Don't avoid colon screenings
I've noticed that having a discussion about colon cancer screenings with patients older than 50 often makes them feel uncomfortable. In light of this, I feel I must explain this issue. First, this screening is a part of routine preventive health care, just as children receive routine vaccinations from their pediatrician. Second, answers to questions on this topic would enable patients to make educated decisions about their health at this stage of their lives. Let me address some of the questions I often encounter:
Q. Why should I get tested? No one in my family has colon cancer.
A. The most common variety of colon cancer is called "sporadic" colon cancer, typically seen in patients older than 50. This may not run in families. In other words, anyone can get it. Other risk factors for developing colon cancer include a history of inflammatory bowel disease — which includes Crohn's disease or ulcerative colitis; a family history of ovarian, uterine, or breast cancers; and of course, a personal history of smoking. This is why physicians ask those personal questions about your past medical, family and social histories. Physicians are looking for risk factors that may increase your risk of colon cancer.
Q. What are gastroenterologists looking for? I don't have any signs or symptoms of cancer.
A. According to Dr. Khurram Qadir of Valley Gastro, S.C., in Aurora, "by the time one develops symptoms of colon cancer, the cancer is usually advanced, and cure is less likely." Colon cancer is the second most common cause of cancer deaths in both sexes. "Removing precancerous polyps, (the source of most colon cancers) helps avert colon cancer," Qadir said.
Q. Is a colonoscopy the only available test?
A. Colonoscopy is not the only screening test, though it is the only one that finds and removes polyps simultaneously. Other laboratory tests include complete blood count (CBC) and stool for occult (hidden) blood (FOBT). A CBC can detect anemia, which is common in colon cancer. FOBT is used to identify the presence of microscopic blood in stool which can originate from polyps and cancer.
Q. Are there other imaging options other than a colonoscopy?
A. Yes. Sigmoidoscopy, virtual colonoscopy (VC) and double contrast barium enema (DCBE) are other imaging options. However, the sigmoidoscope would be restrictive in screening for colon cancer since it only visualizes the last third of the colon or so. Any polyp in the upper colon would be missed. A virtual colonoscopy is a noninvasive procedure that can be used to image the colon. However, if a lesion is identified (typically greater than 6 mm), then a colonoscopy would be required since the VC does not allow for a biopsy/removal of a polyp or lesion. Also, VC is not covered by insurance for routine colon cancer screening. DCBE has similar limitations, with the added risk of radiation.
Q. Are there items which can affect the testing for occult blood in stool?
A. Yes, patients should avoid red meat before testing since blood in the meat may contribute to a false positive testing result on a FOBT. Medications such as nonsteroidal anti-inflammatory drugs or aspirin can also cause false positive results by increasing the risk of a person developing a bleed. Excessive vitamin C (more than 250 mg a day) from supplements, fruit and juices can contribute to a false negative result by interfering with the testing chemicals. Patients must speak to their physicians about their medical condition and medications before withholding any medications prior to FOBT or any other testing.
Satyen Patel is a physician with a practice devoted to adult health care concerns at Sugar Grove Medical Associates, 140 S. Municipal Drive in Sugar Grove. He can be reached at 630-466-7462. Qadir's office is in the medical offices adjacent to Provena Mercy and Rush Copley Medical Center in Aurora. He can be reached at 630-906-9700. For more information on colon cancer screening, visit www.valleygastrodoc.com
