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Colorectal Cancer: Preventable, Treatable and Beatable When Caught Early
By Nancy Kennedy

In the United States, 1 in 23 people will get colon cancer in their lifetime. In the coming year, 51,000 will die of colorectal cancer. It is the second most common cause of cancer deaths in the U.S. As alarming as that may sound, there is good news: colorectal cancer is one of the most preventable cancers and the death rate is improving, thanks to early detection and screening. “When it is caught early, we can cure colorectal cancer 90 percent of the time,” says St. Clair Hospital’s Scott Holekamp, M.D., a board-certified colorectal cancer surgeon. “Most colorectal cancers start out as polyps. The beauty of colonoscopy versus other screening procedures is that we can treat the cancer immediately, at the same time that we find it.”

The American Cancer Society recommends that people of average risk for colorectal cancer begin regular screening at age 45. What is average risk? It means that one does not have a personal history of colon cancer or certain types of polyps; a family history of colorectal cancer; a personal history of inflammatory bowel disease (such as Crohn’s); or a personal history of getting radiation to the abdomen or pelvis to treat a previous cancer. Screening should continue through the age of 75; beyond that, from 76-84, the need for screening depends on overall health and screening history and should be discussed with one’s primary care physician. Those over 85, in most cases, need not have screening.

Screening for colorectal cancer can be done with a test that examines the stool – fecal immunochemical test or FIT, occult blood test, or DNA test - or a test that directly examines the colon and rectum: colonoscopy. “Colonoscopy is the gold standard,” Dr. Holekamp emphasizes. “Using a stool test as a screening tool is better than no screening at all, but if you are at risk, you need a colonoscopy. It’s essential to understand that colonoscopy is still the best tool for colon cancer screening. Many patients tell me, ‘I can’t have colon cancer, I have no symptoms’ –but in fact, the vast majority of patients will have no symptoms. This is why colonoscopy is so important: symptoms occur late in the game.”

Too many people neglect to follow the screening recommendations for colonoscopy, for multiple reasons. One is the time involved: it can be a two day process, and people may be reluctant or unable to take time from their work. But a much more common barrier is the anticipation of an unpleasant experience. Dr. Holekamp assures that colonoscopy has improved: “The prep, which is the hardest part, is easier today. The actual scoping part is easy, as the patient is sedated. At St. Clair, we have a goal of making the patient experience as positive as possible.”

Stacy Hurt, a survivor of Stage 4 colorectal cancer who now advocates for colorectal cancer screening as Strategic Partnership Manager for the Colon Cancer Coalition, understands that people fear a difficult colonoscopy experience. Her perspective, however, is that the unpleasant aspects of colonoscopy don’t compare to the unpleasant aspects of chemotherapy treatments and colon surgery. “People don’t want to talk about colon cancer. There’s a sense of shame and a stigma attached to it. But colorectal cancer is a common cancer and both men and women get it. Women need to consider colonoscopy as having the same importance as mammograms.”

Although it is still underutilized, colonoscopy is the predominant cancer screening test in the U.S. The use of colonoscopy has tripled since 2000. In that year, only 21 percent of Americans ages 50 and older had a colonoscopy; in 2015, the number rose to 60 percent. That’s great but it means that 40 percent still have not had a colonoscopy.

“We can tell people to quit smoking to reduce their risk for lung cancer, but there’s no such road map for risk reduction in colorectal cancer,” says Dr. Holekamp. “The most important thing is to get screened as recommended – that’s how you can reduce your risk. And never ignore symptoms such as rectal bleeding; don’t assume it’s from a hemorrhoid. If you have symptoms, you need to see a doctor as soon as possible.”

To schedule a colonoscopy at St. Clair Hospital, call (412) 942-8150.

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