is susceptible. However, the highest risk is still for people aged 50 and over.

“At a minimum, the average American over the age of 45 is considered susceptible enough to warrant screening,” said AMA member Dr. Park. “More recently, we reduced those guidelines to 45 to increasingly fail to recognize that Americans are getting colorectal cancer at a much younger age.

This trend is “obvious enough that the guidelines were changed to an earlier start date of 45 years,” he said. While the U.S. Task Force on Preventive Services recommends screening for colorectal cancer in adults ages 45 to 75, adults ages 76 to 85 should be screened selectively because the benefit of screening for all people this age group is weak.

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“The real benefit is that participating in a screening program, like screening colonoscopy, reduces your risk of developing colon cancer by about 80 percent,” Dr. Park said.

Although “it’s not a 100% guarantee…compared to no colonoscopy, it’s a significant reduction,” he said. “The reason screening is widely encouraged and should be fully covered by your health insurance company is that evidence shows there are benefits to early detection.”

“Colon cancer screening is probably one of the tests that has some of the strongest evidence of benefit,” Dr. Park said. “For us gastroenterologists and gastrointestinal oncologists, caring for colon cancer patients can sometimes seem tragic, because it seems like an opportunity has been missed – many of them could have been avoided. if the patients had participated in the screening.”

Additionally, blacks experience a disproportionately high incidence and mortality from colorectal cancer, nearly 40% higher than whites. This is why it is imperative that screening of black patients be a top priority.

“If you have a first-degree relative, like your mother or father, who was diagnosed at a younger age, you should get tested at a younger age,” Dr. Jin said, noting “that he there are also certain types of family conditions”. genetic conditions where you have a lot of polyps, requiring younger and more frequent screening.

“The first degree is more important than the second degree than the third degree. And the more family members you have who have colon cancer, the higher your risk,” Dr. Park said. “If there appears to be a family history pattern, then genetic counseling should be considered to determine if you should be screened for an inherited mutation that may explain why it seems so common in your family line.”

“Inflammatory bowel diseases include ulcerative colitis and Crohn’s disease, two autoimmune diseases that affect the gastrointestinal tract,” Dr. Jin said. “Ulcerative colitis in particular has been associated with an increased risk of colon cancer.”

“These patients with inflammatory bowel disease are treated differently when it comes to screening, monitoring and evaluation,” Dr. Park said. “Patients with inflammatory bowel disease will receive diagnostic colonoscopies,” he added, noting that “they simply get screened by endoscopy to understand the extent and severity of their inflammatory bowel disease. the intestine”.

“But even in their resting state, or considered curative, their history of having such a state requires them to have a different follow-up regimen because their risk is considered higher,” Dr. Park said. “Now, a family history of inflammatory bowel disease does not necessarily confer a change in how one should be screened for colon cancer.”

“For the average American, there are a variety of screening test choices, but the most important thing is just getting screened,” Dr. Park said. “The most invasive, but most thorough, is colonoscopy and if it’s normal then you’re good for 10 years.”

“The best preferred test is colonoscopy. It’s the most accurate test that will give you the most accurate information,” Dr. Jin said. “It’s also the most invasive test because it requires preparation where you have to drink a liquid – a laxative – which cleans your entire gastrointestinal tract.

“You do that by starting the day before and that’s really the part patients don’t like,” she added.

“It’s not a painful experience, but… you have to be home. You have to be near the toilet and you will clearly be running to the toilet a lot,” Dr Park said. “But it’s intentional because you’re trying to extricate yourself and, of course, it’s an uncomfortable experience.”

“There are ways to gamify it or make it more tolerable. A colleague of mine likes to chill the prep drink, put it in his beer glass, sit down and watch his favorite movie,” he said, noting that “sipping it like a beer helped him try to normalize the situation.

“The simplest or least invasive would be stool tests and they can be done every one to three years, depending on which test you choose,” Dr. Park said.

These tests “look for abnormal DNA that could reflect any cancerous cell,” Dr. Jin said.

“But the problem with that one is that there is a high rate of false positives. Then with a positive test you still have to have a colonoscopy as the next step,” she added.

“At the end of the day, any test that patients are willing to do is better than nothing,” Dr. Jin said.

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“On the day of a colonoscopy, you’re sedated, so you’re out for most of it,” Dr. Jin said. “What I hear from patients is that they don’t care that day. In fact, I had a patient who said it was the best nap he had ever had.

“People react differently to the sedatives they receive, but that’s usually the easiest part of the process,” she said. But what is important to note is that “afterwards, you need someone to take you home”.

“You should be fine later today, though. You just shouldn’t drive right after,” Dr. Jin said.

“The biggest tragedy is that patients develop colon cancer when it could have been detected earlier,” Dr Park said. “Sometimes the most motivating factor that I find helpful is, especially for parents with kids, that it’s easy to say, ‘Don’t do it for yourself, do it for your kids.’

“It’s a little harder to convince people who aren’t married or who are single because they say they can live with their own lives,” he added. “But you can make the point: do it for your friends and family too, because you’ll help them not have to take care of you.”

“If you have symptoms of abdominal pain, bloating, changes in stool, blood in the stool, or bleeding that you see in the toilet, talk to your doctor,” Dr. Jin said. “It would be more a case of diagnostic colonoscopy than screening.”

“Any symptom-based concerns should always be addressed separately,” she said, emphasizing that “you should always talk to your doctor.”

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