What better way to take charge of your health in 2020 than to get a colonoscopy!

Said no one ever.

If you are at the recommended age to have a colonoscopy (age 45, with average risk), you’re probably not jumping out of your seat to get one.

Read on to see why you should actually be reaching for the phone to schedule it.

What is cancer screening and why is it important?

Cancer researchers around the globe are not only focused on developing new treatments for cancer, but just as importantly, have established innovative ways to check, or screen, for cancer. Although cancer treatments have dramatically improved over the past few decades, cancer is still a devastating disease that kills over 600,000 people in the United States each year and is a significant burden on healthcare systems worldwide. Because screening methods are so effective, cancer screening is one of the major ways we can improve survival rates and reduce the burden on the healthcare system.

Why is it so important to get a colonoscopy when it’s recommended? Why should you get screened for colon cancer (or any cancer) when you feel perfectly healthy and have no symptoms?

The answer is because it can save your life.

Colon cancer is the third leading cause of cancer-related death in men and women and according to the American Cancer Society, approximately 104,610 individuals will be diagnosed with colon cancer this year.

However, although the number of deaths due to colon cancer is high, that number is actually decreasing due to the success of screening methods. And here’s why.

Colon cancer screening is designed to identify precancerous polyps—early stage abnormalities that precede cancer—and larger cancerous tumors. Precancerous polyps can be removed during a colonoscopy, preventing them from developing into a tumor, and if a larger tumor is found, a treatment plan can be started right away.

Medical illustration of Colorectal Cancer – Polyp

Cancer screening is not something doctors came up with to make you feel nervous and uncomfortable, but is an important preventative measure designed to catch the signs of cancer early when the chances of survival are better.

Some cancers grow so slowly and may not cause actual symptoms until they have grown larger and have become more difficult to treat. Colon cancer is one of these. Colon cancer typically starts with a polyp—a small bump—that grows in the lining of the colon, or large intestine. Over time, this polyp, which usually starts out as benign (or harmless) can grow into a larger tumor that is malignant (or cancerous). Some larger tumors may even spread to other parts of the body (a process called metastasis), forming secondary tumors in other organs.

In this way, the smaller the polyp, the easier it is to remove and/or treat. A tumor’s size, malignancy, and whether it has spread beyond its original location are important characteristics for establishing tumor stage, which is associated with prognosis and survival.

Tumors are staged in a standardized manner based on the results of various diagnostic tests. This thorough characterization of a tumor helps clinicians determine a treatment plan and establish a prognosis.

A lower-stage tumor is less aggressive compared with a higher-stage tumor, and is also generally associated with better prognosis and long-term survival. According to the American Cancer Society, if colon cancer is found localized to the colon (i.e., not spread to other parts of the body), the survival rate after 5 years is 90%. That means that 90% of people diagnosed with localized colon cancer are still alive 5 years later. Once colon cancer has spread, however, the 5-year survival rate is only 14%.

Additionally, in a study of 2,602 patients who had polyps removed during colonoscopy, only 12 of the 1,246 patient deaths were due to colon cancer, suggesting that removing polyps lowered the chances of death due to colon cancer by 53%.

These numbers illustrate how important it is to find colon cancer early – it could literally save your life.

How does colon cancer screening work?

Colon cancer screening is actually quite straightforward. Thanks to development of the colonoscopy, a clinician can simply just look for it.

This is in contrast to other cancer types, where a tumor may not be easily visible without sophisticated imaging techniques like magnetic resonance imaging (MRI) or positron emission tomography (PET). During a colonoscopy, a small camera is positioned in the colon, allowing a doctor to look at the inside. A healthy colon lining is typically smooth, whereas polyps or tumors appear as bumps or irregularities in the smooth surface.

This is the screening part of the procedure.

But a colonoscopy can also be preventative. Polyps generally grow out of the colon’s inner surface. Think of the head of a flower before it opens, attached to a stalk. Similarly, a colon polyp is attached to the inner colon lining, but buds outward toward the center. This facilitates its removal during a colonoscopy, where the doctor can simply pinch it off, using a biopsy tool. Since many polyps do progress and develop into full-blown cancer, polyp removal can help prevent colon cancer.

Removal of a colonic polyp with a electrical wire loop during a colonoscopy – 3d illustration

If only polyps are found, a repeat colonoscopy may be recommended in a given period of time. This helps to ensure that additional polyps do not develop; if they do, the repeat colonoscopy is designed to catch and remove them, preventing further progression and helping to ensure a colon cancer-free life.

However, sometimes a colonoscopy reveals a tumor that is too large to pinch off or is more embedded in the intestinal lining, indicating that the tumor is cancerous. In cases like these, a biopsy may be taken to further characterize tumor stage. Once this is established, a treatment plan can be put into action to prevent further disease progression.

When should I get screened?

The first piece of advice is to always listen to your doctor’s recommendations. Additionally, the American Cancer Society website is an excellent resource to learn more about cancer in general, as well as cancer-specific information, treatment options, and screening guidelines.

Regarding colorectal cancer screening, the American Cancer Society has recently lowered the recommended age to begin colonoscopy screening for anyone of “average risk” from age 50 to 45. This means that anyone aged 45 or older without a family history of colon cancer or inflammatory bowel disease is at the recommended age for their first colonoscopy screening.

Screening for anyone of “high risk” may need to occur earlier than age 45 or more often. High risk includes “a strong family history of colorectal cancer or certain types of polyps, a personal history of colorectal cancer or certain types of polyps, a personal history of inflammatory bowel disease, a known family history of a hereditary colorectal cancer syndrome, or a personal history of radiation to the abdomen (belly) or pelvic area to treat a prior cancer.”

It is important to note that these guidelines are not determined randomly. The recommended age was lowered in 2018 based on data showing that colon cancer was arising in a younger population; therefore, to ensure screening continued to capture early stages, the recommended age was lowered to 45 years old, “resulting in more lives saved from colorectal cancer.”

Are there alternatives to colonoscopy?

There are alternatives to colonoscopy, although they should always be discussed with your doctor. Colonoscopy is a visual-based test, meaning that the colon itself is inspected for any abnormal signs. Alternative colon cancer screening tests include stool-based tests, where stool samples are analyzed for cancer markers—molecules present in the stool that might indicate that cancer is present.

You may have seen advertising for Cologuard®, an FDA-approved stool-based test for adults aged 45 or older of average risk that can be taken in the comfort of your home. But how effective is Cologuard® compared with a colonoscopy?

According to the Cologuard® website, Cologuard® was compared with colonoscopy in a clinical trial of 9,989 adults who had no symptoms of colon cancer and were of average risk. According to the study results, the stool test correctly identified 60 of the 65 patients (92%) with colon cancer (confirmed using colonoscopy) and 321 of the 757 patients (42%) with advanced precancerous lesions. This means that although almost all of the patients with cancer were picked up by the test, the test failed to identify half of the patients who already had signs of precancerous changes and were at high-risk of developing cancer in the future.

Both stool-based colon cancer screening and colonoscopy have their pros and cons, and which you choose is up to you and your health care provider. If you are not sure about your choices, the American Cancer Society Colorectal Cancer Screening Guidelines state the following: “If you’re age 45 or older, you should start getting screened for colorectal cancer. Several types of tests can be used. Talk to your health care provider about which ones might be good options for you and to your health insurance provider about your coverage. No matter which test you choose, the most important thing is to get tested.”

Remember, March is colorectal cancer awareness month, so there is no better time than the present to take control of your health and get screened