A Colonoscopy Saved My Life: It Could Save Yours, Too.
People intellectualize their way out of a colonoscopy saying, ‘I’m too busy, I don’t want to do the prep, I’m scared of complications,’ none of these things should prevent you from having a test that can save your life.Stefan Holubar, MD, MS
Colon cancer is the number two cause of cancer deaths in the U.S.; but, it doesn't have to be. Screening tests can prevent this cancer, or find it early, when treatment works best. No one knows that better than Dartmouth-Hitchcock (D-H) Colon and Rectal Surgeon Stefan Holubar, MD, MS, who was diagnosed and treated for colon cancer while still in medical school. Cancer-free for 15 years, Dr. Holubar uses every opportunity to spread awareness about the importance of colonoscopies, especially in March during National Colorectal Cancer Awareness Month.
A Gift to Yourself
Regular screening, beginning at age 50 for people without a family history, is the key to preventing colorectal cancer, according to the Centers for Disease Control and Prevention. "I love it when I hear my patients say, 'the best thing I did was give myself a screening colonoscopy for my 50th birthday.' It's true," Dr. Holubar says. There is a 30-40 percent chance of finding a polyp (a small growth of tissue that could potentially be precancerous) when you have your screening colonoscopy, according to Dr. Holubar. The size and type of polyps found, together with your personal risk, will determine the scheduling of your next screening (often 5 or ten years later). This is because some colon polyps can turn into cancer over a period of several years; and colon cancer is typically, but not always, slow growing. "It takes about seven to ten years to go from a single cancer cell to a one centimeter cancer," he says. Removing pre-cancerous polyps during a colonoscopy can prevent colorectal cancer. It is extremely rare for a cancer to be found during a screening for an average risk person that is done at the recommended age. However, if a cancer is found, treatment is much more effective for colorectal cancers that are found early.
More than One Test
"With early detection the survival rate for colon cancer is excellent," Dr. Holubar says. That's why regular screening is so important. For people at average risk (no personal history of polyps or colorectal cancer (CRC), and no close relatives with CRC, there are several options when it comes to screening methods:
- Fecal Occult Blood Test (FOBT) - Annual test to check for hidden blood in three consecutive stool samples (a possible sign of colon cancer).
- Fecal Immunochemical Test (FIT) - A newer test, done annually, that uses antibodies to detect blood in the stool.
- Flexible Sigmoidoscopy - Doctor looks for polyps in the rectum and lower quarter of the colon. Generally done every five years.
- Colonoscopy - Internal walls of the entire colon (large intestine) and rectum are examined through a flexible, lighted instrument called a colonoscope. Generally done every 10 years if no polyps are found.
New Test on the Horizon
An at-home, screening test called Cologuard, was recently approved by the Food and Drug Administration (FDA). The test is based on a stool sample which is analyzed at the Mayo Clinic for cancer DNA in the stool. While these less invasive tests are becoming more accurate, "colonoscopy is still considered the 'gold standard,'" Dr. Holubar says, "and unlike these other tests if you find a polyp you can remove it at the same time."
The procedure itself is easy for most people; click here for a video with Dr. Lynn Butterly on tips and tricks to make the prep easier.
Colorectal cancer is generally not a young person's disease, but underestimating the incidence of the disease can lead to missed diagnoses. "A couple of times a year we see a younger person, meaning well-under 50 years old, who has had rectal bleeding for one or two years and everyone thought it was hemorrhoids, but it turns out it was colorectal cancer. If you're treated for presumptive hemorrhoids and you've made all the dietary and lifestyle modifications to treat it and you're still bleeding a year later, that could be a problem," says Holubar. Colon cancer is called a 'silent killer'— because by the time symptoms develop, it can often be too late. Check with your doctor if you're experiencing any of these early warning signs:
- Rectal bleeding (bright red or maroon colored stools)
- A change in bowel habits (size, shape or quality changes)
- Abdominal and pelvic pain
- Fatigue (caused by bleeding tumors that can result in iron deficiency and anemia)
- Unexplained weight loss
There are things you can do now that can help lower your risk for colorectal cancer:
- Consume fiber and water: Eat a high-fiber diet and drink lots of water throughout the day.
- Exercise: It increases blood flow and oxygen that supports healthy digestion.
- Maintain a healthy weight: Obesity has been linked to colon cancer risk.
- Don't smoke: Smokers are more likely to develop colon and other cancers.
- Limit intake of red and processed meats: Processed and smoked meats are high in sodium nitrates which are linked to a higher cancer risk.
- Limit alcohol consumption: Heavy drinking increases your cancer risk.
Most Important of all: Get Screened
"People often intellectualize their way out of a colonoscopy," says Dr. Holubar. "They'll say, 'I'm too busy, I don't want to do the prep, I'm scared of complications.'" None of these things should prevent you from having a test that can save your life. It's very disheartening to see an otherwise healthy 70-year-old come in with a relatively advanced colon cancer which could have been prevented by a simple screening colonoscopy.
If you are uninsured and may have difficulty with the cost of a colonoscopy, please call the NH Colorectal Cancer Screening Program (NHCRCSP) at 603-653-3702 to see if you are eligible for a free screening.
The benefits and risks of screening methods vary. Talk to your doctor about which test is best for you. For more information about colorectal cancer screening services at Dartmouth-Hitchcock please visit http://www.dartmouth-hitchcock.org/colorectal.html