Tue | Sep 26, 2017

Get tested for colon cancer

Published:Monday | March 21, 2016 | 3:00 AM

When I turned 50, I decided to steel myself and arrange to have a colonoscopy done. I knew that screening for colorectal cancer should begin at that age.

In spite of my chosen profession, I really hate having to go to doctors, and I absolutely loathe having to submit to intrusive investigative procedures. But, over the years, sad to say that I had witnessed unspeakable pain and suffering endured by patients who succumbed to preventable colon cancer.

I wanted to do the right thing by facing up to my responsibilities.

With advances in medical science, we can significantly reduce the risk of certain cancers. Screening allows us to detect many cancers at an early stage and remove them in the hope that they did not get the opportunity to spread or metastasise. Some can be cured in that way.

 

PREVENTABLE CANCERS

 

However, there are currently only two types of preventable cancers - colorectal cancer and cervical cancer. Through proper screening, we can detect and remove lesions that could possibly become cancerous long before they have a chance to do so. In other words, they can be stopped before they start.

Interestingly, a small, benign polyp was found during my first colonoscopy (25 per cent of 50-year-olds have them). Because of that finding, I was put on a five-yearly schedule for colonoscopy. My second investigation (five years ago) was normal, and my third colonoscopy is due in a few months' time. It's been 10 years since that polyp was discovered and removed.

If I did not do that test, by now - 10 years on - I could have been in trouble (less than one per cent of subcentimetre polyps and about 10 per cent of larger polyps become malignant within that time). It is a daunting and sobering thought. I'm glad that I suppressed my strong aversion to that type of intrusive investigation. It may have saved my life. I often wonder how many people out there are walking around with undetected cancerous colorectal time bombs quietly growing and spreading inside of them.

Colorectal cancer is the third most common cancer in men and women. In men, prostate holds the number-one spot, followed by bronchial (lung) cancer. In women, breast cancer is the number-one cancer, and that is followed by cervical cancer.

The best screening test for colorectal cancer is the colonoscopy. Worldwide, it is agreed that the most uncomfortable component of the investigation is the bowel preparation. It requires clear fluids for one or two days along with strong laxatives to produce a clean colon. The test itself is done using a flexible light source with the ability to remove tissue in whole or in part. The patient is given mild sedation and air is inflated to allow for visualisation of the bowel lining. The procedure is projected on a colour monitor.

The possibility of causing a leak from the bowel is extremely low and the risk-to-benefit ratio makes the investigation well worth it. It should be performed every 10 years or sooner, depending on what is found. It has a 95 per cent pickup rate and probably reduces the risk of developing colorectal cancer by 90 per cent. The only real issue is the cost.

The simplest and most affordable test is the faecal occult blood test. It should be done annually from 50 years old. It's done by submitting three separate samples of stool to the lab. It has an 80 per cent pickup rate and provides a 10-30 per cent reduction in mortality from colorectal cancers.

Some other screening tests include computerised tomographic colonography (every five years), sigmoidoscopy (every five years), sigmoidoscopy with faecal occult blood and barium enema (every 5 years).

Since 2000 when United States President Clinton dedicated March as National Colon Cancer Awareness Month, it has been observed annually. The Jamaica Cancer Society held a symposium on colon cancer with six presenters. Consultant gastroenterologist Dr Mike Mills (from whom I got some of my information) ended his talk by reminding us that the goal of screening is to reduce mortality and that the best screening test is the one that is actually done.

- Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm.com and garthrattray@gmail.com.