Newswise, April 20, 2017 — Perhaps
you’ve seen the commercial: an animated box sitting on a toilet that tells you
to “just go” — that is, collect your stool — and ship the sample to a lab to be
screened for cancer and pre-cancer. This DNA-based, non-invasive test is just
one option now available to screen for colon cancer.
In the past, colonoscopies were the
go-to form of screening. While some people sign up for regular checkups, not
everyone is so willing to be probed when they may not feel symptoms of disease.
However, cancer can grow without noticeable signs and when disease becomes
obvious, it may already be advanced.
Samir Gupta, MD, is a
board-certified gastroenterologist at UC San Diego Health and Veterans Affairs
San Diego Healthcare System with expertise in colorectal cancer screening and
prevention., so we asked him about the importance of early detection and less
intrusive testing, including fecal and blood tests, that might increase
participation in screening for disease.
Question: Why
are colorectal cancer screenings necessary?
Answer:
Colorectal cancer is the second leading cause of cancer death in the United
States. According to the National Cancer Institute, an estimated 134,000 new
cases were diagnosed in 2016 and nearly 50,000 people died. But when discovered
early through screening, colorectal cancer is highly treatable. Screening can
even prevent cancers from developing through detection and removal of
precancerous polyps. Also, screening can detect polyps and cancer before you
even have symptoms.
Q: Which
screening tests should be used?
A: The
best test is the one that is most acceptable to you. The one that you are
willing to have done now. Your physician might recommend a specific test based
on your medical and family history, but ultimately it’s up to you. Tests
include http://jamanetwork.com/learning/video-player/13030589 a traditional
colonoscopy, a CT colonography, a stool test to check for blood or abnormal DNA
or a sigmoidoscopy.
According to the United States
Preventive Services Task Force (USPSTF), an independent group of national
experts in prevention that makes evidence-based recommendations about clinical
preventive services, including screenings, there is no information
demonstrating that any one is better than another so pick one and get screened
based on your personal preferences.
For example, if you want to place
the greatest emphasis on sensitivity for colon cancer and polyps, ability to
detect and remove polyps if present and a long interval between normal exams,
colonoscopy may be the best test for you. If you prefer the convenience of a
non-invasive, at-home test and don't mind repeating a test frequently, consider
a stool test that checks for blood or blood and abnormal DNA. Your doctor can
also help you decide the best test for you.
Q: Who
should be screened for colorectal cancer and when?
A: Men
and women of all racial and ethnic groups should be screened for colorectal
cancer. The USPSTF recommends that men and women start screening for colorectal
cancer at age 50 and continue until age 75. After that, it’s best to have a
conversation with your physician to make individualized decisions on whether it
is necessary. For people 85 and older, screening is no longer recommended.
Although it is most often found in people 50 years or older, incidence in
people younger than 50 is on the rise. If you’re under 50 and you have family
history or notice a change in bowel movements, blood in your stool and/or
weakness or fatigue, talk to your physician. It may be nothing, but to use an
old cliché, isn’t it better to be safe than sorry?
Q: What
happens if the test shows abnormalities?
A:
Should the results of a test come back indicating the presence of polyps or
cancer, your physician may request further tests.
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