Dr. Charles Casale: Colorectal Cancer Awareness

March is Colorectal Cancer Awareness Month.  This month your healthcare providers are broadcasting the news that Colorectal Cancer can be prevented or cured if found early. Why is this important for you? Because you are at risk of developing and dying from this frequent cancer. We are all at risk, not just those with family histories or signs and symptoms of colon cancer.  If not prevented, one in 20 of us will develop colon cancer. In round numbers, approximately 135,000 Americans will be found to have colon cancer per year, while 50,000 per year will die from colon cancer. That's greater than the number of people that die in car accidents! The second leading cause of cancer death can be prevented.

One of the keys to screening (looking when there are no signs or symptoms) is to understand your personal risk rather than the overall risk of the greater population. This is the new paradigm in healthcare, "personalized medicine", meaning what specifically pertains to your personal health, not the other guy.

Fortunately, or unfortunately, this effects real people close to home.

Jeremy is a professor at Hartwick College, he knew it was time to get screened just because of his age of 46.  Lucky for him, a large but benign precancerous polyp was removed safely and completely at our Bassett Oneonta Specialty Services. Here is what he had to say about his experience, "I teach issues in the ethics of healthcare and just had my first colonoscopy. I had what I expected are normal anxieties about the screening.  Undergoing any procedure can make one feel a little vulnerable. It can be difficult to be the object of medical attention, but I couldn't have asked for better treatment. The entire OSS team was great at every step: answering my questions, making sure I understood what was happening and why.  I felt like I was in good hands; I didn't feel vulnerable at all- and that's saying a lot when you're wearing a gown with an open back. The procedure was straightforward, the medical staff was outstanding, and I was ready to return to life after a little rest."

Another gentleman I had just spoken to yesterday, named Phil, wishes he had followed his doctor's advice to get screened. He postponed his referral and a year later they discovered advanced colon cancer that had already spread to his liver. He wishes he had listened like Jeremy did, and avoided all the misery and the shortened life he now faces.

So what is your "personal risk" to develop colon cancer and what can you do to prevent it?

Average risk is everyone age 45 and above. 1/20, or 5%, of men and women equally will get colon cancer if not prevented.  Increased risk means you have a predilection such as a family history in a first degree relative with colon polyps, cancer or a rare hereditary cancer syndrome. 

The screening tests available are a colonoscopy and stool testing colonoscopy, which are the gold standards to prevent colon cancer by finding and removing precancerous polyps at one time. If you have a normal high quality colonoscopy, by a high quality Endoscopist, then you are good to go for 10 years. No other test should be done in the interim. The Fecal Immunochemical Test (FIT) and the DNA-occult blood test (Cologuard) can find colon cancer and less reliably precancerous polyps and must be done yearly, or every three years respectively. These tests are only for patients at average risk for colon cancer. So, if you have a personal history of colon polyps, a family history of polyp or colon cancer, a gene for hereditary colon cancer, Crohn's Disease, or Ulcerative Colitis then you are at an increased risk and these two tests are not appropriate for you - colonoscopy is the best and only approved test.

Bottom line is get tested and rest assured you are good to go!

Charles Casale, MD, FACG is Chief of Gastroenterology at Bassett Medical Center