Early Detection is Powerful Weapon Against Risk of Colorectal Cancer

Tuesday, March 17, 2009

SCOTTSDALE, Ariz. — The good news is that an increasing number of Arizonans are getting the word about the importance of colorectal screening, slightly edging out the rest of the U.S. at 55.6 percent.

The better news would be if the other 44.4 percent of Arizonans recommended for screening would also get tested early enough to contribute to the encouraging statistics that indicate the rate of colorectal cancer has been decreasing over the past two decades.

March is National Colorectal Cancer Awareness Month, and the takeaway from the American Cancer Society is simple yet profound: Regular testing is the most powerful weapon available for preventing colon cancer.

Reasons for people putting off screening run the gamut — fear, issues with sedation, lack of a driver to and from the appointment or simple procrastination.

Beginning in April, Mayo Clinic in Arizona will allow qualified patients to participate in a one-day program where they can elect the CT, or "virtual," colonography diagnostic procedure that does not require sedation. Then, following the CT scan, patients are given a pager that will send an alert if polyps or other issues are discovered. If so, the patient can undergo the second, complete colonoscopy required for polyp removal the same day.

The same-day opportunity within the integrated Mayo Clinic practice has been well received by patients. As of yet, not all insurance companies pay for CT colonography, so it is important for patients to check with their provider in advance. However, if polyps are detected following the CT scan, most insurance companies will pay for the complete colonoscopy procedure for removal of suspicious polyps.

Previously, patients would have been sent home following CT colonography if polyps were found — necessitating the inevitable "bowel prep" all over again and returning to Mayo on another day. According to Mayo Clinic statistics, approximately 12 percent of patients screened by CT colonography also require the complete colonoscopy.

CT, or virtual colonography, is a non-invasive screening process that uses a CT scanner and computer software to produce three-dimensional images of the colon and rectum. Because sedation is not required, it has the advantage of allowing the patient to return to work or normal activities immediately following the procedure.

In the more standard, or complete colonoscopy, patients are sedated, and if a polyp or abnormality is detected, the lesion is removed or sampled at the time and preliminary findings are shared with the patient after the exam. Because of the sedation, patients are required to have someone drive them home.

Both procedures require the standard preparation the night before, familiar to legions of people over age 50 who have recognized the advantage of early detection of colorectal cancer and the advancing risk with age. Preparation involves a liquid diet and medications to evaluate the bowel.

By either method, Mayo physicians representing both Gastroenterology and Radiology strongly agree that the key is to be tested — by age 50 — or sooner if there is a family history of colorectal cancer. The recommendation for African Americans, who are at greater risk, is age 45.

"The important thing is, we want more people screened," notes C. Dan Johnson, M.D., chair of Radiology at Mayo Clinic, who was the lead investigator for an American College of Radiology imaging trial involving more than 2,600 patients at 15 medical sites nationwide. His research found that CT colonography performed comparably to colonoscopy in detecting medium and large-sized polyps.

"Colorectal polyps are very common, and each one of us is at risk," warns Suryakanth Gurudu, M.D., director of Mayo's Colorectal Neoplasia Clinic as well as director of the Inflammatory Bowel Disease Clinic. "The lifetime risk of colon polyps is 25 to 35 percent, and the risk of colon cancer is 6 percent," he adds.

Dr. Gurudu agrees that "any method of screening is better than no screening."

In addition to screening and early detection, the American Cancer Society recommends reducing the risk of colon cancer through healthy living, including quitting smoking.

Mayo physicians cite certain lifestyle and dietary risk factors as enemies of the colon. Lifestyle risk factors include obesity and low physical activity, according to Russell Heigh, M.D., a Mayo gastroenterologist who also does research on colorectal cancer prevention. As for diet, enemies include high caloric foods, high fat, excessive red meat, low fiber and inadequate intake of fruits and vegetables.

Dr. Heigh emphasizes that doing an acceptable colon test is better than doing no test to prevent colorectal cancer. And, he adds, "The best test is the one the patient is willing to undergo."

###

For more information about colon cancer, go to Mayoclinic.com or the American Cancer Society.

###

About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit MayoClinic.com or MayoClinic.org/news.