Dear Doc: I am 45-years-old and today I saw my gynecologist for my annual exam. I was surprised when he referred me for a colonoscopy. My father is a survivor of colon cancer but I thought I didn’t need a colonoscopy until I was 50. Do I need to get a colonoscopy now and are there any other options for screening for colon cancer?
According to the American Cancer Society, more than 49,000 people will die of colon cancer in 2016. While we are far from solving the problem of colon cancer, the mortality rate from colon cancer has declined an astounding 49 percent between the years of 1976 to 2012 and it continues to decline. This is largely due to the advances in screening and early detection of colon cancer. Colon cancer screening starts at the age of 50 for people with an average risk of colon cancer. Having family members with a history of colon cancer, a personal history of inflammatory bowel disease, and Type 2 Diabetes are some of the risk factors for colon cancer. People with a higher risk of colon cancer are advised to start screening earlier.
According to my colleague from Rochester Regional Health, Gastroenterologist Jason Gutman, MD, “In general, a patient with a first degree relative with colon cancer before the age of 60 should start routine screening with a colonoscopy at age 40 or ten years before the age the cancer was diagnosed in the affective relative, whichever is earlier.”
I asked Dr. Gutman if there are any specific concerns for women in relationship to colon cancer. “Colorectal cancer is the third most common cancer and cancer causing death in women, behind both lung cancer and breast cancer. There are no differences between screening guidelines for men and women. All women should undergo colonoscopy or some form of screening starting at age 50, and then routinely until the age of 75. After the age of 75, you should discuss with your primary care provider to determine if colonoscopy or other screening is still right for you,” he said.
While there are no specific guidelines for colon cancer screening for women we do know that women with a strong family history of colon cancer may benefit from genetic screening. Lynch Syndrome is a genetic condition that puts a woman at risk for colon cancer along with certain gynecological cancers such uterine and ovarian cancer. Many patients with colon cancer often do not have symptoms until the disease has progressed to an advanced stage. They may look and feel well during the early stages of cancer. As the disease progresses, the most common symptoms are a narrowing of bowel movements or ‘pencil stools,’ rectal bleeding or blood in the stool, abdominal cramping, unexplained weight loss and fatigue. You should alert your primary care doctor if you are experiencing any of these symptoms.
The purpose of screening for colon cancer is to detect and remove precancerous polyps from the colon. This allows us to stop colon cancer before it even starts! Screening can also detect early stage cancer. If colon cancer is found at an early stage it is highly curable with five year survival rates of 90 percent. Unfortunately, if it is found at an advanced stage, the five year survival rate decreases to as low as 13 percent.
The preferred screening test for colon cancer is a colonoscopy. This test allows the gastroenterologist to remove polyps or biopsy any abnormal findings at the time of the test. The doctor is also able to evaluate the entire colon. There are some acceptable alternatives to colonoscopy. These include yearly stool sampling checking for blood, a flexible sigmoidoscopy every five years, CT colonography, or a double contrast barium enema every five years. You should discuss these options with your primary care physician or gynecologist to decide on the best screening option for you.
I asked Dr. Gutman how we can lower our own personal risk of colon cancer and he said, “I recommend healthy habits which includes maintaining a healthy body weight, regular exercise, tobacco and alcohol avoidance, limiting red meat in your diet, and consuming ample fruits and vegetables. Most importantly it is about completing your screening tests at the appropriate time so that polyps can be removed to prevent future colon cancer and to discover colon cancer earlier if present to allow for better treatment outcomes.”
The Cancer Services Program of Wayne County makes it easy to get screened by offering free cancer screenings for uninsured or under-insured men and women 50 and older. Call (315) 332-2255 for more information or to get screened.
Tara Gellasch, MD, is the Chief of Obstetrics and Gynecology at Newark-Wayne Community Hospital (NWCH) and sees patients at The Women’s Center at NWCH, a Rochester General Medical Group practice. Dr. Gellasch earned her Medical Doctorate from McGill University in Montreal, Quebec and completed her residency in Obstetrics and Gynecology at Emory University. This column is meant to be educational and not intended to be used to make individual treatment decisions. Prior to starting or stopping any treatment, please confer with your own health care provider. To send questions on women’s health, please email Dr. Tara Gellasch’ s assistant, Monica Decory at Monica.Decory@rochesterregional.org and write “Ask a Doc” in the subject line. The Women’s Center at NWCH is located at 1250 Driving Park Avenue, Newark. Call (315) 332-2427 to schedule an appointment.