45 or Older? Don't Overlook This Life-Saving Screening

 

According to the American Cancer Society, colorectal cancer is the third-leading cause of cancer-related deaths in men and the fourth leading cause in women, but it's the second-most common cause of cancer deaths when numbers for men and women are combined. In 2024, colorectal cancer is expected to cause about 53,010 deaths. The ACS estimates that about 106,590 cases of colon cancer will be diagnosed in 2024, (54,210 in men and 52,380 in women) and about 46,220 new cases of rectal cancer (27,330 in men and 18,890 in women) will be diagnosed.

In recognition of March as Colorectal Cancer Month, we talked with Dr. Jorge Galan, a gastroenterologist with Columbia Gastroenterology Associates, which partners with MUSC Health Midlands, to learn more about colorectal cancer, who is at risk, and how it can be prevented.

What is the purpose of the colon?

The colon and the rectum make up the large bowel, which is part of the digestive system. The colon absorbs water and salt from food matter that remains after it has passed through the small intestine (small bowel). The waste matter that's left after going through the colon goes into the rectum.

What is colorectal cancer?

Most colorectal cancers begin as polyps in the lining of the rectum or the colon. These polyps become cancerous if not detected and removed.

Who is at risk for getting colorectal cancer?

Individuals who have a first-degree relative, such as a parent or a sibling, who was diagnosed with colorectal cancer at age 60 or younger, are at a higher risk for getting colorectal cancer. Certain colon cancer syndromes are hereditary and tend to appear as clusters in families. Lynch Syndrome and Familial Adenomatous Polyposis are two examples. Underlying conditions such as inflammatory bowel disease and ulcerative colitis can also increase one's risk for developing colorectal cancer.

How can we minimize our risk for colon cancer? Diet? Other healthy habits?

• Maintain a healthy weight and exercise regularly
• Avoid excess intake of processed foods
• Do not smoke
• Minimize alcohol consumption
• Have adequate intake of calcium and vitamin D
• Eat fiber-rich foods like fruits and vegetables

What is a colonoscopy?

A colonoscopy is a procedure that is performed by a gastroenterologist to examine the colon for polyps and cancer and other abnormalities. It lasts about 20 minutes and is done with the patient under sedation.

How effective is a colonoscopy?

A colonoscopy is the most effective way to screen for colon cancer. In fact, of all the early screenings for cancer, colonoscopy is the only screening that can actually prevent cancer because we can detect and remove polyps before they turn into cancer. When we find precancerous polyps in patients, we alert them and put them in a high-risk category, for more frequent colonoscopies. The flip side is that patients who don't have polyps will not need another colonoscopy for 10 years. The incidence of colorectal cancer has decreased among older Americans since the early 1990s because more people are getting colonoscopies. However, the rate among adults younger than 55 has inched upward, which is the justification for lowering the initial age for screening to 45.

At what age should someone get a colonoscopy?

The U.S. Preventive Services Task Force recommends adults get a colonoscopy at age 45. Individuals who have known risk factors for colorectal cancer should be screened at age 40.

How does someone prepare for a colonoscopy and what happens during the procedure?

The prep for a colonoscopy has improved immensely over the last few years. If you are having a colonoscopy, the day before your procedure you must drink only clear liquids. In the evening, you will drink a laxative solution that is prescribed to empty your bowels, which will occur several times. The intent is to clean out the colon thoroughly before the colonoscopy to allow your gastroenterologist to see clearly.

During the procedure, I insert a flexible scope, about the diameter of a finger, into the rectum, through the anus and into the colon. The flexibility allows me to advance the scope through the colon, which is four to six feet in length. A sophisticated light and camera are attached to the scope so I can view the interior in precise detail. The scope itself has a channel in which we can insert instruments to sample and remove the polyps without cautery. This helps to prevent bleeding and promote healing. The sedation has improved significantly and is administered by a certified registered nurse anesthetist (CRNA). Patients wake up alert and able to discuss the findings with their physician.

What do you tell patients about non-invasive methods like Cologuard for detecting colorectal cancer?

Cologuard is not a bad option. It's less invasive and it is less expensive, but it has limitations because it has a certain false negative rate. That's why a Cologuard test is recommended every three years. Furthermore, if a Cologuard test is positive, a colonoscopy is still necessary because it's the only way to determine if the patient has a lesion.

What do you want people to know about colonoscopies?

Cancer in general is a huge contributor to deaths and morbidity in the United States. We see a lot of cancer in medicine, and those cancers are responsible for significantly shortening your life and affecting your family. In this day and age, you don't have to die of colorectal cancer. I emphasize that it is the only cancer that is preventable, and the reason is because we know that colorectal cancer begins with polyps. If we can detect and remove the polyps, we can drastically reduce the incidence of colon cancer.

On the question of effectiveness of colonoscopy:

I agree adding the piece about the increased incidence of colorectal cancer in younger adults which is the justification of lowering the initial age for all screening to 45.

On the question of Cologuard:

We should clarify that the limitations of Cologuard include a false positive rate of 13% and a false negative rate of 8 percent. If positive, a colonoscopy would be required. If negative, a repeat Cologuard test is required in three years.

Columbia Gastroenterology Associates is located at 2739 Laurel Street, Suite 1-A, in Columbia. To make an appointment with Dr. Galan, call 803-799-4800.