By RAYMOND KENNY
For Montclair Local
Editor’s note: This series is written by the doctors at Summit Medical Group (SMG) on health-related topics. The following article is by Raymond Kenny, MD, a gastroenterologist in Glen Ridge. He is a pioneer in endoscopic procedures and the early use of endoscopic ultrasound.
Two weeks ago, a middle-aged man was referred to me after receiving a positive screening test for colon cancer. He had been advised regularly by his primary care physician at each wellness exam to get a screening colonoscopy. But for more than a dozen years, he declined.
I am not sure why he deferred the screening for so long—perhaps it was inconvenient to take time out of his busy schedule. Maybe he feared the discomfort or was worried about the cost. While these concerns are all valid, they could have been quickly assuaged if he simply had more information.
Finally, after years of wrangling he agreed to at least perform a stool test, which returned positive and brought him in to see me. Within days I performed a colonoscopy and found a tumor encompassing most of the circumference of his colon.
Colorectal cancer, which originates in the colon or the rectum, is the third most common cancer diagnosed and the second leading cause of cancer death among both men and women in the U.S. In 2017, an estimated 135,430 people were diagnosed with colorectal cancer and 50,260 people died from the disease, according to the American Cancer Society.
Given that this man had no symptoms, and his cancer was found through screening, his prognosis is better than a patient who walks into my office with symptoms. There are rarely signs in the early stages of the disease, but as colon cancer progresses it can cause abdominal pain, bleeding, or a change in bowel habits. Unfortunately, however, the patient and his family now have to go through the stress of surgery and six months of chemotherapy.
This story is an example of the adage “the best screening test for colon cancer is the one that gets done.” Since colonoscopy screenings were first performed in the U.S., the incidence of colon cancer has declined by 30 percent and the chance of dying from the disease has decreased by 55 percent.
People are often surprised to learn that at least 60 percent of individuals who are in the age group to be tested have already undergone screening. My fellow gastroenterologists and I would like to see that figure increase to 80 percent by the end of 2018 — a rate similar to mammography and Pap smears screening adherence among eligible women.
Anyone between the ages of 50 and 75 should be screened. People identified as high-risk should start even earlier — African-American males are advised to begin screening at age 45 and patients with a family history of colon cancer in a parent or sibling can start at 40 years old.
During a colonoscopy, gastroenterologists often remove polyps—noncancerous growths that can develop into cancer over time. While it is not yet the standard of practice, many of us already monitor our performance with a quality measure. An adenoma detection rate (ADR) is the percentage of screening examinations in which at least one precancerous polyp (adenoma) is found.
Why is this important? ADR measures the quality of colonoscopic performance. If your colonoscopist does not track this metric it means they do not know what they are doing with the colonoscope.
We have made great strides in the detection and prevention of colon cancer. While colonoscopy is not perfect, it is the current gold standard for screening and has helped reduce both the incidence and mortality of this disease.
If you are apprehensive about colonoscopy, have an honest conversation with your physician. If you choose not to be screened, a noninvasive stool test is a reasonable proxy to detect colon cancer.
Talk to your doctor to find out what type of screening is best for you. And, for more information online, visit cancer.org or smgcolonoscopy.com.