Colorectal cancer prevalent but plenty preventable

Colorectal cancer prevalent but plenty preventable

CHAMPAIGN — Give in and have the dreaded colonoscopy, or keep putting it off and hope for the best?

For millions of older adults advised to undergo a screening for colorectal cancer, it's option two. But screening doesn't have to be a choice between colonoscopy or nothing.

Deaths from colorectal cancer have declined 52 percent between 1970 and 2015, in part due to increased screenings to find precancerous and cancerous growths called polyps and get them removed before they become serious trouble.

But about one in three adults in the 50-75 age group don't get the recommended screenings.

Colorectal cancer — which can include cancer starting in the colon or rectum — is preventable when polyps are removed before they grow into cancer, and it's largely curable when the cancer is caught and treated early. Yet it ranks near the top of the list of causes of cancer deaths, second-highest only to lung cancer.

Among those likely to skip screenings are men in the 50-64 age group, people who live in rural areas and those with lower education and income levels, according to the National Colorectal Cancer Roundtable — an initiative striving to raise screening compliance to 80 percent.

If an 80 percent screening compliance rate would be achieved this year, the organization projected 277,000 colorectal cancer cases and 203,000 colorectal cancer deaths would be prevented by 2030.

Often blamed for screening gaps is the standard colonoscopy, an invasive procedure done under sedation that requires an unpleasant prep beforehand.

Dr. Paul Tender, a colon and rectal surgeon at Carle, understands why many people turn down colonoscopies.

"You're asking them to put themselves through that for this theoretical advantage, and a lot of people make a choice not to do that," he said.

But there are other screening options for people in the normal risk range. Tender's advice is to choose one of them with your doctor to give yourself the best chance of avoiding a devastating disease.

"The majority of people who get it have no family history, and if you wait for symptoms to develop, it's too often incurable," he said.

Choices available

Among the other screening choices to standard colonoscopy are virtual colonoscopy, done with a CT scan; sigmoidoscopy, which examines only the lower part of the colon; the fecal occult blood test, which checks for hidden blood in the stool; and a newer do-it-yourself fecal test being marketed under the brand name Cologuard.

All the screening options come with their own advantages and disadvantages, and none — including colonoscopy — are 100 percent accurate.

The Cologuard test, which is available by prescription, checks for both blood and/or DNA biomarkers in the stool, which can be an indication of cancer or pre-cancer. Patients collect their samples in the privacy of their own bathrooms and mail them to a lab.

Cologuard caught 92 percent of cancerous polyps and 42 percent of the highest risk precancerous polyps in a trial of 10,000 people — though some false positives and false negatives do occur, according to the product maker, Exact Sciences.

This test isn't for everyone. Cologuard is intended for adults 50 and older who are of typical average risk for colorectal cancer rather than higher-risk people — for example, those with a family or personal history of colorectal cancer or polyps.

Tender considers it a viable screening choice — with some warnings. Because of the detection rate for precancerous polyps, this test needs to be done more frequently — once every three years — as opposed to a 10-year interval for a colonoscopy when polyps haven't been found, he said.

"The expectation is that the increased interval in Cologuard testing mitigates the degraded polyp detection rate, so the end result is a similar effect on cancer prevention," he said.

The doctor's choice

Tender also warned that any positive Cologuard test findings will require a follow-up colonoscopy.

Data collected by Carle on its own patients indicated the odds of avoiding a colonoscopy after a Cologuard test aren't bad. Polyps are found in only about 30 percent of people at average risk, Tender said.

"Arguably, 70 percent of people could avoid a colonoscopy," he said.

Dr. Qazi Khusro, a Christie Clinic gastroenterologist, views Cologuard as a good screening tool to catch cancer, but not so much for pre-cancerous polyps. And the way he sees it, preventing cancer tops finding it early.

"Colon cancer screening is really a misnomer," he said. "What we are really aiming for is prevention."

For those choosing Cologuard or another screening option, be aware that the colonoscopy that follows to diagnose a positive finding likely won't be considered a screening, Khuro warned.

The Affordable Care Act requires insurers to cover colonoscopies without cost to patients only when they're done on a screening basis. That is, when there have been no symptoms or previous findings of polyps.

When he explains the risks and benefits of the different screening methods, Khusro said most patients choose to have the colonoscopy.

"That's what I choose for myself. That's what I'd recommend for my wife," he said.

Regional rates

Some East Central Illinois counties have higher colorectal cancer rates than others.

In the most recent data available from the State Cancer Registry, Champaign County had what was considered to be a substantially lower rate of colorectal cancer compared to the rest of the state, while Vermilion, DeWitt and Edgar counties had significantly higher rates.

Champaign County also had a significantly lower rate of colorectal cancer deaths.

Keep in mind that colorectal cancer risk has been higher in older adults, said Vermilion County Health Department Administrator Doug Toole. The median age in Champaign County is 29 and the median age in Vermilion County is 40, he said.

"Eighteen percent of our population back in 2015 was 65 or older, and statewide it's 14 percent," he said.

The levels of health-related lifestyle choices, such as smoking and lack of exercise, also vary by county, Toole said.

Nobody can control two of the major risk factors for colorectal cancer, which are older age and a family or personal history. But lifestyle choices — including smoking, being overweight, excessive drinking and lack of exercise — also raise the risk.

"In areas where there is a higher incidence of screening, there's lower incidence of colorectal cancer," Tender said. "It's things like access, health care literacy, financial impact, cultural values, what connections do people make between their health care choices and their health care outcomes."

While screening has contributed to a national decline in colorectal cancer cases in older adults, an upswing in cases among younger adults recently prompted the American Cancer Society to call for screening to begin younger — at age 45 — for those at average risk. People with a family history of colorectal cancer should begin screenings even younger than that, Tender cautioned.

"If your father had it at 45, you should be getting your screening in your 30s," he said.

Regardless of the screening option chosen, they're all better than doing nothing, Tender and Khusro said.

"How do you measure a horrible thing that never happened to you? How do you measure the impact of a horrible thing that you avoided?" Tender said. "I don't know how to impress that upon people."

Did you know?
➜ Colorectal cancer is expected to cause 500,600 U.S. deaths this year.
➜ Smoking raises the risk for this cancer by 30 to 40 percent.
➜ The lifetime risk of getting colorectal cancer is one in 22 for men and one in 24 for women.

COUNTY COMPARISON

In Illinois, the rate for colorectal cancer per 100,000 people is 51.6 for men and 37.6 for women. Here’s a breakdown of how area counties stack up using the same per-100,000 formula:

County: Men and Women
Champaign: 40.6 and 29.5
Douglas: 56.6 and 26.2
Ford: 44.8 and 51
Piatt: 39.9 and 31.6
Vermilion: 66.5 and 44.9

Note: The rates are for 2011-15, the most recent data period available through Illinois State Cancer Registry.

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