According to the National Institute of Health, Colorectal cancer is the fourth most common type of cancer diagnosed in the United States. While deaths from colorectal cancer have significantly decreased with the use of colonoscopies, early detection is essential. Statistics from the American Cancer Society place the relative survival rate for people with stage 1 colon cancer at around 92%. That’s why having a first colonoscopy at age 50 is routinely recommended.
In this segment, Christopher Hogan, MD, a Gastroenterologist at MarinHealth Medical Center, joins us to discuss the importance of getting your colonoscopy.
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Colon Cancer Screening: There's No Reason To Wait
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Christopher Hogan, MD
Christopher Hogan, MD, is a Gastroenterologist and a member of the medical staff at MarinHealth Medical Center.Learn more about Christopher Hogan, MD
Transcription:
Bill Klaproth (Host): Of all cancers affecting both men and women, colorectal cancer – cancer of the colon or rectum – is the second leading cause of death from cancer in the United States. Fortunate, the death rate from colorectal cancer is declining, and one reason for this decline is an increase in preventative screening. Here to talk with us about colon cancer screening, is Dr. Christopher Hogan, a gastroenterologist and a member of the medical staff at Marin General Hospital. Dr. Hogan, thanks for your time. Can you tell us about colon cancer and who is most at risk?
Dr. Christopher Hogan (Guest): Colon cancer is basically a cancer of the large intestine – that’s the lower part of the intestinal tract. The people who are most at risk are actually people who are older. About 90% of cases are going to occur in patients who are over the age of 50. That’s in large part why our screening tends to start, for average-risk patients, at age 50.
There are other variations in terms of risk, as well, that have to do with things like male versus female. Males are at slightly increased risk compared to females. Additionally, race – actually, African Americans are at increased risk as compared to, for example, White or Asian populations. There are also lifestyle components that come into play. For example, things that keep you healthier, in general, tend to decrease your risk of colon cancer. Those who are smoking tobacco, drinking lots of alcohol, eating lots of red meat, or are obese are going to be at increased risk of colon cancer as well.
Bill: And does genetics play a big part in this?
Dr. Hogan: Yeah, that’s a great question. We just touched upon the environmental factors there, but in large part, genetics are going to drive the risk for colon cancer, as well. That can be as simple as having a first-degree relative with colon cancer or multiple second-degree relatives with colon cancer. And then there’s the more complex cases where there’s actually hereditary cancer syndromes – for example, Lynch Syndrome. These would put an entire family population at risk and therefore, would require screening at significantly earlier ages.
Bill: So there’s a lot of factors there – race, lifestyle, gender, genetics. Tell us then, why is getting a colonoscopy so important?
Dr. Hogan: Great question. Colonoscopy is one of the tests that’s been shown to decrease the risk of ever getting colon cancer, and then also, to decrease mortality from colon cancer. It’s a screening test in part to find colon cancer if it’s there, to find it early so that it will be more treatable and decrease the risk of death. Additionally, it has the ability to prevent colon cancer. For a lot of cancers, we don’t have a test like this, but colon cancer is somewhat unique in that sense where we’re actually able to prevent the cancer from ever occurring in most cases if the person takes part in screening as recommended.
Bill: Are there other screening options besides just traditional colonoscopy?
Dr. Hogan: There are, yes. There are certainly screening options. The classic one that people may know about are going to be the stool tests. Historically, it’s a guaiac based stool test for occult blood – basically, to look for evidence of microscopic bleeding. A fecal immunochemical test is another one, and then, more recently, a fecal DNA test, for example, ColoGuard. I should point out, these are all screening tests, so if any of these were to come back positive, that would then reflex to a colonoscopy, which would then be the gold-standard and diagnostic test at that point. Other options would be a CT Colonography, which historically, was called a virtual colonoscopy. Another option is a partial colonoscopy, which is a flexible sigmoidoscopy, which looks at just under half of the colon.
Bill: Now, is the colonoscopy the gold-standard, as you mentioned, because you can see things that you can’t see on the other screening methods?
Dr. Hogan: Yeah, it’s the gold-standard because it’s the most sensitive test for picking up a colon cancer if it’s there, but it’s also, in essence, the gold-standard because it has that extra component of being not just a screening test, but also a preventative test. For example, in my office, a lot of the conversations that I will have around screening with my patients will touch upon not just do you want to screen for colon cancer and find it when it’s there, but also, do you want to prevent colon cancer from ever occurring? That’s, I think in large part why most people end up choosing colonoscopy as their primary screening test for colon cancer. Estimates of about two-thirds of people will go straight for a colonoscopy as opposed to those other modalities, which in essence are just screening tests and don’t prevent colon cancer.
Bill: Right. I think one of the things that scare people away is the prep. Can you tell us about that? I have had a colonoscopy --
Dr. Hogan: Oh, good.
Bill: And I can tell you it’s not that bad.
Dr. Hogan: [LAUGHS] Right, yeah, that’s the funny thing. We often say that a colonoscopy is not a big deal in terms of the patient experience because the way we perform them the patient is asleep. You don’t feel the colonoscopy, but the hard part is the bowel prep. With that being said, the good news is the bowel prep keeps getting easier and easier. It’s classically, now, a split-dose bowel prep where you’re taking half of the prep the night before, half the morning of. There are a lot of options out there now. There didn’t used to be as many bowel preps available, and many of the options now are lower volume preps. When you think about that gallon jug that people had to drink for a colonoscopy – some patients may still need that option, but most of my patients, I’m able to prescribe a lower volume bowel prep, which tends to be better tolerated.
One other thing to point out is there’s data recently showing that staying on a clear liquid diet for the whole day prior to a colonoscopy is not really necessary at this point. We, actually – at Marin General Gastroenterology, we recommend that patients have a low residue breakfast the day before their procedure so that you have a little bit of a base to be on that clear liquid diet the rest of the day. Again, that’s for the day preceding the actual colonoscopy. We all that Prep Day.
Bill: Again, not that bad. Get your colonoscopy. It’s such a preventable disease. You’re not allowed to get it because of the testing method, and it is so preventable. Let me ask you this, after the colonoscopy, we hear this, “Oh, they found a polyp.” Can you tell us what that is and what that means if one is found?
Dr. Hogan: Certainly. A polyp is basically a growth within the colon, and there’s many different types of polyps. Two major camps are going to be benign polyps and then the benign, but pre-cancerous polyps. Those are called adenomas. Those ones with pre-cancerous potential are the ones we want to take out during a colonoscopy to actually prevent those polyps from ever developing into a colon cancer.
Again, there are many different types of polyps. Some of them are going to look like a little growth, almost like a cauliflower stalk and head, but there are other polyps that are flat polyps. These occur more frequently in the right side of the colon and can be difficult to pick up even with colonoscopy. However, with newer techniques and awareness of these types of polyps, we do not have increased rates in general of picking up even these flat, difficult to detect polyps so that they can be removed and reduce the risk of colon cancer. That’s in large part why the quality of the preparation for the procedure is so important – the hard work that the patient's doing to get ready for the procedure is important. And then, our ability to give a high-quality colonoscopy is really important with a high adenoma detection rate to detect those polyps and take them out to basically get the patient the best chance of reducing the risk of ever getting colon cancer.
Bill: And if a polyp is found then, how often do you need to see that person back again?
Dr. Hogan: It depends on the type of the polyp, the size of the polyp and the number of the polyps that we remove. For example, if you have one to two small, pre-cancerous polyps that are tubular adenomas, a classic finding, typically, you’ll come back in five years instead of the ten-year time frame for average risk screenings. If you have three or more polyps, then it’s usually three years, and for some higher risk polyps, three years, as well.
Bill: And these polyps grow slowly. That’s why if you’re clean they say come back in ten years because it takes that long for them to establish, right?
Dr. Hogan: That’s right. The natural history of a polyp forming to becoming colon cancer has been shown to be, on average, about ten years, with notable exceptions, especially, for example, some of those flat polyps on the right side of the colon. In general, we do say there tends to be a ten-year time frame, and that’s why we’ve set that ten year average risk screening time frame.
Bill: Dr. Hogan, we appreciate you being on with us today. For more information, visit MarinGeneral.org/HealthConnection, that’s MarinGeneral.org/HealthConnection. And this is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thank you for listening.
Bill Klaproth (Host): Of all cancers affecting both men and women, colorectal cancer – cancer of the colon or rectum – is the second leading cause of death from cancer in the United States. Fortunate, the death rate from colorectal cancer is declining, and one reason for this decline is an increase in preventative screening. Here to talk with us about colon cancer screening, is Dr. Christopher Hogan, a gastroenterologist and a member of the medical staff at Marin General Hospital. Dr. Hogan, thanks for your time. Can you tell us about colon cancer and who is most at risk?
Dr. Christopher Hogan (Guest): Colon cancer is basically a cancer of the large intestine – that’s the lower part of the intestinal tract. The people who are most at risk are actually people who are older. About 90% of cases are going to occur in patients who are over the age of 50. That’s in large part why our screening tends to start, for average-risk patients, at age 50.
There are other variations in terms of risk, as well, that have to do with things like male versus female. Males are at slightly increased risk compared to females. Additionally, race – actually, African Americans are at increased risk as compared to, for example, White or Asian populations. There are also lifestyle components that come into play. For example, things that keep you healthier, in general, tend to decrease your risk of colon cancer. Those who are smoking tobacco, drinking lots of alcohol, eating lots of red meat, or are obese are going to be at increased risk of colon cancer as well.
Bill: And does genetics play a big part in this?
Dr. Hogan: Yeah, that’s a great question. We just touched upon the environmental factors there, but in large part, genetics are going to drive the risk for colon cancer, as well. That can be as simple as having a first-degree relative with colon cancer or multiple second-degree relatives with colon cancer. And then there’s the more complex cases where there’s actually hereditary cancer syndromes – for example, Lynch Syndrome. These would put an entire family population at risk and therefore, would require screening at significantly earlier ages.
Bill: So there’s a lot of factors there – race, lifestyle, gender, genetics. Tell us then, why is getting a colonoscopy so important?
Dr. Hogan: Great question. Colonoscopy is one of the tests that’s been shown to decrease the risk of ever getting colon cancer, and then also, to decrease mortality from colon cancer. It’s a screening test in part to find colon cancer if it’s there, to find it early so that it will be more treatable and decrease the risk of death. Additionally, it has the ability to prevent colon cancer. For a lot of cancers, we don’t have a test like this, but colon cancer is somewhat unique in that sense where we’re actually able to prevent the cancer from ever occurring in most cases if the person takes part in screening as recommended.
Bill: Are there other screening options besides just traditional colonoscopy?
Dr. Hogan: There are, yes. There are certainly screening options. The classic one that people may know about are going to be the stool tests. Historically, it’s a guaiac based stool test for occult blood – basically, to look for evidence of microscopic bleeding. A fecal immunochemical test is another one, and then, more recently, a fecal DNA test, for example, ColoGuard. I should point out, these are all screening tests, so if any of these were to come back positive, that would then reflex to a colonoscopy, which would then be the gold-standard and diagnostic test at that point. Other options would be a CT Colonography, which historically, was called a virtual colonoscopy. Another option is a partial colonoscopy, which is a flexible sigmoidoscopy, which looks at just under half of the colon.
Bill: Now, is the colonoscopy the gold-standard, as you mentioned, because you can see things that you can’t see on the other screening methods?
Dr. Hogan: Yeah, it’s the gold-standard because it’s the most sensitive test for picking up a colon cancer if it’s there, but it’s also, in essence, the gold-standard because it has that extra component of being not just a screening test, but also a preventative test. For example, in my office, a lot of the conversations that I will have around screening with my patients will touch upon not just do you want to screen for colon cancer and find it when it’s there, but also, do you want to prevent colon cancer from ever occurring? That’s, I think in large part why most people end up choosing colonoscopy as their primary screening test for colon cancer. Estimates of about two-thirds of people will go straight for a colonoscopy as opposed to those other modalities, which in essence are just screening tests and don’t prevent colon cancer.
Bill: Right. I think one of the things that scare people away is the prep. Can you tell us about that? I have had a colonoscopy --
Dr. Hogan: Oh, good.
Bill: And I can tell you it’s not that bad.
Dr. Hogan: [LAUGHS] Right, yeah, that’s the funny thing. We often say that a colonoscopy is not a big deal in terms of the patient experience because the way we perform them the patient is asleep. You don’t feel the colonoscopy, but the hard part is the bowel prep. With that being said, the good news is the bowel prep keeps getting easier and easier. It’s classically, now, a split-dose bowel prep where you’re taking half of the prep the night before, half the morning of. There are a lot of options out there now. There didn’t used to be as many bowel preps available, and many of the options now are lower volume preps. When you think about that gallon jug that people had to drink for a colonoscopy – some patients may still need that option, but most of my patients, I’m able to prescribe a lower volume bowel prep, which tends to be better tolerated.
One other thing to point out is there’s data recently showing that staying on a clear liquid diet for the whole day prior to a colonoscopy is not really necessary at this point. We, actually – at Marin General Gastroenterology, we recommend that patients have a low residue breakfast the day before their procedure so that you have a little bit of a base to be on that clear liquid diet the rest of the day. Again, that’s for the day preceding the actual colonoscopy. We all that Prep Day.
Bill: Again, not that bad. Get your colonoscopy. It’s such a preventable disease. You’re not allowed to get it because of the testing method, and it is so preventable. Let me ask you this, after the colonoscopy, we hear this, “Oh, they found a polyp.” Can you tell us what that is and what that means if one is found?
Dr. Hogan: Certainly. A polyp is basically a growth within the colon, and there’s many different types of polyps. Two major camps are going to be benign polyps and then the benign, but pre-cancerous polyps. Those are called adenomas. Those ones with pre-cancerous potential are the ones we want to take out during a colonoscopy to actually prevent those polyps from ever developing into a colon cancer.
Again, there are many different types of polyps. Some of them are going to look like a little growth, almost like a cauliflower stalk and head, but there are other polyps that are flat polyps. These occur more frequently in the right side of the colon and can be difficult to pick up even with colonoscopy. However, with newer techniques and awareness of these types of polyps, we do not have increased rates in general of picking up even these flat, difficult to detect polyps so that they can be removed and reduce the risk of colon cancer. That’s in large part why the quality of the preparation for the procedure is so important – the hard work that the patient's doing to get ready for the procedure is important. And then, our ability to give a high-quality colonoscopy is really important with a high adenoma detection rate to detect those polyps and take them out to basically get the patient the best chance of reducing the risk of ever getting colon cancer.
Bill: And if a polyp is found then, how often do you need to see that person back again?
Dr. Hogan: It depends on the type of the polyp, the size of the polyp and the number of the polyps that we remove. For example, if you have one to two small, pre-cancerous polyps that are tubular adenomas, a classic finding, typically, you’ll come back in five years instead of the ten-year time frame for average risk screenings. If you have three or more polyps, then it’s usually three years, and for some higher risk polyps, three years, as well.
Bill: And these polyps grow slowly. That’s why if you’re clean they say come back in ten years because it takes that long for them to establish, right?
Dr. Hogan: That’s right. The natural history of a polyp forming to becoming colon cancer has been shown to be, on average, about ten years, with notable exceptions, especially, for example, some of those flat polyps on the right side of the colon. In general, we do say there tends to be a ten-year time frame, and that’s why we’ve set that ten year average risk screening time frame.
Bill: Dr. Hogan, we appreciate you being on with us today. For more information, visit MarinGeneral.org/HealthConnection, that’s MarinGeneral.org/HealthConnection. And this is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thank you for listening.