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Colon Cancer Screening

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Dr. Minocha  is a practicing gastroenterologist and author of " Natural Stomach Care: Treating and Preventing Digestive Disorders with Best of Eastern and Western Therapies ". 


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March is colon cancer awareness month. Did you know that colon cancer is America's number two cancer killer? Did you know that we can prevent these unnecessary deaths by removing pre-cancerous polyps and by diagnosing cancer at early stages? Did you know that screening for colon cancer is cost-effective and saves lives?

Polyps versus cancer

As many as 95% of colorectal cancers begin as polyps. It takes about 7-10 years for pre-cancerous polyps to transform into cancer. After this initial transformation, the cancer takes about 1-3 years to spread, and this process is known as metastasis. Up to 80% of colon cancer deaths can be prevented by timely removal of the pre-cancerous polyps!

The goal is to screen the people before any symptoms develop. Once the symptoms of bleeding, pain or altered bowel habit appear, over half of the cancers have already spread.

Extent of the problem

About 130,000 patients are diagnosed with colorectal cancer each year. As many as 56,000 deaths occur each year, half of which may be preventable.

As a result of cancer screening, the 5-year survival for patients with colorectal cancer has steadily climbed from 50% in the 1970s to 62 percent in 1990s. The colorectal cancer mortality has been decreasing by 1-2% per year since 1985. Yet, only 25-30% of those eligible persons actually undergo screening.

 

Who is at risk?

Everyone is at risk for colorectal cancer, some more than others. High risk patients include those with close relatives with polyps or cancer, those who have had polyps or cancer themselves and those with other diseases predisposing to cancer like ulcerative colitis and Crohn's disease.

President Reagan was found to have colon cancer during his presidency and is a shining example of the fact that early detection saves lives. Other celebrities afflicted with this disease include Supreme Court Justice Ruth Ginsberg, and pro-baseball Yankee player Darryl Strawberry.

The NBC Today Show anchor Katie Couric became an outspoken champion of screening after she lost her husband to colon cancer. In order to demonstrate her commitment, she went that extra mile by undergoing colonoscopy herself on live television.

METHODS OF SCREENING

Fecal occult blood test

It is an inexpensive and a noninvasive method of screening and is recommended every 1-2 years in average risk persons above the age of forty. This method of screening results in only a 15-30% reduction in colorectal cancer mortality. As such, it alone is not sufficient and must be combined with some other test.

Flexible sigmoidoscopy

It is easy, relatively inexpensive and examines the lower one-third of the colon. It cannot detect cancer rising above the limits of the colon reached by this scope. Such an incomplete exam of the colon is analogous to performing a mammography on only one breast for breast cancer screening. Screening program involving sigmoidoscopy results in 48-80% reduction in colorectal cancer mortality.

 

Screening colonoscopy

 

It examines the entire colon. A screening program utilizing this modality results in 76-90% reduction in colorectal cancer mortality. Because of the huge up front costs, many third payor parties are reluctant to pay for it, except in cases of high risk patients. However, this reluctance is declining as they realize that they save money in the long run, besides saving lives.

Barium enema

It is a test where the physician is looking at the x ray shadows of the colon instead of directly visualizing the inside of your colon. It misses many polyps and even cancers. I do not recommend this method of screening.

INSURANCE COVERAGE

Medicare as well as most insurance companies pays for annual fecal occult blood test. They also covers flexible sigmoidoscopy every four to five years in average risk and a colonoscopy every two years in high risk subjects.

Cost per life year saved

There is a popular misconception that the colorectal cancer screening is expensive. Nothing could be farther from the truth. Breast cancer screening cancer costs $22,000 cost per life year saved, heart transplant costs $160,000, and cervical cancer screening costs $250,000. In contrast, a colonoscopy every 10 years costs approximately $7000 per life year saved.

 

Barriers to screening

 

There is enough blame to go around. The insurance companies are reluctant to pay the huge up-front costs involved in screening programs, although this is changing. Patients may not feel comfortable discussing it with their physician. Last but not the least, the medical profession has not done its part in educating the public about the benefits of such screenings.

Do not let any barriers deter you. Talk to your doctor today. After all, it's your life!

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