Colorectal cancer is diagnosed in 147,000 new patients in America each year. 53,000 die from colorectal cancer in the US annually making it the second leading cause of cancer deaths in our country. A major effort is made each year to try to combat this problem. The first strategy is to try to find the cancer in its early stages, when the chances for cure are fairly good. This SCREENING strategy involves looking at the stool for evidence of microscopic blood (FIT test or hemoccult test) or for evidence of cancer DNA (Cologuard). A second strategy, which we advocate at SWGI, is to try to PREVENT colorectal cancer from forming.
To understand this concept, one needs to grasp the pathogenesis of colorectal cancer. Colon cells first undergo small mutations in their DNA. This leads to those cells having a growth advantage over their neighbors, and they proliferate much faster, forming small benign growths called POLYPS. Over the years one of these little polyps often enlarges and sometimes undergoes additional mutations -eventually becoming a cancer. Most polyps don’t turn into cancers, but the great majority of cancers come from polyps. When a colonoscopy is done and a polyp is found, it is carefully removed when it is benign. This removal, called a polypectomy, PREVENTS colorectal cancer from forming.
Most current guidelines call for average risk people to begin screening at age 50. Those that have a first degree relative with colon cancer or a pre-cancerous polyp, need to have screening start at age 40, or 10 years before their relative had their cancer or pre-cancerous polyp. The guidelines specify having a colonoscopy every ten years, a stool test for blood every year, or a stool test for DNA every three years. Note that for those that have a family history per above, stool tests are not recommended. Note also that it is not helpful to combine these strategies. Having a colonoscopy every ten years AND doing intermittent stool testing is not valuable.
At SWGI we think doing the colonoscopy makes sense. It allows for cancer prevention per above. The colonoscopy is a fairly safe procedure that involves taking about a day to do, including the prep time, procedure time, recovery time, etc. And, it only needs done every ten years. Whatever you decide, we highly recommend that you do some form of colorectal cancer screening. It could save your life!!!