Sunday, March 31, 2024

Colon cancer - find it early!

Cancer of the colon and rectum is very common. Colorectal cancer will occur in over 150,000 Americans this year. It is the third-leading cause of death in men and the 4th in women. Because it is an “equal opportunity” scourge, it is the second-leading cause of death when combining men and women (just behind lung cancer).

Very troubling is the increasing incidence in younger people, a phenomenon that doctors cannot yet explain. We used to think that it was very rare in people under 50 unless you had an uncommon genetic risk, but colorectal cancer is being increasingly diagnosed in people in their 40’s or even 30’s.

When caught early, it is very curable. The secret is early detection.

The controversy is how best to detect it early and when to start looking.

Most cancers begin as polyps, some of which slowly develop into cancer. The hallmark of such pre-cancerous polyps is “atypia,” which can only be proven with microscopic examination. If all polyps are removed, the likelihood of ever developing cancer is minimal.

Clearly the ‘gold standard’ of early curable cancer detection is colonoscopy. After a good clean-out, allowing the gastroenterologist to see well, any polyps present can be removed and sent for examination. Ideally, everyone over 40 should have a colonoscopy (5 years ago I would have said over 50). If it is entirely normal, your next one can be in 8-10 years. If polyps are removed, that timetable will be shortened.

The problem is that no one LIKES having a colonoscopy. It is really not that bad. When you finish this post, Google “Dave Barry colonoscopy.”

No matter how much I or your primary care doctor urge it, not everyone will consent. There are other ways to detect colorectal cancer before symptoms develop, when it is often advanced.

The commonest test is to check for hidden bleeding in the bowel, which can herald polyps. Of the available tests for this, the current standard is the FIT (fecal immunochemical test), which has only about a 25% predictive value for cancer and advanced polyps when positive. A negative test does NOT guarantee you are in the clear, and to be useful the test must be done annually.

Another option is a stool DNA test, which is much more specific for advanced polyps and early cancers. On the horizon are blood tests that are fairly accurate.

Key to properly using any stool or blood test is to follow a positive test with a colonoscopy – sadly only half of people with such positive tests get one in a timely manner.

Buck up – listen to Dave Barry and just do it. The life you save will be your own.

Prescription for Bankruptcy. Buy the book on Amazon

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