Undergoing a colonoscopy to screen for colorectal cancer offers a unique difference from other preventive cancer screenings: it provides a chance to prevent cancer, not just detect it.
As we see an increased incidence of colorectal cancer in younger adults, we should stop viewing colonoscopies as an uncomfortable rite of passage but rather as an empowering way to take control of one’s health. As gastroenterologists, we should expand our role from simply performing a colonoscopy to that of a healthcare advocate. We need to encourage certain patients to advocate for their family’s health by sharing their health histories.
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And primary care physicians play a critical role as their patients’ best advocate, serving as an all-important first line of defense in stressing the importance of prevention and encouraging them – more than once if necessary – to follow through on what could be a life-saving screening.
CRC in younger patients
The stories of a 22-year-old waitress and an 18-year-old college freshman have left an indelible mark on me, evoking a sense of profound empathy and contemplation. Their stories have compelled me to reflect on the pressing need for greater collective action.
Both were grappling with the burden of rectal cancer, an affliction that struck one at Stage IV, prompting her to move back home with her parents. Her future was overshadowed by uncertainty and the disheartening realization that her life would be unjustly shortened. She found herself grappling with the reality that there was little within her control to alter her prognosis.
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The 18-year-old young man, having recently withdrawn from college, had sought solace in the refuge of his parents’ care. Enduring a permanent colostomy, he was visibly distressed by the prospect of undergoing further medical examinations. The traumatic experiences he endured to preserve his life had left a long-lasting emotional scar, surpassing the physical toll. Nothing like the youthful exuberance he’d expected, this phase of his life had been abruptly altered. Neither of these patients had the necessary financial or emotional reserves to confront these unforeseen circumstances. They had to struggle with the little they had.
While I have always taught my children not to anticipate fairness in life, I could not suppress the nagging question as to why, on certain occasions, the scales of life tipped so unjustly. These young people’s stories have lingered within me, reminding me of the capricious nature of existence, fueling a desire to advocate for change and address persisting inequities.
The importance of colonoscopy
It’s hard to sugarcoat what goes into the preparations associated with a colonoscopy. To get the best results possible, patients need to fast and clean out their bowels, allowing the gastroenterologist to clearly examine the entire lining of the colon. A colonoscopy is considered the most effective screening and prevention option for colon cancer, giving physicians the best opportunity to detect and remove precancerous polyps potentially before they become malignant.
Only a small percentage of polyps removed during colonoscopies run the risk of becoming cancerous. But any polyp that measures 1 cm or larger should be considered high-risk and means the patient should be screened more frequently. It also means that the patient’s close relatives may be at higher risk of colon cancer.
A family affair
While we’re catching a high-risk population through preventive screenings, we are also identifying an entirely separate high-risk population: children of the patients that were just screened and found to have high risk polyps such as greater than 1 cm or with certain advanced characteristics.
Family history plays a significant role in our health. If you’ve had a high-risk polyp removed, that potentially leaves your children at a higher risk. If your doctor finds any polyps during a colonoscopy, ask questions. What type of polyps were found? How big were they? How many were found? Where were they found?
Make sure to then share this information and your full family health history with your children, so they too can empower themselves and their health-related decisions.
The U.S. Preventive Services Task Force (USPSTF) in 2021 lowered its recommended age to begin colorectal cancer screenings from 50 to 45. The change in screening age is critical given the rates of colorectal cancer in a younger age group at the time the USPSTF made its recommendation.
While the incidence rates have generally declined since the 1980s, the American Cancer Society reports that rates of colorectal cancer have increased for unknown reasons by 1%-2% per year in people younger than 50 since the mid-1990s. And when it changed its screening guidelines, the USPSTF reported that the incidence of colorectal cancer in adults between the ages of 40 and 49 had increased nearly 15% between 2000 and 2016.
It’s important to note that other colorectal cancer screening tests are also available, including an annual fecal immunochemical test (FIT), which checks for hidden blood in the stool from the lower intestines or a fecal DNA test that detects cancer and certain polyps. A colonoscopy will be necessary if the test returns abnormal results,6 but a patient can address that issue when, and if, necessary.
Barriers are real: Don’t let yourself be one of them
The key is being proactive. The best test someone can take is the one they are willing and able to take.
The Centers for Disease Control and Prevention estimate that nearly 72% of adults ages 50 to 75, or roughly 64 million people, were up to date on colorectal cancer screenings using a variety of tests in 2020, the year before the recommended screening age dropped to 45.
Barriers to preventive care do exist, including poor insurance coverage, patients not having a regular primary care physician, logistical challenges such as a lack of transportation and no recommendation from a PCP regarding screenings. Physicians need to advocate where they can and take an active role where they are able, such as simply discussing with patients when it’s time to get screened. The importance of preventive screenings is further illustrated when you consider the five-year survival rates of colorectal cancer.
If a screening does reveal cancer, the five-year survival rate of patients diagnosed with a localized stage is an estimated 90%. When cancer is found because of symptoms there is a higher likelihood of it being at a more advanced stage. When found at a more advanced stage, survival rates drop to an estimated 71% and 14% for regional and distant stages, respectively.
Don’t be the person asking, “Why me?” The idea of a colon cancer screening in any form may be uncomfortable, but that’s offset by the idea of having power over your own health and to prevent cancer. Don’t leave it up to chance.
Dr. Kachaamy is a paid consultant to Olympus Corporation, its subsidiaries and/or its affiliates.
Photo: sorbetto, Getty Images
Toufic Kachaamy, MD is the Chief of Medicine and the Medical Director Gastroenterology at City of Hope in Phoenix, Arizona. As a nationally recognized therapeutic endoscopist whose career has focused on the care of cancer patients, his clinical expertise includes gastrointestinal malignancies prevention, diagnosis, staging, and palliation. As a researcher and pioneer in the field of Endoscopic Oncology, he founded and chairs of the Endoscopic Oncology Special Interest Group for the American Society of Gastrointestinal Endoscopy. He has founded a continuing education course focused on Innovation and Endoscopic Oncology with the aim of educating the multidisciplinary cancer care team on the advances in this field to improve patient access to innovative procedures. He was voted Favorite Valley Dad for 2022 as part of the Arizona Foothills Magazine Best of the Valley competition. He considers this recognition as his favorite achievement.
