Imagine a screening test that could not only detect cancer at its earliest stages but also prevent the majority of cases from developing. When it comes to colorectal cancer — the third most common type of cancer diagnosed in both men and women in the U.S. — such a test already exists. It’s called a colonoscopy.
“Colonoscopy is both diagnostic and therapeutic,” says Eisenhower Gastroenterologist Mamta Mehta, MD, MPH, who is Board Certified in Internal Medicine and Gastroenterology. “We’re able to directly visualize the inner lining of the colon for small precancerous polyps and remove them at the same time, which significantly reduces the risk for colon cancer. In fact, studies show that we’re able to reduce overall risk by 70 percent and mortality by 70 percent with this highly effective screening tool.”
“While we have other approved screening tests, colonoscopy differentiates itself because during this procedure, we can see a lesion and cut it out,” says Eisenhower Gastroenterologist Yash Mittal, MD, Board Certified in Internal Medicine and Gastroenterology. “That’s where it is more advantageous than other tests – because it enables us to remove precancerous lesions.”
The other screening tests he refers to include at-home tests that check for blood in the stool, “but they don’t tell us what’s causing it if it’s detected,” he notes. There’s also CT colonography (sometimes called a virtual colonoscopy), which he says is best at detecting lesions greater than 5 millimeters (under ¼ inch). “But cancer can be present in smaller lesions,” he points out.
What’s more, if either of these tests yields a positive result, a colonoscopy is still required in order to make a diagnosis.
“In my mind, colonoscopy is the gold standard because it can be preventative, not just diagnostic,” Dr. Mittal adds.
While Dr. Mehta says that the “best test is the one that’s accepted and completed by patients,” she concurs that colonoscopy is the gold standard. “Each of these other tests has its strengths and weaknesses, but colonoscopy is highly sensitive and likely to capture those patients with small polyps or cancer at earlier stages when intervention is likely to yield the highest success.”
Who should have a colonoscopy?
The U.S. Preventive Services Task Force recommends that people aged 45 to 75 undergo periodic colorectal cancer screening, usually every 10 years. If you have a family history of this disease, you might benefit from earlier and more frequent screening, so it’s important to talk to your doctor.
Notably, the age at which experts recommend most people start colonoscopy screening was recently lowered from 50 to 45. Dr. Mehta explains why:
“Although there’s been a steady decline in the number of colorectal cancer cases found in those over 50 — mainly because of screening — we’re seeing a steady rise in a younger population, those between 45 and 49,” she says.
In fact, according to the American Cancer Society, from 2012 through 2016 the incidence of colorectal cancer increased every year by two percent in people younger than 50 and by one percent in people 50 to 64. And although the overall death rate has continued to drop — also thanks to screening and people changing their lifestyle-related risk factors — deaths from colorectal cancer among people younger than 55 have increased one percent per year from 2008 to 2017.
What are the risk factors for colorectal cancer?
“We know that obesity, age, poor diet, physical inactivity and a family history of colorectal cancer are risks for this disease,” Dr. Mehta says. “The western lifestyle has contributed to an obesity epidemic which is a big factor in the rising numbers among younger people. Conversely, there is convincing evidence that a high intake of fiber and reducing alcohol and red meat may be protective.
“We also know that African Americans have a higher incidence of colorectal cancer at every age,” she continues. “And in individuals who have a first degree relative under age 60 with colorectal cancer, it doubles their risk versus those with no family history. That’s why giving your primary care physician a detailed family history is very important in determining your risk for colorectal cancer,” she adds.
What are the possible signs of colorectal cancer that warrant a visit to see your doctor?
“Concerning symptoms include blood in the stool, a change in bowel patterns such as thinner stool or being constipated, unexpected weight loss and abdominal pain,” Dr. Mittal says.
However, polyps and early-stage curable colorectal cancer don’t cause symptoms. So the entire point of colonoscopies is to get rid of polyps before they turn into cancer.
“Many colorectal cancers are found in individuals without symptoms, which is why screening is so important,” Dr. Mehta affirms. “By the time someone develops symptoms, the disease may be presenting at an advanced stage.”
If colorectal cancer is detected, how is it treated?
“It depends on the stage of the cancer,” Dr. Mittal says. “In its earliest stage, there are times when we can cut it out during colonoscopy, effectively curing it.”
“Staging determines whether the cancer is limited to a particular area or, if it has started to spread, the degree of that spread,” Dr. Mehta explains. “Treatment options for colorectal cancer generally include surgery, chemotherapy and radiation therapy. Some combination of these may be recommended based on the stage and genetic characteristics of the cancer.”
Newer targeted therapies may also be indicated in certain cases. Targeted therapy is a type of treatment that targets proteins that control how cancer cells grow, divide and spread.
All of these treatments are available at Eisenhower Health.
“But I can’t stress enough that when colorectal cancer is found in its earliest stages, there is a much higher likelihood of ensuring a good outcome,” Dr. Mehta says. “Which is why screening is so vital.”
“Colonoscopy has been a gamechanger in terms of how we not only detect and treat but also prevent colorectal cancer,” Dr. Mittal adds. “Everyone who is eligible for screening should be getting screened.”
For more information, contact your primary care physician. If you need a primary care physician, call Eisenhower’s Primary Care Physician referral line at 760.773.1460.