Colorectal cancer is the fourth leading cause of cancer death in the United States, but it’s also very preventable.
National Colorectal Awareness Month was first introduced in February 2000, where former President Bill Clinton designated the cancer awareness month to March. Since its inception, the month has garnered support from patients, survivors, caregivers, and advocates nationwide to join together by wearing blue, fundraising and educating, and encouraging their loved ones to get screened.
Colonoscopies are important for adults 45-75, and are the primary way to find the cancer early.
The U.S. Preventive Services Task Force, a group dedicated to evidence-based preventive services, lowered the recommendation age from 50 to 45 in February 2021, as more people in this age range are being diagnosed. While patients between the ages 75-85 are still encouraged to get screened for colon cancer, doctors recommend thinking twice before choosing a colonoscopy as a first choice.
Dr. Collin Sharp, a general surgeon who specializes in general surgery and vascular surgery at Blue Sky Surgery (which is affiliated with Montrose Memorial Hospital), recommends early screening as a proactive preventative measure. Colon cancer screening and treatment is a recurring topic in Montrose, he added.
“All the signs that people have from colon cancer are usually very late signs,” Sharp said. “There are signs to watch for, but once you start to have them, they are indicative of something way late, and at this point is beyond our ability to cure you of the disease.
Between the ages of 50-75, 4.5% people will get colon cancer, which is why Sharp encourages his patients to screen early.
“The hospital has a robust screening system in place for colonoscopies,” said Sharp. “You need to contact your primary care doctor and then your surgeon in town to be able to get it done.”
The process for testing starts with a discussion with your endoscopist, then you can schedule your procedure. The day before the test is the hardest, said Sharp.
The day is dedicated to prepping the colon with clear liquids, such as water, coffee, tea, jello, and broth. At 3 p.m., you take some tablets to help your intestines move forward. At 5 p.m., you drink a 64 ounces bottle of Gatorade in which you mix in Miralax, a laxative. You don’t eat or drink anything after midnight.
“The next morning when you come in, you see the endoscopist, the anaesthesiologist, the nurse who makes sure all the paperwork is ready to go, and we make sure you are comfortable, then we sedate you for the procedure,” Sharp explained.
How often should someone get tested? Sharp said this depends on what is found in the initial screening.
If the patient has no primary relatives with colon cancer history, if no polyps (growths in the inner lining of the colon or rectum) were found in the colonoscopy, and if the patient is well cleaned out, then a healthy patient can get tested once every 10 years. If polyps were found in the screening, then moving forward depends on what the polyps are like, as well as their characteristics.
“Tests could be done every three, five or seven years, depending on the characteristics,” Sharp said.
Sharp warns patients of using any colorectal screening alternatives, such as ColoGuard. ColoGuard is a DNA-based, stool and chemical test that can be used to check for colon cancer.
“While they are tools that can be used for patients resisting colonoscopies, they are not recommended as a primary testing tool,” Sharp said. “They are not yet good enough to find the cancer reliably or accurately.”
Because colonoscopies tend to be expensive, insurance companies are known to send tests like ColoGuard as a cheaper option, but, again, they aren’t a reliable one.
“Some health insurance companies try to get by the requirement to pay for a screening,” Sharp explained. “The Affordable Care Act requires a screening for colon cancer, but it doesn’t say what screening is required to be covered.”
Because of the price, Sharp said some health insurance companies are sending tests out to people without a doctor’s note or without having had a doctor see the customer, telling them to take the supplemental test instead.
“People are doing it, taking a test that’s not as sensitive as a colonoscopy is, and the insurance gets to check the box for the screening coverage under the Affordable Care Act,” he said.
With the ColoGuard tests, people are either not finding their cancer when it’s there due to the lack of sensitivity in the test, or people will test positive and the insurance company no longer
has to pay for your colonoscopy from a screening perspective.
“We’re really trying to push patients to stick with the colonoscopies,” said Sharp. “If their insurance sends the ColoGuard test, we’re encouraging people not to do that test.”