Michael DeSimone, MD, of Concord Gastroenterology Associates sat down with the host of Emerson’s Health Works Here podcast series to provide insights on colon cancer screenings. Read his insights on the screening and listen to the podcast below.
Colon cancer is one of the most common cancers among both men and women. The American Cancer Society estimates there will be approximately 150,000 new cases of colon and rectal cancer this year and about 50,000 people will die from the disease. To put these numbers in perspective, the lifetime risk of developing colon cancer is just over four percent. This means about one out of every 25 Americans will be diagnosed with colon cancer at some point.
“It is a serious condition. There is a lot of potential harm, and therefore a lot of benefit to trying to prevent it with screenings,” states Dr. Michael DeSimone, gastroenterologist with Concord Gastroenterology Associates.
Alternatives to Colonoscopy
Colonoscopy is often referred to as the “gold standard” of colon cancer screening, but it is not the only option. The most important factor, says Dr. DeSimone, is that people are taking some type of action to get screened.
Non-colonoscopy approaches generally involve stool analysis to detect minute traces of blood or other chemical marker associated with colon cancer. Options include traditional “stool cards” provided by your doctor, as well as newer at-home stool testing kits.
“If any of those tests come back positive, you proceed to a diagnostic colonoscopy. We look to see if there is a cancer, or potentially some other type of precancerous growth that could be addressed with a colonoscopy,” explains Dr. DeSimone.
Cutting Cancer Off at the Pass
There are a few reasons colonoscopy is revered among gastroenterologists. First, it is considered the “definitive” test. Individuals having a colonoscopy receive both a screening test and diagnostic test all in one. Second, colonoscopy is much more sensitive for picking up precancerous lesions, compared to stool tests, which are really designed to identify cancer itself.
Finally, and perhaps most importantly, colonoscopy acts as treatment in some patients. “When we go in and identify precancerous lesions, we remove them right then, and therefore prevent the cancer from ever developing. We are not waiting to identify an early cancer based on a stool test. We are going in and removing the lesions before they ever have the chance to turn into colon cancer.” This means that for many patients, colonoscopy is not just a test to look for colon cancer, it is a cancer prevention procedure.
Family History Guides Age and Frequency
Dr. DeSimone advises anyone with a family history to opt for colonoscopy over other screening methods — particularly if a first-degree relative (parent, sibling or child) has had colon cancer. In these cases, screening starts at an earlier age and occurs more frequently.
The recommendation is to start exams at age 40, or 10 years earlier than the age at which the family member was diagnosed, whichever comes first, and then have a colonoscopy at least every five years. For example, if the family member was diagnosed at 45, one would want to start screening at age 35.
When it is a more distant relative (grandparent, cousin, aunt/uncle), individuals can follow the general population guidelines for screening. “Having that family history information means you should have an extra degree of vigilance, knowing you have some increased risk hiding in your genes,” he notes.
Updated Screening Guidelines
Prior to 2018, most organizations recommended screening begin at age 50, but the American Cancer Society updated their guidelines and lowered the age to start colon cancer screening to 45 based on new evidence showing increased risk in younger adults. Another influential agency, the U.S. Preventative Services Task Force, followed suit and also recommends that colon cancer screening begin at age 45.
Screening frequency depends on risk level. An average risk person can undergo colonoscopy every ten years. If an exam reveals polyps or a person is diagnosed with colon cancer, the recommendations change. “You come out of the screening pool and jump into the surveillance pool. The surveillance exams are done at different intervals, depending on your history. If you had cancer, it is one set of guidelines. If you had a lot of polyps, it is a different set of guidelines. If you had one polyp, it might be a less frequent set of exams,” says Dr. DeSimone.
The Colonoscopy Process
While most people have heard stories about preparing for colonoscopy, advances in prep medications and other protocols have mitigated some of the challenging effects.
“Colonoscopy preps have come a long way. There are some options for colonoscopy preps that are a smaller volume, less fluid to drink, and they don't taste quite as bad. They are a little easier to tolerate,” assures Dr. DeSimone. “There is even a pill form now that just came out recently.”
The colonoscopy procedure itself is painless, as patients are administered anesthesia. If polyps are detected, they are almost always removed during the procedure. “It is pretty straightforward, and tacks on only a few moments to the exam,” he adds. Polyps are sent to a pathologist to determine the type of growth (e.g. benign growths, typical pre-cancerous polyps or lesions that have advanced further towards cancer). Those results are translated by the gastroenterologist into recommendations for future screening.
A Life-Saving Option
Dr. DeSimone urges individuals to participate in any screening, whether it is the less-invasive stool assessment or colonoscopy. However, he stands by his opinion that colonoscopy is the most thorough, definitive, and potentially life-saving option.
“If I have colon cancer and it is detected — in an early stage where it can be treated and ideally cured — and I then go on to live a good, long life, that is a great outcome. The best way to do that is through colonoscopy.”
Listen to the Podcast: Understanding Colon Cancer Screenings
Dr. Michael DeSimone discusses options for colon cancer screenings and when and how you should be screened.
Subscribe to the Health Works Here Podcast on Apple Podcasts, Spotify, Google Podcasts and wherever podcasts can be heard.
About Dr. Michael DeSimone
Dr. Michael DeSimone is a board-certified gastroenterologist at Emerson’s Concord Gastroenterology Associates in Concord, Mass. A graduate of Brown University’s Warren Alpert Medical School, Dr. DeSimone specializes in colorectal cancer screenings and prevention, liver disease, and inflammatory bowel diseases including Crohn’s disease and ulcerative colitis. Visit Dr. DeSimone’s physician profile to learn more and request an appointment or call 978-287-3835.