Colonoscopy saves lives

This screening test can help prevent unnecessary deaths from colorectal cancer

Mortality rates from cancers of the colon and rectum are going down—and many of the roughly 50,000 American lives still lost to these cancers each year could be saved by wider use of colonoscopy. It’s a screening test in which a video camera is inserted into the colon to search for incipient growths called polyps, which can develop into cancerous tissue.

“It’s one of the very few tests we have that are both diagnostic and therapeutic,” says Mark E. Gilder, M.D., a colorectal surgeon at Saint Barnabas Medical Center. “Colonoscopy can find problems and do something about them, which makes it very effective.”

During a colonoscopy, the doctor puts you under sedation so that you are either semi-wakeful or asleep. He or she inserts a thin, flexible tube into your rectum and colon. The tube has a small light, a camera and a surgical tool. If the doctor finds any polyps that look even remotely suspicious, he or she can remove them right then. The tissue is sent to a lab to examine for cancer cells. In most cases, the polyp is benign, and no extra follow-up is required. If the polyp is a type that is more likely to become cancer, or if you have other risk factors for the disease, the doctor will decide on what follow-up screening or other services you need.

Colonoscopy is the “gold standard” in screening for colorectal cancer, Dr. Gilder says. People with no known risk factors should have their first colonoscopy around age 50 and undergo the test again at least every 10 years. “But if you have a family history of the disease, start being screened 10 years before the age at which your first-degree relative was diagnosed with the disease,” says Dr. Gilder.

Preparing for a colonoscopy involves taking laxatives that clean out the colon completely over a period of several hours. It’s not fun. Yet that small inconvenience might spare you for decades of living you’d otherwise miss. Still, according to the Centers for Disease Control and Prevention, some 22 million Americans are not up to date with their screenings.

While colonoscopy is the best way to find and treat this cancer, there are other things you can do to make those problematic polyps less likely to develop in the first place. “It helps if you are lucky enough to have good genetics,” Dr. Gilder concedes. “But lifestyle choices play a huge role too.” He lists weight control, moderation in alcohol and meat consumption, regular exercise and quitting smoking as “common-sense things” that can lower your risk for colorectal cancer. A daily low-dose aspirin and calcium supplements may also help prevent the disease, the doctor adds, but you should talk to your physician before starting either of these therapies.

A diet rich in fiber has long been associated with lower incidence of colorectal cancer, but this link was based mostly on descriptive studies. In recent years, when scientists have conducted randomized trials comparing people with high-fiber and low-fiber diets, says the Harvard School of Public Health, “no difference was found in the rates of colon polyps”—cancer precursors. So don’t count on a high-fiber diet to save you from this cancer. “But we still recommend it for other reasons,” says Dr. Gilder, citing among these reasons overall digestive and heart health.

Dr. Gilder is quick to add that treatments for colorectal cancer have improved tremendously over the past two decades. If a polyp is too large to remove during a colonoscopy, the tissue can be removed via minimally invasive surgery. Further treatment choices, including more surgery, radiation and chemotherapy, depend on where the tumor is located and how far it has progressed. “We’ve become more aggressive, using minimally invasive surgery, including robotic surgery, and changes in chemo and radiation therapies have also helped to greatly improve survival rates,” he says. Indeed, when colorectal cancer is caught in stage 1, the earliest stage, the cure rate is over 90 percent. And with today’s minimally invasive methods, adds Dr. Gilder, patients spend less time in the hospital and return to daily activities more quickly. “Patients typically can drive back to our office for their initial postoperative visit after one week,” he says.

It takes a multidisciplinary team of physicians, surgeons, pathologists, oncologists and nurses, like the team at Saint Barnabas, to assure the best possible clinical outcomes in the battle against colorectal cancer, Dr. Gilder points out. “But the most important player on that team is you,” he says. “It’s your responsibility to take an active part in preventing this disease, through making healthy lifestyle choices and undergoing colonoscopy when it’s recommended.” —D.L.

Good news— and not-so-good
50% In 2003–2007, colorectal cancer screening prevented about half of the new cases—and deaths—that would have been expected according to trends a few years before.
13% The percentage of adults screened for colorectal cancer increased 13 percent from 2002 to 2010.
$14 billion The estimated direct medical cost of colorectal cancer care in 2010 was a whopping $14 billion.

Source: U.S. Centers for Disease Control and Prevention

Are you at risk for colorectal cancer? People over age 50 face the highest danger of developing colorectal cancer. Other risk factors are:

• polyps inside the colon
• family history of colorectal cancer
• smoking
• obesity
• lack of physical activity
• heavy alcohol consumption
• a health condition such as Crohn’s disease, which causes chronic inflammation of the intestines

Source: healthfinder.gov, U.S. Department of Health and Human Services