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Noise pollution in the colon

DR. THOMAS RUFFOLO

Noise pollution. It has several meanings but essentially is a term to describe when so much information is out there that you can’t sort through it all. In the GI world of colon cancer screening, the noise level has gone up significantly in the past few years. This, in turn, is causing a lot of confusion for individuals and even healthcare providers.

What we used to encourage in terms of colon cancer screening is being redefined by new technology and evolving trends in the age distribution of colon cancer development.

So what is the latest need-to-know information for 2020? Here, briefly, are the facts.

Colonoscopy remains the primary test for the accurate detection and treatment of pre-cancerous colon polyps. It is the only test that is therapeutic — meaning you can remove the polyps at the same time as the test is being performed.

Colonoscopy is the best tool for screening for colon cancer.

Noninvasive yearly screening for colon cancer should start at age 40. This includes testing stool for hidden blood with either a FIT stool test or Hemoccult stool test. The FIT test is better at detecting blood coming from the colon.

The age of 50 is still generally the appropriate age for an average-risk individual to have their first colonoscopy.

Many medical groups, including the American Cancer Society, recommend colon cancer screening beginning at age 45 with a procedure such as colonoscopy. Check to see if your insurance carrier provides coverage for screening earlier than age 50.

“High risk” individuals with a strong family history of colon polyps/cancer or a familial hereditary cancer syndrome need earlier screening (about 10 years younger than the index patient’s age).

The Cologuard test (you know the commercial, “Get, Go, Gone”) is essentially a test for colon cancer. Its ability to detect pre-cancerous polyps is poor (misses 30% of the large polyps). It also misses about 9% of the actual cancers!

The Cologuard test, in the opinion of many experts, is totally unacceptable. It also has a high false-positive rate, meaning the test is positive but nothing is found on a subsequent colonoscopy. Although this is an FDA approved test, it severely lacks the sensitivity to be relied upon. This is not an equivalent test to a colonoscopy.

The number of colon cancers in people under age 45 is rising rapidly. Symptoms should not be ignored just because of someone’s young age.

Virtual colonography (a CT scan of the colon) is not equivalent to a colonoscopy and does not allow removal of a colon polyp if detected. Colonoscopy would still be needed if something is identified on the CT scan.

A test to detect circulating cancer antigens in blood is being evaluated. This could become a simple screening test in the future. We are awaiting more studies.

The warning signs for possible colon cancer and polyps have not changed. These include unexplained weight loss, anemia (low blood count), abdominal pain and a change in the stool pattern. These symptoms require appropriate evaluation.

From my perspective, the only good thing about “noise” is that it stimulates discussion.

I have been in practice for nearly 30 years. While people are more knowledgeable now, it remains frustrating to see someone in my practice that has advanced colon polyps or cancers. Many of these patients should have had an earlier screening exam or were provided an inappropriate screening test. An informed discussion at an earlier time may have prevented these situations from developing.

Hopefully, with the information from this article, you can help distinguish the truth from fiction.

Remember, being informed and seeking the appropriate screening studies could save your life or that of a loved one. Still not sure? Then have a discussion with your healthcare provider. Don’t get lost in the noise.

Dr. Thomas Ruffolo is a gastroenterologist/hepatologist with Vidant Gastroenterology Washington and can be reached by calling 252-946-1573.