Exam need is the bottom line

An ounce of prevention is worth a pound of cure, according to Benjamin Franklin, but in the case of colon cancer, a gallon of prevention may be worth a life that’s cancer-free. Colon cancer is the second-leading cause of cancer deaths in the U.S., and doctors in the gastroenterology department at Trinity Health have noticed an increase in colon cancer cases.

Colorectal cancer, sometimes called colon cancer, is cancer that occurs in the colon (large intestine) or rectum. Both men and women can get it, it’s most often found in people age 50 or older and the risk increases with age, according to a fact sheet from the federal Centers for Disease Control and Prevention. It’s important to have a screening test because symptoms aren’t always present, but some symptoms include blood in or on your stool, stomach pain or aches or cramps that don’t go away and unexplained weight loss.

North Dakota, according to the fact sheet from the CDC, had an interval of 54.1 to 59.2 percent of adults aged 50 to 75 years who reported being up-to-date with colorectal test screening in 2010. “Up-to-date” means that the respondent had a fecal occult blood test during the previous year, a sigmoidoscopy within the previous five years and an FOBT within the previous three years, or a colonoscopy within the previous 10 years.

Dr. Edmundo Justino, gastroenterologist at Trinity Health, said that compared to the national average, North Dakota does poorly when it comes to getting screened for colon cancer.

“Colon cancer rates are pretty high,” he added. “About 50,000 people will die from it this year and we can cut those numbers significantly if people come in for a screening.”

Colon cancer gives a big window for prevention, though, Justino said, and prevention is key. “At age 50, about 25 percent of the population will have some kind of polyp, so they’re suggested to get screened.”

Dr. Rukshana Cader, also a gastroenterologist at Trinity Health, said it takes 10 years for polyps to develop into cancer, but between ages 50 and 55, the risk doubles. People can have polyps and have no symptoms of colon cancer, she added. “Patients don’t know they have it, so they think they have no symptoms. Screening saves lives.”

Both Justino and Cader don’t know why the rates for people getting screened for colon cancer are lower in North Dakota. Justino thought it was because people think insurance doesn’t cover the screening and also there’s a misunderstanding of the procedure or not being familiar with the procedure.

“I blame us for not getting the education out there,” he said. “The procedure is not painful, but a lot of people think it’s painful.”

However, screening for colon cancer at age 50 will generally be covered through insurance, Justino added.

There are several different types of screening tests, but people are seemingly most familiar with the colonoscopy where a long, thin, flexible, lighted tube is used to check for polyps or cancer inside the rectum and the entire colon. During the test, the doctor can find and remove most polyps and some cancers. It is also used as a follow-up test if anything unusual is found during one of the other screening tests.

The colonoscopy is the best method to screen for colon cancer, Cader said. It’s the preferred method for screening, she added, because they can really see the colon. However, the preparation for the colonoscopy usually puts people off, Cader noted. One of the preparation steps for the colonoscopy involves drinking a gallon of phosphosoda laxative mixed with water or ginger ale to flush out the colon the night before.

The actual colonoscopy procedure takes 20 minutes to a half hour in a normal colon, said Justino.

“That’s 20 minutes of being in the procedure room, but it takes a longer time getting ready and with recovery,” he said. “We have new sedation that’s used here where the patient doesn’t feel much pain.”

People normally get a colonoscopy at age 50 and if there’s nothing there, Cader added, then they get one every 10 years.

It takes awhile for the person to come in for a colonoscopy, though, Cader said. The person’s primary care physician encourages him or her to get a colonoscopy, but the person will usually come in at age 52, 53 or 54, she explained. Or if the person is a male and has a pushy wife, he will come in earlier for the procedure, Cader noted.

“Unfortunately, some will come in because they have blood in their stool or they’re not feeling well or losing weight for no reason,” she added.

One excuse that keeps a person from getting a colonoscopy is having to take time off from work, Cader said. Another thing, a lot of women feel uncomfortable with a male doctor performing the procedure, she added, but Trinity has Cader, who can do that now.

“Colon cancer is (one of the) leading causes of death and you can eliminate that by coming in for a screening,” Justino said. “So if you come in for a screening, we can catch it and keep an eye on it and you’d never have to die from colon cancer.”

For this area, Justino said he and his colleagues need to be more aggressive with advertising to keep the buzz that the best way to prevent colon cancer is to get screened.

“We also need to be more open about the procedure being private and not painful,” he added.

While the gastroenterology department is a busy place at Trinity, both Justino and Cader assured that the waiting time to get the procedure done would happen within two weeks. The person would need a referral from his or her primary care physician, though, Cader added.

The thought, Justino said, is that if everyone would get screened starting at age 50, the rates of colon cancer deaths could be reduced by 60 percent.