By Carol Wolfenbarger, MSN, RN, FACHE
Most people know that a pink ribbon signifies breast cancer awareness, but do you know what the blue ribbon stands for? Colorectal cancer awareness, and since March is officially designated Colorectal Cancer Awareness Month, it’s a time when we spread the word about how to lower your risk for the disease, including preventive screening options.
Dr. Fletcher points out a worrisome trend: The incidence of younger people being diagnosed with colorectal cancer has risen. “Colorectal cancer has been increasing in incidence, particularly in younger individuals less than 50, since the 1990s,” he states, adding that the “why” remains a mystery. “The exact reason for this increase is unknown, although there’s some suspicion that it has to do with our generally unhealthy American diets. In areas of the world where people eat differently, in particular less processed foods, this upward trend hasn’t been seen,” explains Dr. Fletcher.
Disease risk factors are usually broken up into two categories — those things you can change and those you cannot. “For instance,” shares Dr. Fletcher, “you are unable to change your genetic predisposition to colorectal cancer if you have a strong family history, or if you have other diseases, such as inflammatory bowel disease, that increase your risk for colorectal cancer. You also cannot change the increased risk of getting the disease as you age.” He goes on to share that men are at higher risk for colorectal cancer than women, and white and black individuals are diagnosed with colorectal cancer more frequently than other racial groups.
Dr. Fletcher notes however, that there are quite a few important risk factors that individuals do have control over that impact their risk, including their weight — obesity is a major risk factor — an unhealthy diet, lack of physical exercise, tobacco use and significant alcohol consumption. “These modifiable risk factors are within people’s power to alter,” he says. “For example, diet changes we advise are increasing your fiber intake, steering clear of processed foods, lowering the amount of fat consumed, and eating plenty of fruits and vegetables.”
Multiple forms of screening for colon cancer exist, including colonoscopy, a brief procedure performed at the hospital while a patient is under sedation. During it, the surgeon inserts a thin, flexible tube with a tiny camera on the end of it into the rectum to examine the lower bowel for precancerous and cancerous growths known as polyps. Mission Hospital McDowell’s two talented surgeons, Dr. Roddenberry and Dr. Badger, are versed in performing colonoscopies, and their presence right here at MHM means that patients don’t have to travel far for this vital screening. “We are careful and thorough when we perform a colonoscopy, and as we assess the patient’s colon, we’re able to immediately and efficiently remove polyps should we find them,” says Dr. Roddenberry. “The preparation step that most people dread, which involves drinking the solution that clears your colon, is not as difficult to tolerate as in the past,” he adds, “but it is worth it, because the clearer our view of the colon is, the better able we are to see — and remove — any polyps.”
Dr. Badger echoes Dr. Roddenberry when speaking about the importance of testing and catching colorectal cancer early. “The ‘gold standard’ evaluation is a colonoscopy. With this screening, we can even find polyps and remove them before they begin growing cancerous cells, and it’s even more important to get one earlier if you have someone in your family who has had colon cancer,” she says, adding that it’s a topic that should never be overlooked in an appointment with one’s primary care provider.
Noninvasive stool-based testing methods include fecal immunochemical testing (FIT) and Cologuard®. The FIT test looks for hidden (occult) blood in the stool, while Cologuard also identifies occult blood plus DNA changes that point to polyps and the presence of cancer. “Stool-based testing is good, but I typically recommend them to people who are either unwilling to get a colonoscopy or who have health conditions that limit their ability to have the procedure performed,” explains Dr. Fletcher. “In my opinion, most individuals should get a colonoscopy because it is both a screening test and a treatment. That is to say, if the physician performing the colonoscopy sees anything suspicious, they can remove it then and there.”
Dr. Fletcher also clarifies the sometimes confusing issue of when a person should receive their first colonoscopy and how often they should be screened. “At minimum, colonoscopies are started at age 50, and then done every 10 years. Frequency is a complex topic,” he declares, “because the individual risk factors a patient has, along with whether they have ever had polyps removed in a previous colonoscopy, can dictate whether a patient should receive the screening as frequently as yearly, or every three, five or ten years, which are more common recommendations.” Colonoscopy and colorectal cancer risk are routine topics Dr. Fletcher discusses with his patients during their annual physicals. “Colonoscopy is one of a group of cancer-related screenings I talk with my patients who are eligible about, as part of their overall wellness plan,” he says.
If someone is diagnosed with colorectal cancer in its very early stages, states Dr. Fletcher, treatment is often only surgical. “If the patient’s cancer is more advanced, doctors often use a combination of surgical removal, chemotherapy and potentially radiation. That said, the importance of catching a cancer early cannot be overstated, and is often the difference between life and death. This is why screening tests are so very critical, because they catch cancer in its earliest stages,” he cautions. Sadly, colorectal cancer is one where identifiable symptoms don’t appear until the condition is quite advanced. “Unfortunately,” says Dr. Fletcher, “treatment is much more difficult at this point, and often fatal.”
Asked about the message he feels is most important for people to understand about colorectal cancer, Dr. Fletcher revisits the sobering statistics. “This disease is very common, and very deadly, so it’s critical to take testing seriously,” he says. “As the third most common cancer in the United States that both men and women are diagnosed with, colorectal cancer is the second leading cause of death in men out of all cancers they are stricken with, and the third deadliest cancer in women.”
I appreciate our team’s advice and expertise on colorectal cancer this month. Remember that the COVID-19 pandemic is no reason to put off a colonoscopy. Those at higher risk for severe complications from COVID-19 should have a risk-versus-benefit conversation with their primary care provider. For most, the protocols we’ve put in place to keep patients and staff safe at all of our facilities ensure that the best care can continue to be delivered to our community.
Carol Wolfenbarger, MSN, RN, FACHE, is Chief Executive Officer of Mission Hospital McDowell.