When it comes to colon cancer screening, earlier is better.
“Forty-five is the new 50,” Dr. Richard Johnston of Columbus Gastroenterology Associates told the Columbus Rotary Club Tuesday.
For years the conventional wisdom was colonoscopies should start at 50, and with good reason, he said. About 90% of all colon cancer cases were found in people 50 or older.
“But that’s 10% of cases that are in people under 50,” he said. “The lifetime risk of developing colon cancer is one in 20, which is about 5% of the population. Worldwide, it’s the second most common cancer in women and the third in men.”
While rates in older people are decreasing, that is not true for younger folks.
“Rates are decreasing for people over 50, but they are not decreasing for under-50-year-olds,” Johnston said. “We don’t really understand why the rates for people under 45 have been increasing for the last few years.”
Environmental exposure, personal habits and diets with a lot of processed foods may contribute to that spike, Johnston said.
“The American Cancer Society was the first group to say we should start testing at 45, primarily because of (rising risk in younger adults),” Johnston said. “Thankfully insurers have started paying for it in the last couple of years. If you can’t get it as preventative care, the take rate is not going to be that high.”
Colon cancer has a wide range of symptoms, Johnston said.
“The most common is probably rectal bleeding,” Johnston said. “Although when people come to my office the most common cause of bleeding is hemorrhoids. We have a little joke that they are lifesavers, because that prompts (patients) to have a colonoscopy.”
Other symptoms include changes in bowel patterns, abdominal or rectal pain, weight loss and anemia, he said, but some patients have no symptoms at all, especially early on.
Age is probably the biggest risk factor, he said, but family history and genetics play a part as well.
“Those risk factors are going to change when we start (testing) and how often we do it,” Johnston said. “Race also plays a factor – Blacks, Hispanics and Indians are at a higher risk than whites.”
Diabetes, diets low in fiber, a sedentary lifestyle and smoking all increase risk as well, he said.
The single best way to beat colon cancer is to catch it early, Johnston said, and the best way to catch it early is via colonoscopy.
“The thing we get the most complaints about is the preparation,” Johnston said. “We used to send people home with this four-liter jug of a disgusting solution and tell them to drink it over three or four hours and they would be miserable.”
Now the preparation is split, he said, with patients drinking half of the solution the night before and the second half the morning of the procedure.
“People tell me all kinds of interesting stories about how they did it,” he said. “I’ve had people set up bedside commodes in front of the TV, and I had one lady who put her prep in a bunch of pony beer bottles she had emptied.”
When patients come in for the procedure, they are put to sleep, Johnston said. If the colonoscopy locates any polyps – which, left untreated, can become cancerous – they are removed right then and there.
Most people need a colonoscopy once per decade, but there are some variables in play, Johnston said.
“If you are of average risk and have no polyps, every 10 years,” Johnston said. “If you have a first-degree relative with colon cancer, every five years. If you have polyps, three to five years. … But then if you have another colonoscopy that’s negative, we might be able to push you back out to 10 years.”
Brian Jones is the local government reporter for Columbus and Lowndes County.
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