Get Well Wednesday: Why You Need A Colonoscopy

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WHAT IS COLORECTAL CANCER?                                                                                                                                                        Colorectal cancer is a cancer that occurs in the colon or rectum. The colon and rectum make up the final part of the gastrointestinal (GI) system, which processes food for energy and rids the body of solid waste (fecal matter or stool). Most colorectal cancers start as a growth on the inner lining of the colon or rectum. These growths are called polyps. Some types of polyps can change into cancer over time (usually 10 years or more), but not all polyps become cancer.

 WHAT’S ONE THING MOST PEOPLE DON’T KNOW ABOUT COLORECTAL CANCER?

Getting screened for colorectal cancer can save your life. People don’t know that colorectal cancer is the third leading cause of cancer-related death in the United States, yet it is preventable. Prevention is within our control.

IS COLORECTAL CANCER PREVENTABLE? IF SO, HOW?

Yes, colorectal cancer is highly preventable. Colorectal cancer can be prevented through screening and lifestyle.

Screening. Screening tests that detect and remove adenomatous polyps are the most reliable method of preventing colorectal cancer. Colonoscopy is the gold standard but there are many other screening methods that are less invasive. Talk to your doctor about which test is right for you—and when you should have it.

 Lifestyle: The food choices we make and how much we move could prevent 50% of cases that occur in the US every year, according to the American Institute for Cancer Research. Strong evidence shows that:

  • being physically active decreases the risk of colorectal cancer
  • consuming whole grains decreases the risk of colorectal cancer
  • consuming foods containing dietary fiber decreases the risk of colorectal cancer
  • consuming dairy products decreases the risk of colorectal cancer
  • taking calcium supplements decreases the risk of colorectal cancer
  • consuming red meat increases the risk of colorectal cancer
  • consuming processed meat increases the risk of colorectal cancer
  • consuming one or more alcoholic drinks per day increases the risk of colorectal cancer

 HOW MIGHT SOMEONE KNOW THAT THEY NEED TO GET CHECKED OUT FOR COLORECTAL CANCER?

 Many of the following symptoms may indicate that you should be checked for colorectal cancer

  • A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days.
  • A feeling that you need to have a bowel movement that is not relieved by doing so
  • Rectal bleeding
  • Dark stools, or blood in the stool
  • Cramping or abdominal (belly) pain
  • Weakness and fatigue
  • Unintended weight loss

HOW DOES IT IMPACT THE BLACK COMMUNITY?

Colorectal cancer dramatically impacts the Black community.

  • An estimated 17,240 cases of colorectal cancer are expected to occur among blacks in 2016. Colorectal cancer is the third most common cancer in both black men and women. Incidence rates (or “new cases”) are higher in black males and females compared to whites (27% and 22%, respectively) (Table 5, page 8).
  • From 2003 to 2012, incidence rates for colorectal cancer decreased by 3.0% per year among black men and by 3.1% per year among black women, compared to 3.3% and 2.9% per year among white men and women, respectively.
  • Prior to 1989, incidence rates were predominantly higher in white men than in black men and were similar for women of both races. Since 1989, however, incidence rates have been higher for blacks than whites in both men and women.
  • This crossover may reflect racial differences in the trends of risk factors for colorectal cancer and/or greater access to and utilization by whites of recommended screening tests that detect and remove precancerous polyps (Cancer Facts and Figures for African-Americans 2016-2018).

WHY DO YOU SUPPOSE THERE IS SO MUCH SENSITIVITY AND SHYNESS AROUND THIS DISEASE?

Studies indicate that people who are fearful and embarrassed about colon cancer screenings were three to 10 times less likely to get screened. People are embarrassed to talk about their recent bowel movements with their doctor or expose their bottom for a colonoscopy. People are ultimately dying of embarrassment.

 WHAT’S THE COLORECTAL CANCER ALLIANCE DOING TO HELP? 

 The mission of Colorectal Cancer Alliance is to end colorectal cancer within our lifetime. Working with our nation of passionate allies, we diligently support the needs of patients and families, caregivers, and survivors; eagerly raise awareness of preventive screening; and continually strive to fund critical research. Our goals are to save 100,000 lives, invest $10 million in critical research, and double the number of patients and families we serve.

The Colorectal Cancer Alliance offers the following resources:

  • Free Helpline: The Colorectal Cancer Alliance is your place to call for help and advice on how to cope with a colorectal cancer diagnosis, treatment, and more. Dial (877) 422-2030.
  • Blue Hope Nation: Blue Hope Nation is a private Facebook community where you can connect with thousands of allies who know exactly what you’re going through.
  • Buddy Program: Our Buddy Program matches volunteers with patients, caregivers, or family members to provide a unique support system. Buddies have first-hand experience with colorectal cancer and can provide hope and encouragement.
  • Clinical Trial Finder: Answer a few questions about your diagnosis, and we’ll tell you about applicable clinical trials.
  • For more information, please visit: http://ccalliance.org/get-support

AT WHAT AGE SHOULD YOU START GETTING CHECKED?

 Because colorectal cancer often doesn’t cause symptoms until it is advanced, the American Cancer Society recommends regular colorectal cancer screening for most people starting at age 50. People with a family history of the disease or who have certain other risk factors should talk with their doctor about beginning screening at a younger age.

Because African-Americans are at in increased risk for developing CRC, recommendations are to initiate screening at the age of 45. Screening tests find polyps so they can be removed before turning into cancer. Screening also helps find colorectal cancer at an early stage, when treatment often leads to a cure.

Christine Molmenti is a cancer epidemiologist and Assistant Professor in the Department of Occupational Medicine, Epidemiology, and Prevention at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

Over the past 15 years, Dr. Molmenti has been integrally involved in the design and conduct of cancer chemoprevention clinical trials and epidemiologic pooling studies specifically focused on colorectal cancer, colorectal polyps/adenomas, and risk factors related to colorectal cancer.

Dr. Molmenti is a member of the Colorectal Cancer Alliance Medical Scientific Advisory Board and Co-Chair of the Colorectal Cancer Alliance Peer-review grants program.

Dr. Malmenti answers your “Text Tom” questions below:

Can coffee cause one to have OAB?

Coffee has been linked to a lower risk of colorectal cancer, regardless of it being caffeinated or not. Regarding the relationship between coffee and overactive bladder (OAB), coffee is a diuretic and stimulant and will trigger an increase in bladder activity and urine production. Please consult your physician to discuss risk factors related to OAB further.

For additional information on the association between coffee and other dietary factors related to colorectal cancer, please visit American Institute for Cancer Research (AICR):

http://blog.aicr.org/2017/09/07/new-colorectal-cancer-report-your-faqs-answered/

http://www.aicr.org/foods-that-fight-cancer/coffee.html

http://www.aicr.org/press/press-releases/2018/coffee-does-not-need-cancer-warning.html

 Hi Tom, I’m 46 years old and just had my first colonoscopy last month. The doctor who performed it said they are asking that black people have their colonoscopy closer to 45 and 46 now rather than 50 years old. Is that right?

Yes, there are guidelines from several professional gastroenterology societies that African-Americans should start screening around age 45 because they have a higher risk of colorectal cancer than whites.

Please see the link to screening information provided by the colorectal cancer alliance below for additional information:

https://www.ccalliance.org/get-screened/

Had first colonoscopy at 50. Now I’m 54. Surgeon removed non-cancerous polyps. How frequently should I have colonoscopy?

It depends on the type of polyp and their size. If they are 1-2 adenomatous polyps and they are small with no worrisome histologic features then a 5-year follow up is typically recommended but if there are 3 or more or if any are large (more than 1 cm) or have worrisome histologic features, the follow-up interval is 3 years.

There are similar guidelines for sessile serrated polyps. If they are very small hyperplastic polyps in the lower colon and rectum only, the recommendation could be for a 10- year follow-up. The recommended follow up interval should either be on the endoscopy report or a recommendation sent to your primary care provider. If not, call the surgeon’s office to find out what the follow up recommendation is.

Can narrowing of stool also be from hemorrhoids?

It can, but narrowing of the stools should be evaluated with a flexible sigmoidoscopy or colonoscopy and not attributed to hemorrhoids without an endoscopic evaluation of the cause.

This is for the doctor. My mom died from colon cancer. My insurance still made me wait until age 50 before they would pay for my colonoscopy. Then, the doctor found 9 polyps and charged me for removal. The insurance said that the polyps changed it from preventive to a procedure.

This is a common problem that some insurers change the code for colonoscopy from screening to a diagnostic procedure if polyps are removed. Many insurers are not changing that policy and I would recommend appealing that decision to your insurer and get help from your endoscopist.

 Is having high amounts of mucus in your stool is that a sign of possible colon cancer?

Typically not. Mucus is a normal secretion from the colon and seeing some mucus on the stool is common. If there is blood, a change in bowel habits or abdominal pain, the symptom complex should be evaluated. If you are over 50, you should have screening and I would recommend colonoscopy, since it will also evaluate causes for excess mucus on the stool.

What about Oscar Mayer now making lunch meat without nitrites and nitrates, the cancer-causing agent? What should we take from that?

It is not clear if the carcinogenic potential of processed meats is totally due to the nitrites and nitrates and it is not clear what Oscar Mayer is using for preservatives in place of nitrites and nitrates. Therefore, it may or may not change the cancer causing potential of processed meats.

However processing may also involve smoking, which leads to formation of cancer-causing compounds called polycyclic aromatic hydrocarbons (PAHs), which may increase colorectal cancer risk.

For more information on red meat consumption and risk of colorectal cancer, please visit AICR at:

FAQ: http://www.aicr.org/reduce-your-cancer-risk/diet/red-and-processed-meat.html

Information from the latest AICR report on colorectal cancer: http://www.aicr.org/cancer-research-update/2017/09_20/cru_processed-meats-increase-colorectal-cancer-risk-new-report.html

Helpful swaps from the AICR blog: http://blog.aicr.org/2015/11/04/tasty-swaps-to-help-you-eat-less-red-and-processed-meats/

 What about constipation?

Constipation is common and it can be a symptom of colorectal cancer but other causes are much more common. If it has been going on for a long time (years) and is intermittent, it is unlikely to be due to colorectal cancer. If, on the other hand, it is of recent onset, is persistent or progressive, it should be evaluated and one of the potential causes could be colorectal cancer.

Are there risk of colon or rectal cancer if you take a lot of laxatives?

There is no known risk of colorectal cancer from taking laxatives. The overlap between laxative use and colorectal cancer risk is that people take laxatives for constipation and recent onset constipation can be a sign of colorectal cancer, but the laxatives don’t cause the cancer.

Why do they not test early? I have a friend that died at 38 because they never checked for cancer. He had symptoms for years and they said it was everything but…then it was too late. What age should they start looking?

Symptoms of rectal bleeding, or recent onset, persistent or progressive change in bowel habits, abdominal pain or unexplained weight loss should be evaluated at any age. Those with a personal or family history of colorectal cancer or large polyps should start screening at age 40 or earlier.

I recommend talking with your provider about your family history of cancer when you start with the practice and again at age 40 and decide what age your screening should begin.

Is colitis a direct indicator of colorectal cancer? Some insurance companies will increase premium if you get this diagnosis.

Inflammatory bowel disease (Ulcerative colitis and Crohn’s disease) are associated with and increase risk of colorectal cancer, but other types of colitis are not known to be a risk for the disease.

For additional information and support, please contact the Colorectal Cancer Alliance:

  • Free Helpline: The Colorectal Cancer Alliance is your place to call for help and advice on how to cope with a colorectal cancer diagnosis, treatment, and more. Dial (877) 422-2030.
  • Blue Hope Nation: Blue Hope Nation is a private Facebook community where you can connect with thousands of allies who know exactly what you’re going through.
  • Buddy Program: Our Buddy Program matches volunteers with patients, caregivers, or family members to provide a unique support system. Buddies have first-hand experience with colorectal cancer and can provide hope and encouragement.
  • Clinical Trial Finder: Answer a few questions about your diagnosis, and we’ll tell you about applicable clinical trials.
  • For more information, please visit: http://ccalliance.org/get-support

The above information has been provided by:

Christine L. Sardo Molmenti, PhD, MPH, RD and Dennis J, Ahnen, MD

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2 thoughts on “Get Well Wednesday: Why You Need A Colonoscopy

  1. Ted Gravely on said:

    Agreed the prep is unpleasant, but this procedure can be a lifesaver. Please get one, stop being hard headed and putting it off.

  2. Preparing for the colonoscopy is the worst.
    Drinking all of that GoLightly stuff and spending the nite on the commode.

    However, it is all worth it if it will keep me from developing Colon Cancer.

    Once, they inject you with the pain meds–it’s like “beam me up Scotty.”
    You are knocked out until the entire procedure is over.

    Thankfully, it is only necessary to have a colonoscopy every five or ten years.

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