Recently, the American Cancer Society changed its recommendation regarding colorectal cancer screenings. The ACS now recommends screenings should begin at age 45 rather than age 50.
According to Dr. Imran Hassan, colorectal surgeon at Mercy Medical Center in Cedar Rapids, the key thing for patients to remember is that the ACS is calling for screenings — but not necessarily colonoscopies — at an earlier age.
“It’s not that you need to have a colonoscopy at 45; it’s that you should be screened for colorectal cancer at age 45 with one of the five methods that they recommended,” Hassan said.
Those methods include three different kinds of stool tests, CT colonography and colonoscopy.
“The ACS did not recommend one over another,” Hassan said. “They said they are all equally recommended.”
The new recommendation from ACS is not necessarily going to be simple to implement across the board, because there still is some question as to whether or not insurance companies will agree to pay for testing for people who are not yet 50 years old.
When it comes specifically to colonoscopies, regardless of a person’s age, Hassan said there are two main barriers people face. The first is the horror stories people tell about colonoscopies; the second is the discomfort that comes with such an invasive test. Hassan has advice for overcoming each impediment.
“Don’t go by what people tell you because people will tell you a lot of things. That’s the first thing,” he said. “Maybe you had a co-worker or an aunt or an uncle who said something and that sort of puts people off. Most of the time it’s the prep that they hear about — that the prep was terrible. They had to drink and have a purge and were in the bathroom all night, and it was a bad experience. It’s obviously not a pleasant experience, but almost everybody gets through it. And once you get through it, the test in itself is not that complicated. Most people handle it well. It’s mostly the fear of the unknown that drives people from doing it.”
As for the invasiveness of the test, Hassan acknowledges the awkwardness.
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“It’s an embarrassing test. People are looking at your bottom and you feel like it’s a violation of your privacy,” he said. “But the slogan is, ‘Don’t die of embarrassment.’ Just because you’re embarrassed and don’t do the test, you could die of colon cancer. You don’t want that to happen.”
Your primary caregiver can make a referral or order a screening. The downtime for a colonoscopy is brief in most cases.
“You can go back to work the next day. You miss usually one day of work or function, because you do the prep in the evening when you come home,” Hassan said. “Then you can have the test in the morning or in the afternoon, and then you should be good to go the next day in most cases.”
Hassan emphasized the importance of overcoming discomfort and embarrassment in order to get screened.
“We do colon cancer screening to find cancers early and to detect polyps and remove them — this prevents the polyps from turning into cancer. Colon cancer is curable. If you find it early, then 90 percent of colon cancer is curable. But if you catch the cancer late, once it has already spread, then the survival rates go down substantially — by half or even less, depending on how far it spreads.”
Colonoscopies and the other screening options aren’t just for individuals who have suspicious symptoms like rectal bleeding or changes in their bowel habits (though those with symptoms or who have above average risk factors — including family history and conditions like inflammatory bowel disease — need to be screened earlier).
“Two-thirds of all colon cancers don’t have any symptoms; it’s asymptomatic,” Hassan said. “So waiting for symptoms is not the right thing to do. Instead, they should get screened. And that’s what people have to understand.”