COLORECTAL CANCER SCREENING

If you are not particularly enthusiastic about colorectal cancer screening, you are not alone. But according to the U.S. Preventive Services Task Force, a governmental agency that provides recommendations for clinical practice, people over the age of 50 should start getting used to the idea. The task force strongly suggests that colorectal cancer screening begin at the age of 50 years of age for men and women who have an average risk of colon cancer. For those at higher risk, screening can begin earlier.

Colorectal cancer is the second leading cause of cancer death in the United States, and its symptoms often appear only late in the cancer's development. Regular screening techniques can catch the disease when it is still curable.

Below, colorectal cancer experts describe the various procedures for colon cancer screening, and explain why early detection can make a difference between life and death.

Why is screening so important?
If you detect and treat the disease when it's localized, you essentially can cure any cancer. If you wait until the disease has spread, or metastasized, it becomes very difficult to cure patients. So screening, with the detection of early, curable disease, is a very important aspect of all cancer, and it's a very important aspect of colon cancer, which is a really common disease in the United States.

What are the  ways people go about screening?
The most effective and most comprehensive is colonoscopy, which is a procedure that involves putting a tube in the intestine, and looking around the entire colon. That's also the most invasive, and it's done with sedation, so a patient is relatively sleepy or asleep.

Then there's a sigmoidoscopy, which is a much less invasive test, and the doctor is looking at the bottom of the colon only. That's usually combined with fecal occult blood testing, which is the little card that doctors or nurses use to see if there's any occult or microscopic blood in the stool (feces).

Barium enema is another test used in the screening of colorectal cancer, and this is a radiographic, or an x-ray, test.

Finally, there is virtual colonoscopy, which is a fancy three-dimensional CAT scan, which still requires the same preparation as colonoscopy, but it's an indirect or an x-ray measurement of the internal view of the colon.

Decide which method is right for you If you do a colonoscopy and you find that the colon is entirely normal - it has no polyps, no abnormalities - this substantially decreases the risk of death from colon cancer in the next 7-10 years. So it's a very good screening test. Also, if you find an abnormality with colonoscopy, the doctor can do something on the spot. The doctor can take a biopsy, if it's a tumor, or can actually remove a polyp. So it's a useful procedure, both diagnostically and therapeutically.

Does this disease affect men  much more than women?
Some people think of colon cancer as a male disease, and that's completely false. It affects men and women equally.

Why don't men and women get screened? Are people afraid of the screening process?
Yes! It's the same reason people tend not to get their blood pressure checked regularly. Or prostate exams or pap smears. There's sort of a natural aversion to screening procedures among healthy people. When we make screening an important part of ongoing healthcare, then people tend to do it. And if it can be made relatively easy, people will do it.