Screening may seem like a mild inconvenience, but believe me, cancer treatment is a greater inconvenience.
Gabriel A. Brooks, MDColorectal cancer is still the second most common cause of cancer deaths in the United States. However, this doesn’t have to be the case. Screening tests such as colonoscopy can identify and remove polyps (growths on the colon’s lining, some of which can become cancerous over time).
“The whole idea behind colonoscopy is to interrupt the polyp-to-cancer sequence,” says Lynn F. Butterly, MD, Gastroenterology and Hepatology, Dartmouth Health. “In other words, if you have a polyp, over 10 to 15 years it might develop into colorectal cancer. We're trying to interrupt that process by finding the polyp before it has a chance to become a cancer—and removing it.”
In this month’s Thriving Thursday webinar, sponsored by Dartmouth Cancer Center and the American Cancer Society, Butterly joins Gabriel A. Brooks, MD, medical oncologist in the Gastrointestinal Oncology Program, to share information and updates on preventative screening and treatment for colorectal cancer.
Screening test options
For individuals who are at average risk for colorectal cancer, there are several ways to screen for it, including at-home test kits that can be mailed back to a lab or provider’s office. These stool tests include fecal occult blood tests (FOBTs, such as FIT) and multi-target stool DNA (Cologuard).
- Fecal occult blood tests look for and identify blood hidden in stool. If the test shows a positive result, a colonoscopy is necessary to complete the screening. If the FOBT result is negative, it should be retaken in 1 year.
- Cologuard is an at-home stool DNA test that’s more sensitive than FOBTs according to a large comparison study. While more expensive than FIT, Cologuard is covered by most insurances and doesn’t need to be repeated for 3 years if results are negative.
- Colonoscopy is a procedure that allows for polyps to be found and painlessly removed during the test. Removal prevents a polyp from being able to develop into cancer. If cancer is already present, finding it early allows for better treatment outcomes. At least 40% of patients are found to have polyps.
When to screen
In 2018, the American Cancer Society changed its recommendation to start colorectal screenings earlier: at age 45 instead of 50 for people at average risk. Data from the New Hampshire Colonoscopy Registry supports this recommendation. If results are normal and the patient is at average risk, the test is repeated in 10 years. When polyps are found, or if there is a significant family history of colorectal cancer or polyps, a colonoscopy is repeated sooner depending on the patient’s individual results and risk factors.
People with a family history of polyps or colorectal cancer are at an increased risk. They should be screened by colonoscopy starting at age 40 or 10 years earlier than the family member’s age at diagnosis of colorectal cancer—whichever comes first.
Treatments today and looking ahead
Most people with colorectal cancer are diagnosed from biopsies resulting from a colonoscopy. There are three main treatment approaches to colorectal cancer: surgery, chemotherapy and radiation. Brooks explains that for patients with stage 1 or average risk stage 2 colon cancer, surgery is usually the only required treatment. Stage 3 colon cancer or higher risk stage 2 patients typically have surgery followed by chemotherapy to reduce the chance of cancer returning. Radiation is used mostly for the treatment of rectal cancer, often as the first treatment.
Dartmouth Cancer Center is leading several clinical trials to determine the best treatment for different types and stages of colorectal cancer. Two of these trials focus on immunotherapy and new technology that monitors DNA circulating in the blood, called circulating tumor DNA.
“Colon cancer and rectal cancer are, in many cases, treatable, but they are also preventable,” Brooks says. “Even though screening may seem like a mild inconvenience, believe me, cancer treatment is a greater inconvenience.”
To learn more about colorectal cancer screening and treatment, view the full Thriving Thursday webinar featuring Butterly and Brooks on the Dartmouth Health YouTube channel.