Thursday, 5 September 2013

Screening: Colorectal Cancer - Yes this applies to you!

Nobody wants to talk about screening for colorectal cancer and I've never completely understood why. Is it because the colon is in the "backside" neighbourhood of the body? It's close to and may somehow end up involving poop? Are people worried that some major machinery might be inserted "up there" and "up there" is considered an exit-only kind of place?


Patients don't tell me why they don't want to have screening for colorectal cancer. They just go very very quiet. Sometimes even pale. I think they run into my clinic for medication renewals praying that I won't look at their health profile and notice that they haven't had screening. But here's the thing...I am going to look. The clinic will send letters. I'm even willing to run after you in the street with a screening kit if it will work. Let me tell you why....
  1. Colorectal cancer is the second most common cancer diagnosed in Ontario (prostate is #1)
  2. Colorectal cancer is the second most common cause of cancer death in Ontario (lung is #1).
  3. Ontario has one of the highest rates of colorectal cancer in the world.
  4. Colorectal cancer is 90% curable if detected early. 
Screening can be the difference between life and death. As more people engage in screening the survival rates for colorectal cancer are going up. Patients often request mammograms, cervical pap tests, and prostate specific antigen (PSA) blood tests and this is a great thing. I'd like to get people asking for the colorectal screening tests. So what's involved? It's really not as bad as one might think.

People with an average risk of getting colorectal cancer:

  • No symptoms of bowel disease, no family history of colorectal cancer
  • Screening starts at age 50 years old until age 79 years old for both men and women
  • Screening test used: Fecal Occult Blood Test (FOBT). Affectionately known as The ShitKit
  • The FOBT is a very simple test that you do at home. There are three collection cards on which you smear a very small sample of feces from three different bowel movements on three different days. There are detailed instructions. The kit is returned in an envelope to your clinic. 
  • Preparation: there is none for the FOBT. You are asked to avoid fruit juice while collecting. 
  • Frequency of screening: every 2 years until age 79y


People with an increased risk of getting colorectal cancer: 
  • A first degree relative (parent, sibling, child) has had colorectal cancer
  • Screening starts at age 50 years OR 10 years before the age that your relative was diagnosed whichever comes first. Some guidelines recommend starting at age 40y. 
  • Screening test used: Colonoscopy
  • A colonoscopy is an examination of your rectum and colon using a flexible tube with a camera on the end. Don't panic. You can be under general anaesthetic for the procedure and you don't feel a thing. If polyps are seen on the bowel they can be removed right there on the spot and sent to the lab for analysis. This procedure is completely painless.
  • Colonoscopies are available in Campbellford, Cobourg, Peterborough and Belleville.
  • Preparation: I won't lie. You have to "clean out" which means staying at home close to your bathroom for a day. But hey....some people pay good money for colonic cleansing? You are going to get it for free!
  • Frequency of screening: depends on results of your first colonoscopy and if you had any polyps or not. Frequency can be every 10 years (no polyps) to every 1-5y (polyps).
  • After the test: someone has to come and pick you up from the hospital and then make you dinner. A very big dinner. 

So screening isn't all that scary. Talk to your Nurse Practitioner or Physician about screening. If you have general questions please post them in the comments section below (click on the pencil icon). There are some excellent websites - please see the reference list below. In upcoming articles there will be specific information on reducing your risk of colorectal cancer (hint: it involves fruit and vegetables! Are you surprised?). 

Thanks for reading Getting Healthy with NP Sam. Comments welcome.






References:
Canadian Association of Gastroenterology. (2004). Guidelines on Colon Cancer Screening. In Can J Gastroenterology, Vol 18 No 2, Feb 2004. Accessed at http://www.cag-acg.org. 

Cancer Care Ontario. (2012). Colon cancer check 2010 Program Report. Toronto, Canada. Accessed from www.cancercare.on.ca/coloscreening.


Cancer Care Ontario. (2008). Colon cancer check. Toronto, Canada. Accessed at www.ColonCancerCheck.ca 

Cancer Care Ontario. (2008). Insight on cancer: News and information on colorectal cancer and screening in Ontario. Toronto: Canadian Cancer Society (Ontario Division), December 2008. 2008. Accessed at www.cancer.ca or www.cancercare.on.ca 

Evans, M. (2009). Testing for cancer: my options my choice. Toronto: Centre for Effective Practice. January 2009. 

3 comments:

Anonymous said...

How often should this test be done?

Samantha Dalby said...

The fecal occult blood test (FOBT) should be done every 2 years. If you need a colonoscopy the surgeon will advise when to repeat it based on your results. If there are no polyps or abnormalities the colonoscopy is usually repeated in 10 years.

Bobby said...

Wonderful Information. Thanks for sharing. I had no idea that early colonoscopy screening would prevent colon cancer cases.