March 1, 2017: New York Gastroenterologist Yaron Langman, MD, attending physician at Montefiore Nyack Hospital, shares the importance of colorectal screenings and why you should not put it off. Colorectal cancer is a disease that is largely preventable through screening, yet too many people avoid getting tested for the disease, says Yaron Langman, MD, with Digestive Disease Associates of Rockland in Pomona and attending physician at Montefiore Nyack Hospital.
“Screening for colorectal cancer can save lives—but only if people get tested,” Dr. Langman says. “We can dramatically decrease the number of cases each year if more people get screened.”
Colorectal cancer is the third leading cause of cancer death in men and women in the U.S. More than 140,000 adults are diagnosed with the disease each year. When adults get screened for colorectal cancer, it can be detected early at a stage when treatment is most likely to be successful. In some cases, it can be prevented through the detection and removal of precancerous polyps.
However, about one-third of adults between the ages of 50 and 75 – about 23 million people – are not getting screened for colorectal cancer. Most people should be screened every 10 years starting at age 50, unless they are in a high-risk group. People at higher risk are those who have a close relative who has had colorectal polyps or have had colorectal cancer, or who have had polyps or who have a history of the cancer themselves; people with inflammatory bowel disease; and those who have genetic syndromes such as familial adenomatous polyposis, an inherited condition that causes polyps to form in the large intestine and in the upper part of the small intestine.
There are several test options for colorectal cancer screening:
- Colonoscopy. This is the “gold standard” preferred method for colorectal cancer screening. The doctor uses a flexible, lighted tube called a colonoscope to look in the rectum and the entire colon. Samples of tissue may be collected for examination, or polyps may be removed. Colon polyps are small clumps of cells that form in the lining of the colon. Most polyps are harmless, but some can eventually become cancerous. This test should be done every 10 years.
- Flexible Sigmoidoscopy. During this procedure, a doctor uses a flexible, lighted tube called a sigmoidoscope to look in the rectum and lower part of the colon. It should be done every five years. If the test finds polyps or cancer, a colonoscopy should be done. Some doctors recommend sigmoidoscopy should be combined with an annual fecal occult blood test (see below).
- High-Sensitivity Fecal Occult Blood Test (FOBT). This test checks for hidden blood in stool samples. It should be done every year. If the test is positive, a colonoscopy should be done.
- Cologuard Test. This is a do-it-yourself kit that allows you collect your stool sample and mail it to a lab, which sends the results to your doctor. The test determines if there is blood in your stool, a common sign of colon cancer or precancerous polyps. The lab will also look for DNA cell changes associated with cancer. This test is done every three years.
“One of the major reasons more people don’t get screened is that they have heard stories about the preparation involved in getting a colonoscopy, and they get scared off,” Dr. Langman says. “Or they’re worried it will hurt.” He reassures his patients that they are sedated for the test so they won’t feel anything – it’s quick and painless. He says most patients find the preparation, which involves drinking laxatives and plenty of fluids over a period of hours the day before the colonoscopy, is more of an inconvenience than anything terrible. “It’s not comfortable or fun, but it’s really not bad – and you only have to do it once every 10 years,” he notes.
People having a colonoscopy late in the day can split their prep between the evening before and the morning of the test, which can make it easier.
A colonoscopy is most accurate colorectal cancer screening test. It can remove any precancerous polyps, unlike the other tests. But if a person just can’t face going through a colonoscopy, Dr. Langman says the other tests are a good option.
Montefiore Nyack Hospital is participating in a national initiative called “80% by 2018,” in which dozens of organizations including the American Cancer Society and Centers for Disease Control and Prevention have committed to eliminating colorectal cancer as a major public health problem. They are working toward the shared goal of reaching 80% of adults aged 50 and older screened for colorectal cancer by 2018. Health care providers at Montefiore Nyack Hospital are educating patients about the benefits of screening.
The Hospital is partnering with New York State to screen uninsured patients with fecal occult blood tests. People whose tests come back positive will receive a colonoscopy, free of charge.
“One-third of eligible New Yorkers have never had any screening for colorectal cancer,” Dr. Langman says. “If we can get to an 80 percent screening rate, we can dramatically decrease the rate of this disease.”