Talking with Patients about
Why They Need Colorectal Screening
Ninety percent of colorectal cancers caught in their early stages can be cured—yet they are the second leading cause of U.S. cancer deaths (51,690 in 2012). This paradox underscores why screening is critical, according to Rebekah S. Kim, MD, of Virginia Hospital Center Physician Group – Colorectal Surgery.
Keep in Mind
- A person has a 1 in 20 chance of colorectal cancer.
- Early detection results in a 90% cure rate.
- Only 50% of the recommended population has been screened.
- Colorectal cancers are the second leading cause of U.S. cancer deaths: 51,690 in 2012.
1 in 20 Chance
A person has a 5 percent chance of having colorectal cancer in his or her lifetime. The disease affects both sexes, and more often those above age 50. Risk factors include family history of colorectal cancer or polyps; smoking, inflammatory bowel disease; and prior breast, ovarian, or endometrial cancer. Incidence is up among African Americans and Hispanics, and they are more likely to come in with more advanced stages, underscoring the role of early screening.
Symptoms may include rectal bleeding, a change in bowel habits, or unexplained weight loss. However, Dr. Kim stressed, 50% of cases have no symptoms until the cancer has advanced.
Guidelines are to screen beginning at age 45 for African Americans and smokers, and age 50 for asymptomatic individuals without risk factors, through age 75. Those with a family history should begin screening at age 40 or 10 years before the age when the family member was affected, whichever is earlier.
Screening options include a digital rectal exam and fecal occult blood test every year, flexible sigmoidoscopy every five years, and colonoscopy every 10 years. A study published in the May 2012 New England Journal of Medicine found sigmoidoscopies reduced the incidence of colorectal cancer by 21% and mortality by 26%. “Every patient who presents with rectal bleeding at a minimum receives a flexible sigmoidoscopy in the office setting,” she said.
Some patients say they prefer a virtual colonoscopy. Although the technique has an advantage of being considered noninvasive, it still requires a vigorous oral cathartic laxative similar to preparation for a regular colonoscopy. “A traditional colonoscopy is the gold standard,” Dr. Kim said, but “any screening is preferable to none at all.”
Possible Prevention of Polyps
There is some evidence that low-dose aspirin decreases the incidence and mortality of some colorectal cancers. Likewise, a person with a history of adenomatous polyps who takes NSAIDS may have less recurrence. However, the medications’ side effects indicate not to use them for routine prevention of colorectal cancers. Screening remains the best option.
Compliance and Colorectal Cancer
Dr. Kim has conducted research to correlate prior compliance with colonoscopy screening in patients who had surgery for colorectal cancer. She presented the results at the 2012 annual meeting of the Society of American Gastrointestinal Endoscopic Surgeons.
“Our study showed that about 75% of surgical patients for colorectal cancer were not compliant with screening guidelines,” she said. “Most patients in the study had a colonoscopy because they already had symptoms as opposed to being screened preemptively.”
Rebekah Kim, MD, is a member of Virginia Hospital Center Physician Group – Colorectal Surgery. She received her medical degree at Dartmouth Medical School and undertook her residency in general surgery at St. Luke’s-Roosevelt Hospital Center, University Hospital of Columbia University. She completed a fellowship in minimally invasive laparoscopic surgery and colorectal surgery at Orlando Regional Medical Center. She performs laparoscopic colon and rectal surgery and screening colonoscopies.