March is National Colorectal Cancer Awareness Month. According to the National Institutes of Health National Cancer institute, colorectal cancer, or CRC, is the third-leading cancer and second-leading cause of cancer-related mortality in the United States, despite a drop in incidence over the past decade.
During this time, colorectal cancer incidence and mortality rates have decreased in all racial/ethnic populations, with the exception of American Indians/Alaska Natives. Men and women have similar incidence rates through age 39; at and above age 40, rates are higher in men.
Preventive screening has been attributed to the decrease in mortality. What's the difference between preventive screening and cancer detection screening and when should you have them done?
Preventive screening most commonly refers to the commonly dreaded colonoscopy, although there are less recommended options. The procedure — which takes less than 30 minutes — saves lives, and according to the CDC, as many as 60 percent of deaths linked to colon cancer could be avoided by such regular screening.
The recommended age at which to begin colonoscopy screening is 50 years old, with African Americans being advised to start at age 45. High-risk individuals should also begin screening at an earlier age. This includes those with a first-degree relative diagnosed with colon cancer or polyps, especially when diagnosed prior to age 50; or with certain genetic predispositions, such as a relative diagnosed with ovarian or endometrial cancer. Anyone in these high-risk groups should share their family history with their physician and inquire about screening at an earlier age.
Colonoscopy screenings should be every 10 years thereafter unless recommended more frequently by your doctor due to diagnosis of polyps or for those with the previously mentioned high-risk traits. Again, consult with your physician to discuss frequency of screening.
While the colonoscopy gets a bad rap, anyone who has experienced one will tell you that the procedure itself is the easy part. The prep for bowel clean-out means taking only liquids the day before the procedure until the prep begins with a regime to clear the bowel. No food or drinks are allowed from midnight before until after the procedure. For most, that's the unpleasant part. After the procedure, you may resume eating, although not heavily the first day, and resuming a normal diet after that.
Dr. David Blumberg, Chief of Colorectal Surgery with Carroll Health Group of Carroll Hospital Center, cites Maryland as being in the top 10 — number six in fact — in the country for colonoscopy screening rates. That's the great news. However, on the flip side: only two-thirds of those who should be getting screened are actually doing it, leaving one-third of the candidates for screening at risk for missing an opportunity to prevent or diagnose a potentially treatable cancer.
In fact, in 2011 Carroll and Baltimore counties saw approximately 500 new cases of CRC in addition to 1,000 deaths from the often-preventable disease. Blumberg suggests that reasons for not receiving screening most often is due to patient non-compliance, in many cases secondary to lack of or inadequate health insurance.
The American College of Gastroenterology recommends that cancer detection screening, meaning identification of the disease through screening for blood in the stool, should be performed annually if a colonoscopy is refused. Formerly, a stool guaiac test was recommended by the ACG although a more sensitive Fecal Immunochemical Test (FIT) has replaced that recommendation. Again, emphasis is on colonoscopy testing for preventive screening.
An ounce of prevention is worth a pound of cure — a common saying that holds true for CRC. Reducing the risk of developing CRC by making healthy lifestyle choices is recommended. Smoking, alcohol and red meat consumption, along with obesity and a sedentary lifestyle increase the risk of CRC. Adopting a healthier diet of less red meat (no more than two times per week), decreasing alcohol intake, entering a smoking cessation program if you're a smoker and exercising can cut your CRC risk.
Recognizing symptoms, which unfortunately do not manifest until late in the disease, should be reported to your physician immediately. Indications that there may be cause for concern include: bleeding, change in bowel habits, constipation or diarrhea narrow bowel movements, fatigue, weight loss, and anemia. These symptoms may accompany other conditions, and while it's important to get checked out immediately, don't panic if you notice anything out of the ordinary.
Carroll Hospital Center offers a collaborative approach to prevention, diagnosis and treatment of CRC.
Blumberg is proud of the new William E. Kahlert Regional Cancer Center and their ability to offer state of the art treatment, which he attests to being comparable to anywhere in the country.
For additional resources about CRC, a free informational brochure is available at coloncancer.about.com.
Visit the Patient Information and Resource Center at the American College of Gastroenterology website: patients.gi.org
The Carroll County Health Department offers a Program for free Colonoscopy screening for eligible Carroll County residents: call 410-876-4425/ 410-876-4443 for more information.