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Every Adult Over 50 Should Get A Colonoscopy

Every Adult Over 50 Should Get A Colonoscopy

He died 31 years ago this month, and I miss him still. Gone at the age of 57, my father left us much too soon.

He didn’t get to meet his granddaughters — one now an adolescent, the other a kindergartner — or indulge their whims. He didn’t get to take them fishing or show them how to stake tomato plants. He never heard them recite their poems at annual church Easter pageants.

Among his own children, he missed college graduations, weddings and professional accolades. He died before his only son finished medical school and his youngest daughter passed the national exam to become a certified architect. He didn’t live to see his four children grow into a productive adulthood aided by many of the lessons he worked so hard to impart.

I so wish we had known decades ago what we know now: Every adult over the age of 50 should be screened for colorectal cancer. Diagnosed and treated early, it has one of the highest survival rates among that collection of malignant maladies we call “cancer.” My dad was otherwise quite healthy and might have lived to a ripe old age.

March is National Colorectal Cancer Awareness Month, when health care advocates labor to spread a simple message: Get screened for colorectal cancer. Research shows that the colonoscopy, considered the gold standard, is very reliable — unlike, say, mammograms, which have a significant rate of false positives.

But there are still too many adults who skip the screenings, either unaware of their importance or uncomfortable with the procedure. That’s a mistake.

Colorectal cancer hasn’t had the wildly successful publicity campaign that has brought so much attention to breast cancer. Advocacy around that disease has taken on the trappings of a cult — with pink ribbons dotting the landscape, fundraisers marketed to men, women and children, and research dollars allotted disproportionately.

Colorectal cancer doesn’t even have the profile now enjoyed by prostate cancer, which has attracted a coterie of activists who’ve taken up the job of educating men about the risks. As a result, prostate cancer screenings are held at churches, barber shops and fraternity gatherings, a boon to middle-aged men who might otherwise skip going to the doctor’s office.

That approach has been especially helpful among black men, who tend to contract prostate cancer at higher rates than men of other ethnic groups, according to the Centers for Disease Control and Prevention. Indeed, the ubiquitous screenings may explain why the gap in the survival rate between black men and their white and Latino counterparts has narrowed ever so slightly.

So why doesn’t colorectal cancer get the attention it deserves? Among cancers that affect both men and women, it is the second-leading cause of cancer-related deaths in this country. But it affects parts of the body — the rectum and the colon — that are decidedly unglamorous and, for many, unmentionable.

Then there’s the screening procedure itself. The colonoscopy (again, there are other screening methods, but this is considered the gold standard) is an invasive procedure, and some people find it uncomfortable. The preparation, which involves taking large doses of a bad-tasting laxative, is worse.

It’s not the sort of thing you’d do without a substantial benefit, and there is one: You’re much less likely to die of colorectal cancer. Nor do most people need annual screenings. Even with a history of colon cancer in my family, I undergo a colonoscopy every three to five years.

Health care advocates have undertaken an aggressive effort to increase screenings. One group, the National Colorectal Cancer Roundtable, has launched an “80 Percent by 2018” campaign, intended to ensure that the vast majority of adults over 50 are screened by then. According to experts, that would save an estimated 200,000 lives over 17 years.

I’m so sorry that campaign wasn’t launched decades ago. My father taught me so much about dying with grace and courage, but I’d much prefer that he had been with us for a lot more years.

Cynthia Tucker won a Pulitzer Prize for commentary in 2007. She can be reached at cynthia@cynthiatucker.com.

Photo: Hospitalman Urian D. Thompson, left, Lt. Cmdr. Eric A. Lavery and registered nurse Steven Cherry review the monitor while Lavery uses a colonoscope on a patient during a colonoscopy at Naval Medical Center San Diego. (U.S. Navy photo by Mass Communication Specialist 2nd Class Chad A. Bascom/Released)

An Alternative To The Colonoscopy — Though It Has Its Own ‘Ick’ Factor

An Alternative To The Colonoscopy — Though It Has Its Own ‘Ick’ Factor

By Jeremy Olson, Star Tribune (Minneapolis)

MINNEAPOLIS — A new test that requires people to send stool samples in the mail for laboratory analysis is proving nearly as reliable as a colonoscopy in identifying potentially fatal colon cancers.

The DNA screening test, invented at the Mayo Clinic, could become an alternative to the colonoscopy — or at least an option for the millions of Americans who ignore their doctors’ recommendations because they are squeamish about the rectal exam or concerned about its cost, said Dr. David Ahlquist, a Mayo gastroenterologist and co-inventor of the “Cologuard” system.

The test was 92 percent accurate at identifying patients with colon cancer and 69 percent accurate at identifying patients with the kinds of bowel lesions or polyps that indicate a high risk for cancer, according to clinical trial results published Wednesday in the New England Journal of Medicine.

“Time will tell,” Ahlquist said. “It’s our hope that many individuals who are not being screened because of their reticence to undergo colonoscopy will choose to undergo screening with a noninvasive option like this.”

Regular screening for colon cancer is recommended at age 50 — earlier for people with family histories or greater risks — and was credited in a report Monday by the American Cancer Society for a decline over the past decade in the U.S. rate of colon cancer mortality.

But the lack of uptake is also why colon cancer remains the third-leading cause of cancer mortality, and contributes to 50,000 deaths in the nation each year.

The DNA test comes with its own “eww!” factor, in that people would need to fish out their own stool samples and package them to send in for testing. But market research by the test kit manufacturer, Exact Sciences of Madison, Wisconsin, indicates that people aren’t bothered as long as the test is effective and covered by health insurance. Surveys showed only 3 percent of people being put off by having to collect a stool sample.

“Our kit comes in its own sturdy box … and the patient also uses it to return the sample to the lab,” said Exact Sciences spokeswoman Cara Tucker. Test results would be sent to doctors in about two weeks.

The findings published Wednesday come from a company-funded clinical trial of 10,023 people who were at normal risk for colon cancer. They come about two weeks before a U.S. Food and Drug Administration committee is scheduled to decide whether the test is safe and effective for clinical use. In an unusual step, the U.S. Centers for Medicare and Medicaid Services are reviewing the test before the FDA review is complete — an indication that the federal agency might expedite Medicare coverage of the test for the nation’s elderly population.
Federal approval could mean the Cologuard test would be available as early as midsummer.

The study was a head-to-head comparison with an existing test called FIT, which detects cancer by finding hidden blood in stools, and showed that the new DNA screening found more cancers and cancer risks.

Cologuard works because tumors and polyps in the colon “shed” cells that are detectable in human waste, Ahlquist explained. However, the DNA test resulted in some false positives — about one in 10 tests suggested patients had colon cancer or an imminent risk for it, when they didn’t.

In clinical care, patients with positive results from Cologuard would undergo colonoscopies to confirm the results, said Dr. Thomas Imperiale, an Indiana gastroenterologist who was lead author of the study.

False positives do cause stress and anxiety, he said, but in the end they would direct patients to receive colonoscopies that they would have likely received anyway if the DNA test didn’t exist.

The rate of false negatives was low, and would likely be overcome if patients repeated the test over time, he said. Whether the test would be recommended annually, or less frequently, is unclear. The cost remains unclear as well, though it would presumably be cheaper than a colonoscopy that requires a visit to a specialty clinic or hospital.

Dr. Cathleen Clouse, a HealthEast family practice doctor in Maplewood, Minn., said she would welcome a new alternative for the many patients who are uneasy about colonoscopies or dislike the voluminous fluids they must consume in advance to clean out their bowels.

Two of her patients were referred to specialty clinics for colonoscopies and suffered the rare complication of having their bowels perforated.

“Given the alternative, I think people are going to choose the DNA test,” she said. “You’d be surprised what people are willing to do because they don’t want the colonoscopy.”

Photo: LTD Team via Flickr