Entries in Colonoscopy (5)


Colon Cancer Among 'Least Prevented'

Ingram Publishing/Thinkstock(NEW YORK) -- Karen Witkus took the prescription, folded it up and tucked it in her wallet. She didn't want to think about the colonoscopy it would procure.

"I heard horror stories about it," said Witkus, 55, imagining the probing test and the gut-cleansing preparation it required. "I kept delaying and before you know it, it had been in my wallet for three years."

A colonoscopy is a procedure in which doctors view the inside of the colon with a small camera to spot and remove pre-cancerous growths called polyps before they turn into deadly tumors. It's the most sensitive of three colon cancer screening tests recommended for men and women over the age of 50, but nearly half of all eligible adults skip the tests altogether, according to a 2009 study.

As a result, colorectal cancer remains the second leading cause of cancer death in the United States, killing more than 50,000 Americans annually, according to the U.S Centers for Disease Control and Prevention. Up to 60 percent of those deaths are preventable through screening, the agency says.

Dr. David Johnson, chief of gastroenterology at Eastern Virginia Medical School and past president of the American College of Gastroenterology says reasons for the low screening rates vary.

"One reason is that the test may not be covered by the patient's insurance," he said, alluding to insurance plans that are unaffected by the Affordable Care Act, which mandates coverage of colorectal cancer screening. Only 29 states and the District of Columbia have mandated that insurance plans cover colorectal cancer screening tests. "Another reason is that patients simply never have the conversation with their doctor."

Then there are people like Witkus, who despite having a referral and insurance coverage forgo the test out of fear. A colonoscopy requires that patients drink a gallon of bad-tasting laxative to cleanse the bowel, making polyps more visible. Patients miss up to two days of work – one for the pre-procedure doctor's visit and bowel prep and another for the procedure itself.

Although the benefits of a colonoscopy far outweigh the inconvenience and discomfort, doctors and researchers have nonetheless been searching for easier and more acceptable alternatives. One such test is currently under review by the U.S. Food and Drug Administration and Centers for Medicare and Medicaid Services. Developed by Exact Sciences, the stool-based screen detects changes in DNA as well as traces of blood that signal the presence of pre-cancerous polyps or cancers of the colon.

"I believe we have a significant opportunity to play a role in winning the battle against colon cancer," said Exact Sciences president and Chief Executive Officer Kevin Conroy, citing results from a recent clinical trial that suggest the stool-based test can detect 65 percent of polyps measuring 2 centimeters or more. "Colon cancer is the most preventable yet least prevented cancer. ... There is a significant need for something different."

Johnson, who was involved in the trial, agrees.

"Anything that brings more people into the screening pool, I'm all for," he said. He hopes the new test will play a "sizable role in increasing the options for screening," but cautions, "the best screening test is still the colonoscopy."

 When Witkus finally had her colonoscopy three years after getting the prescription. She was shocked to learn that she had colon cancer. Had she undergone the test at age 50, her cancer and subsequent surgery to remove 6 centimeters of bowel would have likely been avoided, her doctors told her.

Witkus did undergo screening with fecal occult blood testing two years before her colonoscopy and said she had no problem with the more convenient and less-invasive test. The test was negative but is known to miss the majority of polyps. She hopes that an accurate but minimally invasive test will one day be available, adding that the colonoscopy prep was the worst part.

While the new test is far from perfect, Johnson said he believes it could be refined to improve its sensitivity. But there are other unknowns, including the cost of the test and whether insurers will cover it. Approval by Medicare often triggers other insurance providers to cover the test, but if it's too expensive, the test might struggle to gain acceptance in an increasingly cost-conscious healthcare market. However, the potential to prevent cancer in more people and avoid costly treatment will certainly help its case. The cost of treating colon cancer exceeded $14 billion in 2010, according to the National Institutes of Health.

Thankfully doctors were able to remove Witkus' cancer before it was too late. But she knows that she was lucky.

"I talk to everybody I can now about colon cancer," she said. Her advice? "Definitely get the colonoscopy."

Copyright 2013 ABC News Radio


Older Americans Over-Screened for Colon Cancer

iStockphoto/Thinkstock(NEW YORK) -- Screening is the best way to prevent colon cancer.  So everyone should get a colonoscopy, right?  Not so fast.

The recommendations for colorectal cancer screening are pretty clear: Start screening at age 50 and continue through age 75 with a colonoscopy every 10 years, a sigmoidoscopy every five years or a fecal blood test every year. Those who have a high risk for colon cancer should be screened more often and starting at a younger age.

For people over 75, it all comes down to benefits and risks.

The benefit of colon cancer screening is that it can detect precancerous polyps before they have a chance to develop into cancers.  Removing the polyps takes care of the problem.  However, most polyps develop into cancers quite slowly, and the procedure to spot and remove them carries risks like bleeding, infection and perforation of the colon.

Why worry about detecting a cancer that will do no harm in your lifetime?  You only want to do the screening when the benefits of extending life by preventing cancer outweigh the risks of the screening itself.  For most people, the right cutoff is age 75.

Unfortunately, it looks like a lot of older Americans are unnecessarily putting themselves at risk.  A study published this week in JAMA Internal Medicine found that 32 percent of the colonoscopies performed in people ages 76 to 85 were probably inappropriate. 

It’s one thing to get a colonoscopy when it is likely to be beneficial; it is entirely another matter to have one done when you don’t need one.

It might seem like the more you get screened, the healthier you’ll be.  But that’s just not true.  Here are some of the latest screening recommendations to help you avoid getting over-tested:

  • Cervical cancer: Pap test every three years for women between the ages of 21 and 65; no screening for women older than 65, unless they are at high risk for cervical cancer, or for women younger than 21.
  • Prostate cancer: No PSA-based screening for prostate cancer at any age.
  • Breast cancer: Mammogram every two years for women between the ages of 50 and 74.  Screening based on risk factors and a conversation between doctor and patient for those younger than 50.  Women 75 and older should also base screening decisions on a conversation with a doctor.
  • No screening at all for testicular cancer, pancreatic cancer or ovarian cancer.

On top of their medical risks, unnecessary medical tests cost time and money.  So do yourself a favor and invest in the tests that are right for you.

Copyright 2013 ABC News Radio


To Prevent Colon Cancer, Get Your Butt to the Doctor

Ryan McVay/Thinkstock(NEW YORK) -- Colorectal cancer -- cancer of the colon or rectum -- is the second leading cause of cancer-related deaths in the United States, according to the Centers for Disease Control and Prevention.

Yet, it’s one of the most treatable cancers there is, even in its later stages.

ABC News’ chief health and medical correspondent Dr. Richard Besser held a tweet chat on Monday to raise awareness on how to prevent and treat colon and rectal cancer.  His special guest was ABC talk show host Katie Couric, whose husband, Jay Monahan, died of the disease in 1998.

CDC director Dr. Tom Frieden and chief medical and scientific officer of the American Cancer Society Dr. Otis Brawley tweeted their thoughts, along with experts from the National Institutes of Health; the Colon Cancer Alliance; Mayo Clinic; New York University Langone Medical Center; and the Dana Farber Cancer Institute.

Here are four things the experts say you must know about keeping your colon happy and healthy:

1. Get Screened

Most colon cancers begin as polyps, lumps growing on the lining of the colon wall that can develop into cancer.  Regular screening after the age of 50 is essential for detecting and removing these polyps before they become cancerous.

“Roughly six of 10 deaths from colon cancer could be prevented if everyone age 50+ got screened routinely,” Frieden tweeted.

If your test comes back clean, you won’t need another one for 10 years.  However, if your test shows abnormalities, you should be screened more often.

2. Colonoscopies Aren’t that Bad

The preferred method of screening is colonoscopy in which a doctor gently inserts a long, flexible tube with a light and camera on the end into your rectum to scope out signs of cancer.  The test itself is no big deal.  You’re under anesthetic and won’t feel a thing.

Prep is another matter.  Before the test you need to clean out your colon by drinking copious amounts of a vile-tasting liquid, then retiring to the bathroom for the better part of a day.

3. Don’t Die of Embarrassment

“There may be blood in stool, a change in bowel habits, diarrhea or a change in weight,” experts from the NIH noted.

Experts from Dana Farber added, “A month or more narrowing of the stools, straining, change in stool shape are all symptoms of bowel problems.”

As many of the tweeters noted, people often ignore these symptoms or are too embarrassed to talk to the doctor about them.

4. Know the Risks

Age is an important risk factor.  Colon and rectal cancers most often strike people over the age of 50, but the disease can strike at any age.  Although anyone can get colorectal cancer, it’s deadliest for minorities, because they’re less likely to get tested or seek treatment, the experts from the Colon Cancer Alliance said.  If someone in your family has had colon cancer, this increases your risk too.

As several tweeters noted, Lynch syndrome -- an inherited condition -- puts someone at increased risk of colon cancer and other cancers.  Doctors estimate that about three out of every 100 colon cancers stem from Lynch syndrome, and the disease often occurs at an earlier age.

Copyright 2013 ABC News Radio


Proof at Last? Colonoscopy and Cancer Prevention

iStockphoto/Thinkstock(NEW YORK) -- Do you really need that colonoscopy? It’s a question that seems simple at first. After all, as more Americans routinely undergo the oft-dreaded colonoscopy with each passing year, cases of colorectal cancer have continued to drop.

Yet data from large, conclusive studies that prove this test, currently the primary weapon in a doctor’s arsenal to catch colon cancer early, actually saves lives has so far been lacking.

Some doctors believe that new research, released Wednesday by the New England Journal of Medicine, takes a big step in this direction. In the study, researchers led by Ann G. Zauber of Memorial Sloan-Kettering Cancer Center in New York suggest that removing non-cancerous growths known as polyps could have a big impact on death from colorectal cancer. Doctors routinely remove these benign polyps during a colonoscopy. The new study indicates that people who have polyps removed slash their risk of death from colorectal cancer by more than 50 percent over the next decade and a half compared to the general population.

“This study confirms the suspected benefit of colonoscopy as it relates to reducing mortality from colorectal cancer,” says Dr. Fritz Francois of NYU Medical Center, who was not involved with the study.  He added that while certain questions still remain surrounding the overall body of research on colonoscopy, “the important message is clear: colonoscopy saves lives.”

Not so fast, say other cancer experts. Dr. Rita Redberg of the University of San Francisco, editor of the journal Archives of Internal Medicine, was less impressed by the new study. She said a major shortcoming of the study was that it did not factor in the so-called “healthy-user effect.” In other words, she said, those people in the study who received colonoscopies and had polyps removed may very well be more healthy than the average person in the general population -- perhaps doing things like eating a healthier diet, exercising or taking medications regularly. These aspects of their lifestyle may lower their chances of developing colon cancer even before colonoscopy is considered.

The healthy-user effect has confounded medical professionals before. Redberg said the healthy-user effect is, “the same reason we thought hormone replacement therapy [HRT] was protective against heart disease for women for many years, until a randomized trial was done.”  In the case of HRT, when such a trial was performed, researchers actually found a slight increase in heart disease and strokes among women taking the measure that was supposed to have improved their health.

Other doctors contacted by ABC News agreed that it is difficult to make any conclusions from the study at hand. That said, government health agencies have made prevention of colorectal cancer a top priority and, as a result, have strived to encourage more Americans to have screening colonoscopies. Current guidelines recommend that every American age 50 to 75 undergo screening colonoscopy -- though CDC data suggest 22 million Americans who should be getting screened aren’t.

The stakes for preventing colorectal cancer are high. In the U.S., among cancers that affect both men and women, colorectal cancer is the third most common and the second-leading cause of cancer death, according to the CDC. And the idea that finding and removing precancerous polyps before they turn into cancer seems a logical way to try and solve the problem.

So will doctors ever know conclusively whether or not colonoscopy and the removal of benign polyps save lives? Most experts contacted by ABC News believe so.

“If your doctor finds a polyp on colonoscopy, that’s a tissue we know may turn into cancer,” said Dr. Eric Esrailian, a gastroenterologist at UCLA. “It can be removed during the procedure and the cancer never develops....We can basically prevent cancer.”

Until this can be proven more conclusively, most agree that routine screenings may help -- and are unlikely to hurt.

Copyright 2012 ABC News Radio


When’s the Best Time to Get a Colonoscopy?

Burke/Triolo Productions(NEW YORK) -- If you’re in the market for a colonoscopy, studies have shown that tests performed in the morning are more likely to catch abnormal growths than those performed in the afternoon. This has more to do with doctor fatigue toward the end of the work day than with the colon itself, according to a recent study in the American Journal of Gastroenterology.

In the study, doctors identified abnormal growths in 26 percent of their morning patients but 21 percent in their afternoon patients. Researchers noted that the difference in detection may also have to do with afternoon patients not taking the full precolonoscopy bowel prep, including large doses of laxatives.

Copyright 2011 ABC News Radio

ABC News Radio