Vince Lombardi was one of the toughest, most successful and most revered football coaches of all time. Most people don’t know that he died of colon cancer. According to his biography, he ignored his physician’s advice to have a screening colonoscopy on multiple occasions. When he finally became symptomatic, his disease was too far advanced and he succumbed to a preventable disease.
The fact is, colon cancer is the second leading cause of cancer deaths (behind lung cancer) in the United States today. Approximately 150,000 new cases will be diagnosed this year in the U.S. and about one-third of them will prove fatal. To put these numbers into perspective, colon cancer will kill roughly the same number of people each year as the number of U.S. soldiers killed in the Vietnam War.
The good news is that screening reduces the risk of colon cancer. Susan Blauer, of State College, is a firm believer in screenings since her first colonoscopy at age 51. It was ordered by her doctor, even though Blauer exhibited no symptoms. However, the screening caught a polyp — which was aggressive and could have turned into color cancer — at that time, and it was removed. Blauer received a screening one year later and said she now will receive screenings consistently every three years.
“I now encourage all my loved ones to get a screening at the age of 50. It’s a breeze if you go to the right place,” Blauer said. “I had my first experience at Penn State Hershey Colonnade right here in State College. I was comfortable from the moment I walked in the door, and the screening was truly a breeze.”
Since 1990, more people have embraced the advantages of screening and the rate of colon cancer has actually begun to decrease. On Jan. 1, 1998, Medicare began to cover the cost of preventative colon cancer screening. Subsequently, a report by the Pennsylvania Legislative Budget and Finance Committee confirmed that colon cancer screening is cost-effective. Now, most health insurance companies in the state pay for colon cancer screening, helping to remove a barrier to preventative care.
There are several methods to screen for colon cancer:
■ Annual blood test and sigmoidoscopy every five years.
The blood testing detects blood in the stool that is not visible to the naked eye. A sigmoidoscopy involves passage of a flexible tube through the rectum and lower third of the colon or large intestine. It is usually done in five minutes without sedation following a limited bowel cleansing.
■ Colonoscopy every 10 years.
A flexible tube is passed throughout the entire colon or large intestine for 15 to 30 minutes, with sedation, following a thorough bowel cleansing. This allows for polyp removal or biopsy at the time of the exam.
■ Double contrast barium enema every five to 10 years.
X-rays are taken of the colon after instilling air and contrast material through a tube in the rectum. This takes 15 to 30 minutes, without sedation, after a thorough bowel cleansing.
■ CT colonography.
This is an X-ray of the intestine requiring specialized computer software and a thorough bowel cleansing.
■ Stool DNA test.
This is a newly FDA-approved test in which sloughed cells in the feces are analyzed for tumor markers. It is listed as 92 percent sensitive and 87 percent specific for detecting colon cancers.
Each has its advantages and disadvantages, but colonoscopy remains the only test that evaluates the entire colon and allows for removal of polyps at the time of the procedure, while avoiding X-ray exposure. Consequently, it remains the gold standard and most commonly used form of screening.
The American Cancer Society recommends both men and women begin screening at age 50 for Caucasians and 45 for African-Americans. Those without risk factors should have a colonoscopy once every 10 years. Conditions that are known to increase risk may require more frequent or more aggressive testing. These include personal or family history of colon cancer or polyps, familial adenomatous polyposis syndrome, hereditary non-polyposis colon cancer syndrome or ulcerative colitis/Crohn’s disease.
Colon cancer begins as a polyp, so colonoscopy offers both prevention, by removing polyps, and early detection, which leads to improved survival. If a colon cancer is detected before symptoms appear, the five-year survival rate is 71 percent. If found after symptoms develop, the survival drops to 49 percent in five years. Typical symptoms of colon cancer include abdominal pain, change in bowels, rectal bleeding, iron deficiency anemia and weight loss. Unfortunately, the majority of colon cancers are still diagnosed after the onset of symptoms.
Typically, treatment of colon cancer begins with removing the tumor, either endoscopically or surgically. During the procedure, doctors determine if it has spread to the lymph nodes or any other tissue and determine the stage. The stage will determine what additional treatment, if any, is required. If the tumor is removed completely, no further treatment is needed except for follow-up visits. However, some circumstances warrant radiation, chemotherapy or both.
The lifetime risk for getting colon cancer is about 6 percent. One misconception is that colon cancer is no longer a concern after a certain age. Though screenings start at age 50, colon cancer risk increases over time — it never plateaus and it never goes down; it continues to rise with age. The decision to continue screening is an individual one to be made with one’s physician. In general, the benefit of screening is lost when the life expectancy is fewer than 10 years.
Seventy to 75 percent of colon cancers are sporadic, meaning there are no identifiable risk factors or family history. Most cancers found early enough to potentially cure often produce no symptoms; therefore, everyone should be screened. Almost 35,000 lives could be saved each year, and you could be one of them. What better way to convey to your loved ones that you want to be around for them than to have a test to prevent this disease. Vince Lombardi would tell you that, if he could.
Penn State Hershey has the largest, most-experienced and most-comprehensive colorectal surgical care group in Pennsylvania. Based on data reported by the American College of Surgeons National Surgical Quality Improvement Program, the team is rated “exemplary” in surgical outcomes by nationally defined quality-of-care criteria. Board-certified colorectal surgeons Dr. Evan Messaris and Dr. Frances Puleo see patients at Penn State Hershey Medical Group-Colonnade.
For more information on Penn State Hershey Gastroenterology services or to schedule your next colonoscopy, call (814) 272-4445.
Dr. Joel Haight is medical director of State College’s Penn State Hershey Endoscopy Center and is as assistant professor of gastroenterology and hepatology with Penn State College of Medicine.
