November 30, 2013

Colorectal Cancer Screening Numbers Too Low

Are you over the age of 50 years? Have you had colorectal cancer screening? Do you have a history of colorectal cancer in your family? If you answered yes to two of the three questions, then it is time to talk to your doctor about colorectal cancer screening. If you answered yes to all three questions, what are you waiting for, get-r-done. This is serious and needs attention. “Colorectal cancer is the second leading cause of cancer death in men and women in the United States, after lung cancer, yet is "preventable" through screening,” states CDC Director Tom Frieden, MD, MPH.

Current recommendations call for adults aged 50 years and older to be screened with one or a combination of the three following tests:

#1. A fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year

#2. Flexible sigmoidoscopy every 5 years, with FOBT/FIT every 3 years;

#3. Or, colonoscopy every 10 years.

The above are minimums for the average person, but many doctors will look to family history, grandparents, parents, and siblings before recommending any of the tests. I do not think much of #1 above as most times a positive for these tests indicates you may already have colorectal cancer and may need a section of your bowel removed.

Many doctors think #2 above is sufficient for most purposes, but again this is only doing a partial examination of the colon. If the polyps are beyond the scope of this exam, then colorectal cancer will still develop.

While many people do not like colonoscopies, this is the best test and will prevent colon cancer from developing. I can attest to the value of this, as my first colonoscopy was preformed, on a lark, at age 55 and I had four polyps, one that the oncologist stated from his experience was within about six months of being cancerous. This made a believer out of me and I have had colonoscopies regularly since then at generally every three years.

But you say #3 above says every 10 years. That is correct until the first polyp(s) is discovered. Then the polyp(s) is checked for cancer or the types of cells leading up to cancer and if this analysis is positive, you are scheduled for an exam every three years. When the polyp(s) is clean or free of cancer promoting cells, then you will be scheduled for an exam in five years. If after the first polyp(s) are discovered and you are polyp free on the next exam, you will also be scheduled for another exam in five years. This is what Medicare and most insurance companies require.

I would much prefer one or two days of discomfort every three years to know that I do not have colon cancer. “In 2012, 65.1% of US adults were up-to-date with colorectal cancer screening and 27.7% had never been screened.”

According the Dr. Frieden, “The 2012 data show that colonoscopy is now the most commonly used screening test (61.7%), the CDC said. Colonoscopy was used by more than 53% of the population in every state. There has been a "big increase" in colonoscopy screening in recent years. However, use of the other recommended tests was much lower: 10.4% for FOBT and 0.7% for flexible sigmoidoscopy in combination with FOBT/FIT.”

If you are scheduled for a colonoscopy, please be sure to discuss all medications with the doctor. There are blood thinners that need to halted several days, up to a week or more, before the procedure, Metformin needs to be stopped as well, and these should not be restarted until a few days after the procedure. There may be other medications that require this as well; therefore, please discuss this with the doctor.

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