Precautionary Colon Cancer Screening Can Save Your Life

Posted on Wed., Dec. 12, 2007
By Dr. Paul Reif

"DO I REALLY need to get a colonoscopy?" my patient asked with a grimace. Bob (not his real name) had recently turned 50, the recommended age to start checking most people for colon cancer.

"It could save your life," I told him, explaining that colonoscopies are one of the best ways to detect early colon cancer, which is the second most common cause of cancer death, after lung cancer, among men, and the third most common, after breast cancer, among women.

Fortunately, colon cancer is preventable and curable through screening, which is the early detection and removal of polyps (small growths that can become cancerous).

Who's at risk?

Colon cancer screening is recommended for everyone over the age of 50, but people with a parent, sibling or child that had colon cancer are at greater risk and should get screened earlier.

Many people with colon cancer won't have abdominal pain or abnormal stools, but some may have bloody stools, diarrhea or constipation, abdominal pain and tenderness, and unexplained weight loss.

What tests are used to screen for colon cancer?

Depending on a person's risk factors, the following colon cancer screening tests may be used (there is no blood test for most types of colon cancer):

Fecal occult blood test (FOBT) - Tests the feces for blood, which can be an indication of polyps or cancer, but also less serious problems. The person puts a small amount of stool inside folding cards, which are then returned to the lab for analysis. If positive for blood, a colonoscopy is needed.
Flexible sigmoidoscopy - A short, flexible lighted tube with a small camera is inserted into the rectum, which allows doctors to see polyps in the lower part of the colon. The patient is awake, and the procedure takes 10-20 minutes.
Colonoscopy - A long, flexible, lighted tube with a small camera allows doctors to check the entire colon for polyps. The patient is sedated, and it takes about 20 minutes.
Barium enema - An x-ray of the large intestine using a chemical enema is inserted into the rectum to show polyps.
Virtual colonoscopy - this new, still unapproved procedure uses CAT scan technology to detect polyps in the colon. Most health insurance won't cover it.

Screening recommendations

Screening intervals and tests vary depending on the person's risk factors:

Most people without a family history of colon cancer or any symptoms are at average risk and should get a colonoscopy every 10 years starting at age 50-55 (if tests are negative) or an annual FOBT screening plus a sigmoidoscopy every five years starting at 50.
People with a family history of colon cancer, should start getting colonoscopies every five years starting at least 10 years before the relative was diagnosed. For example, a person whose brother was diagnosed at 40, should start getting tested at 30.
If polyps are found, after they're removed, a colonoscopy is recommended every two to five years depending on the size of the polyps, family history and results of the follow-up tests.

Though not 100 percent accurate, these tests help detect colon cancer early and save lives. If you are over 50, or younger with a family history of colon cancer, talk to your doctor about getting one of these tests.

Reif is the chief of gastroenterology at Contra Costa Regional Medical Center in Martinez.