Colon Cancer Screening

January 9, 2018
Amy Bentley, MD, FACP
Amy Bentley, MD, FACP

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When I was in my OB/GYN rotation in med school, the senior resident received a phone call while we were in the OR doing a procedure.  The senior resident handed me the phone.  A third year medical student was the lowest man in training, so I assumed I was in deep trouble.  I hesitated and took the call.  My mom told me my older brother had just been diagnosed with colon cancer.  The resident told me to break scrub (leave the OR) and go home.  This was also unprecedented – to be told to be with family instead of at work, but my brother was only 35.  Colon cancer is never good, at such a young age can be ugly.  And thus started what is now my 25 year personal history of colon cancer screening.

Colon cancer is the second leading cause of cancer death in the United States.  It is lethal and 30% of people who develop colon cancer will die from the disease.  Treatment of advanced colon cancer can be very unpleasant to say the least, but colon cancer is preventable with appropriate screening.

For those with average risk, meaning no family history of colon cancer or diseases that increase the risk of colon cancer (such as inflammatory bowel disease) and no personal history of high risk disease processes (such as adenomatous colon polyps or colon cancer), then screening generally begins at age 50.  Acceptable screening tests include home stool tests that check for blood, colon DNA testing (Cologuard) and endoscopy (colonscopy, CT colonoscopy, flex sigmoidoscopy).

Colonoscopy – what most patients dread- is the most sensitive and specific test. If there is a polyp or abnormality, then this can be removed or biopsied at the time of the colonoscopy.  Unfortunately, this does require a bowel prep the night before the test.  The test is also invasive and requires sedation, thereby increasing the risk.

Stool DNA testing (Cologuard) is also an acceptable screening test for patients of average risk.  Its benefit is that no prep is required and the test involves only the sample collection at home by the patient.  Its main drawback is that a positive test requires additional testing – meaning a colonoscopy.

Testing the stool for blood is not very specific or sensitive and is probably not the best screening test, though it can be an important adjuvant.

No testing is exactly palatable, but it is much better than suffering through surgery, radiation and chemotherapy.  My brother was lucky and he is 25 years out from the diagnosis, but he has the surgery scars and complications to deal with daily.  Many others are not so lucky.

I have to have a colonoscopy every 5 years and have for the past 25 years. I won’t say I enjoy it, but it is definitely better than the alternative.  Before you dismiss your doctor’s suggestion to obtain appropriate screening, think twice. And if a colonoscopy is suggested, take it from someone who has had 5, it really is NOT that bad.