By Bill Monahan, Grace Cottage Community Health Team RN Outreach Coordinator
as originally appeared in the Brattleboro Reformer’s Graceful Health series, July 1, 2016
When applied properly, any well-proven equation produces good results. The formula for avoiding colon cancer is relatively easy: Colon Health = Preparation + Screening + Prevention.
Colorectal cancer, often referred to as colon cancer, is the third leading cancer killer among men and women in the United States. Colorectal cancer is largely preventable with regular screenings and curable with early detection.
With screenings being the common denominator, you would think that all Baby Boomers would flock to a primary care provider or a gastroenterologist to complete this step, as a rite of passage for a healthy, mature lifestyle. Colon and rectal cancer screening should be a priority for all of us over fifty years of age, and for younger folks with a family history of colon cancer.
Colorectal cancer screening can be accomplished by several different tests, each requiring varying amounts of preparation. Colonoscopies require by far the greatest preparation, and so some patients prefer to start with an easier test. There are several options.
One well-proven, reliable, and fairly easy colorectal cancer screening test that can be performed as a precursor to colonoscopy is the fecal occult (hidden) blood test (FOBT), which tests for blood in the stool, an indicator of problems in the large intestine. The test can be performed at home and requires little preparation beyond a few diet and medication restrictions. The FOBT has been credited with a 30% reduction in colon cancer deaths.
There are two other tests that can be done at home. One of these, the fecal immunochemical test (FIT), has been proven to be more accurate with less false positives than the FOBT. The third home test, the Stool DNA test, is a relatively new, FDA-approved test that looks for cancerous cells and blood in the stool. This particular test has some limitations and is used in the “average” screening patient, someone with no known risk factors.
Any of these three home tests would be ordered by your primary care provider, and test results should lead to a discussion about further testing, which could include a full colonoscopy. None of these tests requires much advance preparation.
The “preparation” component of the equation moves our discussion to other tests that require more extensive preparation than the home tests.
One exam that has a long history in colorectal cancer detection is the Flexible Sigmoidoscopy. An expansive 20-year study published in 2012 has shown that this test can reduce colorectal cancer deaths by to 26%. Sigmoidoscopy may be performed in the doctor’s office, or provided by a gastroenterologist, a doctor who specializes in in the structure, functions, disorders, and diseases of the digestive organs.
Sigmoidoscopy takes about 15 minutes, sometimes more, and sedation is not generally required. Preparation for this test is similar to that for a colonoscopy. The test involves examination of the lower two feet of the colon with a lighted flexible scope by which the doctor can directly visualize the lining of the rectum and the colon. The equipment can take tissue samples for biopsy and can remove polys.
Removing polyps is the “prevention” part of the equation. The two most common types of polyps found in the colon and rectum include hyperplastic/inflammatory polyps and adenomatous polyps (adenomas). Inflammatory polyps do sometimes transform into cancer. Undetected adenomas often transform into colon cancer and are considered precancerous. Early detection is the key to curing colorectal cancers.
While the preceding tests are useful in certain cases, colonoscopy is still the gold standard in colorectal cancer screening because the gastroenterologist can see not just the final two feet, but the entire length of the colon. The instrument used can also remove and biopsy any suspicious areas. The commitment, of course, is the 24-hour preparation and the sedation required during the exam, but these are well worth it for the peace of mind this test provides.
If you are over fifty or have a family history of colon cancer, be on the lookout for some prodding from your primary care provider in the form of a letter or a call. The missing element of the metaphorical colon health equation as it is stated above, of course, is you.
Bill Monahan is one of Grace Cottage’s Community Health Team RN Outreach Coordinators. Bill received his AA in Liberal Studies from Berkshire Community College, his AS in Nursing from Greenfield Community College, and his BA in Health Advocacy from UMass Amherst.
