Colonoscopy an Effective Tool in Colon Cancer Prevention

Ellen Willard, M.D.

T.J. Pulliam, M.D.

ROCKINGHAM – According to the American Cancer Society, colorectal cancer will cause about 50,310 deaths in the United States this year.

Although this is a disturbing number, the number of deaths attributed to colorectal cancer has actually decreased steadily over the past 20 years.

The reason: an increased emphasis on regular screening coupled with lifestyle changes that can lower a person’s risk of developing the disease.

“The number of new cases of colon cancer has declined since the institution of regular colon cancer screening, and the number of deaths from colon cancer has decreased as well,” says Ellen Willard, M.D., a medical oncologist with the FirstHealth Outpatient Cancer Center in Pinehurst.

March is Colorectal Cancer Awareness Month, a time when Americans are encouraged to schedule a colorectal screening or to discuss their risks with their primary care provider.

According to T.J. Pulliam, M.D., a gastroenterologist with FirstHealth Gastroenterology in Rockingham, most cases of colon cancer could be prevented with screening. Unfortunately, he adds, only about half of the people who should been screened are actually being tested.

“That leaves a lot of people at risk for a potential colon cancer diagnosis,” he says.

About 90 percent of colon cancers start out as precancerous growths called polyps. If found in the early stage and successfully removed, these polyps will not progress to colon cancer.

“Typically, we find these polyps in only about 20 to 25 percent of patients during screening colonoscopy,” Dr. Pulliam says.

Several tests are used to screen for colorectal cancer, but the most effective is colonoscopy, an exam in which the rectum and entire colon are examined with a lighted instrument called a colonoscope.

During colonoscopy, which is considered the “gold standard” of colorectal screening, precancerous and cancerous growths throughout the colon can be found and either removed or biopsied during a single procedure.

Because colonoscopy is so effective, primary care providers have become more proactive in recommending that their patients be screened, Dr. Pulliam says, and insurers are becoming more likely to cover the cost of the test.

“Many insurers will even notify their subscribers that they need to have a colonoscopy,” he says.

Although the exact causes of colorectal cancer are not known, studies have shown that certain factors are linked to an increased chance that an individual will develop the disease. They include:

• Age, since the disease is more likely to occur as people get older
• Personal or family history
• A history of ulcerative colitis or Crohn’s disease
• Diet, especially with high consumption of red and processed meats and low consumption of whole grains, fruits and vegetables
• A sedentary lifestyle
• Smoking

According to Dr. Pulliam, individuals should consult with their primary care provider about when to begin colorectal screening. Typically, he says, routine screening is recommended to start at age 50 except for those individuals with a family history of polyps or colorectal cancer and for African-Americans, who have the highest colorectal cancer incidence and mortality rates of all racial groups in the United States.

In these incidences screenings may begin at age 45 or even 40 or earlier, depending on the circumstance.

Because polyps develop and grow slowly, most patients will be told after a clear screening that they will not need another exam for about 10 years.