Blue
Cubbie Blue, Dodger Blue, Go Blue!
Blue stands for a lot of things. Blue also stands for Colorectal Cancer Awareness Month, March. First designated by President Clinton in 2000, this month has become as annual renewal of focus and energy on spreading the word and getting more people screened.
“Oh no”, I hear you say, here comes that Gi Doc nagging me to get that awful, invasive, humiliating test done. Well, yes and no. If you’ve been reading my posts so far, you know Papa don’t preach. I believe that if people are given the facts, and understand the facts, they can make an informed decision that’s best for them. Kind of like COVID-19 vaccines, but different. That’s a whole other discussion for another day, on another venue.
So why should you have a screening colonoscopy? Because, and this is very important, colon cancer is largely PREVENTABLE! This is huge. There are very few cancers you can say that about (skin, maybe cervical). Also very important, colon cancer is COMMON! Third most common behind #1 lung and #2 breast and prostate, in women and men respectively. If that doesn’t get your attention, colon cancer is #2 in terms of cancer deaths (also referred to as mortality) behind lung. You probably know someone who either has colon cancer or is related to someone who does.
Quick aside: Sometimes we say colorectal cancer, sometimes just colon cancer. What’s up with that? You probably know this- the rectum is part of the colon, the very bottom 9 inches or so. If a tumor is located in the rectum, we call it rectal cancer. Rectal Ca is handled a little differently in terms of treatment (chemo, radiation, surgery) than colon cancer further up, so to speak. But the biology is similar. Colorectal cancer is thus a more unmitigated label, if not a bit cumbersome.
Is colon cancer really preventable? Absolutely, we do it every day. Colon cancer is preventable because almost all cancers (95%+) begin as small, benign growths called polyps that can be potentially removed during during a colonoscopy. I don’t know how many times I have been asked, “so what causes colon cancer anyhow, Doc?”. It’s really the same question as what causes polyps. No easy answer to that one, I’m afraid. Genetics (abnormal genes) are big, even if you don’t have a family history of colon cancer. “You sho’ can’t choose your family”, right? But also big are lifestyle factors such as obesity, smoking and diet. Think about that for a moment.
Over the past two decades, there have been multiple studies demonstrating how screening colonoscopy has lowered both the incidence and mortality of colon cancer. For real. In the range of 60-80%. That’s really good. It’s not 100%, but nothing is in medicine. Especially something as complex as colorectal cancer.
What’s that? You hear what I’m saying, but you’re still leary of colonoscopy? Are there any alternatives? What about that smiling Cologuard box I see on TV? You know, the one that gets picked up from my doorstep? That sounds a hell of a lot easier.
Yes, there are alternatives. You can do a stool sample test called FIT, that detects trace amounts of blood. This simple test is better at finding actual cancers at an early stage than benign polyps before they turn malignant. Makes sense, no? Cancers are more likely to bleed a little than small polyps. Two negatives: 1) FIT test has to be done yearly, for 10 years, and 2) If your FIT is positive (10-20% are, btw), you will need a colonoscopy anyway.
The other stool test, the smiling box one, detects genetic mutations (DNA) associated with colon cancer. This is a “better” test at finding both cancers and advanced adenomas (polyps) but again, if positive, colonoscopy is still needed. If negative, this test is done every 3 years for average risk patients.
I’m obviously biased in favor of screening colonoscopy; most GI Docs are. It’s what we do. I’ve even had two of them myself 🙂 Screening for any malignancy is both a personal matter and a public health issue. We are talking about millions and millions of people, which means huge cost issues. There is an ongoing national trial of screening c-scope vs FIT test to settle once and for all, which test is better at preventing cancers and deaths. What’s that, you’re surprised this study has not been done already? Well, these are difficult and lengthy studies to perform. Be glad there are people taking the time to look at this and to do it right.
Coupla more points to ponder. The recommended screening age was recently lowered from 50 to 45 years of age for average risk patients (no family history of colon cancer). For not entirely clear reasons (lifestyle?), the incidence of colon cancer in people under 50 years ancient has doubled (yikes!) over the past decade.
People might complain about the cost of colonoscopy, sometimes for a good reason. The Affordable Care Act stipulated ten years ago that screening colonoscopy would be at no charge to the patient. The problem was, if a polyp was found and removed, the procedure code was changed to diagnostic and thus no longer “free”. What a bunch of BS! It took years, but Congress (yes, your Congress, who recently determined we should all be on Daylight Savings Time) finally passed the “Removing Barriers to Colorectal Cancer Screening Act”, which will “phase out” these “surprise” charges. Please don’t blame your colonoscopist for this.
Lastly, if you have a family history of colon cancer, and specifically if you have a first degree relative (parent, sibling, sometimes child) with colorectal cancer before the age of 60, you are considered “increased risk” and your screening colonoscopy should start at age 40 (or 10 years earlier than your relative if they were unfortunately diagnosed before age 50). No stool test for you, my friend.
I could go on and on. Please get screened. Colonoscopy is very safe and the prep isn’t so bad. Actually, it sucks. But you’ve been through worse, and it’s worth it. If you would really, really, really rather do the stool test, well then, OK, I guess. Just do it exactly the way you are told (annually for FIT, every 3 years for fecal DNA). But doesn’t prevention sound good? Better than early detection?
The slogan for Colorectal Cancer Awareness Month is “Preventable. Treatable. Beatable.” Get screened!