Editor’s note: The following is part of the Active Life special section.
Vince Lombardi was one of the toughest, most successful and most revered football coaches of all time. Most people don’t know that he died of colon cancer. According to his biography, he ignored his physician’s advice to have a screening colonoscopy on multiple occasions. When he finally became symptomatic, his disease was too far advanced and he succumbed to a preventable disease.
The fact is, colon cancer is the second leading cause of cancer deaths (behind lung cancer) in the United States today. Approximately 150,000 new cases will be diagnosed this year in the U.S. and about one- third of them will prove fatal.
To put these numbers into perspective, colon cancer will kill roughly the same number of people each year as the number of U.S. soldiers killed in the Vietnam War.
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The good news is that screening reduces the risk of colon cancer.
Since 1990, more people have embraced the advantages of screening and the rate of colon cancer has actually begun to decrease. On Jan. 1, 1998, Medicare began to cover the cost of preventative colon cancer screening. Subsequently, a report by the PA Legislative Budget and Finance Committee confirmed that colon cancer screening is cost-effective. Now, most health insurance companies in the state pay for colon cancer screening, helping to remove a barrier to preventative care.
There are several methods to screen for colon cancer.
▪ Annual blood test and sigmoidoscopy every five years: The blood testing detects blood in the stool that is not visible to the naked eye. A sigmoidoscopy involves passage of a flexible tube through the rectum and lower third of the colon or large intestine. It is usually done in five minutes without sedation following a limited bowel cleansing.
▪ Colonoscopy every 10 years: A flexible tube is passed throughout the entire colon or large intestine for 15 to 30 minutes with sedation following a thorough bowel cleansing. This allows for polyp removal or biopsy at the time of the exam.
▪ Double contrast barium enema every 5 to 10 years: X-rays are taken of the colon after instilling air and contrast material through a tube in the rectum. This takes 15 to 30 minutes without sedation after a thorough bowel cleansing.
▪ CT colonography: An X-ray of the intestine requiring specialized computer software and a thorough bowel cleansing.
▪ Stool DNA test: This is a newly FDA-approved test in which sloughed cells in the feces are analyzed for tumor markers. It is listed as 92 percent sensitive and 87 percent specific for detecting colon cancers.
Each has its advantages and disadvantages, but colonoscopy remains the only test that evaluates the entire colon and allows for removal of polyps at the time of the procedure, while avoiding X-ray exposure. Consequently, it remains the gold standard and most commonly used form of screening.
The American Cancer Society recommends both men and women begin screening at age 50 for Caucasians and 45 for African-Americans. Those without risk factors should have a colonoscopy once every 10 years. Conditions that are known to increase risk may require more frequent or more aggressive testing. These include:
▪ Personal or family history of colon cancer or polyps
▪ Familial adenomatous polyposis syndrome
▪ Hereditary non-polyposis colon cancer syndrome
▪ Ulcerative colitis/Crohn’s disease
Colon cancer begins as a polyp, so colonoscopy offers both prevention (by removing polyps) and early detection, which leads to improved survival. If a colon cancer is detected before symptoms appear, the five-year survival rate is 71 percent. If found after symptoms develop, the survival drops to 49 percent in five years.
Typical symptoms of colon cancer include abdominal pain, change in bowels, rectal bleeding, iron deficiency anemia and weight loss. Unfortunately, the majority of colon cancers are still diagnosed after the onset of symptoms.
Typically, treatment of colon cancer begins with removing the tumor, either endoscopically or surgically. During the procedure, doctors determine if it has spread to the lymph nodes or any other tissue and determine the stage. The stage will determine what additional treatment, if any, is required. If the tumor is removed completely, no further treatment is needed except for follow-up visits. However, some circumstances warrant radiation, chemotherapy or both.
The lifetime risk for getting colon cancer is about 6 percent. One misconception is that colon cancer is no longer a concern after a certain age. Though screenings start at age 50, colon cancer risk increases over time; it never plateaus and it never goes down; it continues to rise with age. The decision to continue screening is an individual one to be made with one’s physician. In general, the benefit of screening is lost when the life expectancy is less than 10 years.
Seventy to 75 percent of colon cancers are sporadic, meaning there are no identifiable risk factors or family history. Most cancers found early enough to potentially cure often produce no symptoms; therefore, everyone should be screened. Almost 35,000 lives could be saved each year. You could be one of them. What better way to convey to your loved ones that you want to be around for them than to have a test to prevent this disease.
For more information on Penn State Hershey gastroenterology services or to schedule your next colonoscopy, call Penn State Hershey Medical Group-Colonnade at 272-4445.
Joel Haight, M.D., is the medical director of Penn State Hershey Endoscopy Center in State College and serves as assistant professor of gastroenterology and hepatology with Penn State College of Medicine. Haight has been serving patients in the central Pennsylvania area for nearly three decades.