COLORECTAL CANCER IS the second-leading cause of cancer deaths annually in the United States. People such as Dr. Stephanie Pannell want to change that for the better. But they need cooperation from people like, well, you.
“I wish people would follow the screening guidelines,” said Pannell, colon and rectal surgeon with the University of Toledo Medical Center. “If everybody got their screening from age 45, we could change it from being the second-leading cause of cancer deaths.”
The guidelines are that everyone—men and women— from age 45 should take a colon cancer test or undergo a colonoscopy, and repeat it every few years.
“The gold standard still is doing a colonoscopy,” Pannell said. In that procedure, a doctor looks inside the colon and rectum with a tube that has a small video camera at the end. The colon needs to be empty and clean so any abnormalities can be easily seen. For that to happen, the patient undergoes a bowel prep that includes drinking a special laxative to induce diarrhea the night before the procedure. This unpleasantness dissuades many from having a colonoscopy. There is an alternative: an in-home colon cancer screening. With this, available with a prescription, the patient collects a sample of his or her own stool. Some versions of this test require a special paper to be put in the toilet bowl to catch the stool; another has a container—much like a strainer—to secure the sample. A portion of the sample is put in a container or envelope and mailed to a lab for testing.
Pannell said there are two types of in-home tests. One tests for blood, the other for DNA markers. She said the DNA test “has the highest accuracy in detecting colon and rectal cancers.”
The pros to an in-house test over a colonoscopy? “The cost,” she said. “It’s cheaper than a colonoscopy. You can do it at your convenience. There are no dietary restrictions. There’s no bowel prep—having diarrhea multiple times is difficult. Honestly, it’s the worst part.”
The cons? “You could still have a false negative or positive. The chances are low, but they’re not zero.”
She cautions that the fecal-blood one has degrees of returning a false positive, which means the patient doesn’t have cancer but is otherwise concerned, or a false negative, which means the patient has cancer but thinks otherwise. For instance, she said certain foods, such as licorice, can produce a false positive in a fecal-blood test.
“If the DNA test is positive,” she said, “you need a colonoscopy.” In any case, a positive result prompts the procedure.
Whichever way the patient wants to proceed—with either type of inhouse test or a colonoscopy—the need to be screened or examined is there. A few years ago, the age at which the American Cancer Society recommended getting the first colon cancer test was lowered to 45 from 50 “because of an increase in diagnoses of people in their 40s for everybody. There’s been an increase nationwide, absolutely, especially in young African-American men in their 30s and 40s.”
What triggers colon cancer? “I wish we knew,” Pannell said. “Seventy- five percent is sporadic—no family history, no underlying disease to make a person more prone to have it. Random.”
It is treatable and curable. “That’s related to when it’s found,” she said. “Earlier detection increases the survival rate dramatically. That’s why the age was lowered—we’re hoping to find it earlier, before symptoms emerge.”
She said those symptoms are weight loss, bleeding, a change in stool caliber or bowel function, and associated pain. But by the time these symptoms show up, the cancer is advanced, which is why early detection by in-house tests or colonoscopy is important.
Pannell makes one other point, about age. While the age for the first screening is 45, there’s no ceiling. Usually after age 70 people would stop being screened, but with people living to be 90 or 100, she said it’s suggested people in this age group get a colonoscopy or some type of screening. There’s no aging out of colon cancer.
Dennis Bova is a freelance writer and editor. ✲
