With colon cancer being the third most common cause of cancer deaths in both men and women in the United States, screenings are important. Regular screenings help catch cancer risk early.
Dr. Matthew McKenna, Division Director of the Department of Family and Preventive Medicine, explains what you need to know about colon cancer screenings.
The Importance of Colorectal Cancer Screening
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Learn more about Matthew McKenna, MD, MPH
Matthew McKenna, MD, MPH
Matthew McKenna, MD, MPH is Director of Emory University’s Division of Preventive Medicine, and also serves as Professor of Medicine in Emory’s Department of Family and Preventive Medicine. He has extensive experience in public health and preventive medicine.Learn more about Matthew McKenna, MD, MPH
Transcription:
Bill Klaproth (Host): Of all cancers affecting both men and women, colorectal cancer - cancer of the colon or rectum - is the second leading cause of death from cancer in the United States. Fortunately, the death rate for colorectal cancer is declining, and one reason for this decline is an increase in preventative screening. Here to talk with us about colorectal cancer screening is Dr. Matthew McKenna, Division Director Department of Family and Preventative Medicine, Division of Preventative Medicine at Emory Healthcare. Dr. McKenna, thank you for your time. So first off, can you tell us about colon cancer, and who is most at risk?
Dr. Matthew McKenna, MD, MPH (Guest): So you already discussed colon cancer is the second leading cause of cancer death in the United States. People who are most at risk are persons who have a family member, first degree - mother, father, brother, sister - who's had colon cancer. People who have certain diseases of the colon such as Crohn's Disease. But there's also some risk factors that are behavioral that are related to it such as being obese, not engaging in regular physical activity, and having a low fiber, low plant-based kind of diet. Those are all things that can put people at an increased risk of colon cancer.
Bill: So having a family member who has had colon cancer, someone potentially with Crohn's Disease, or even lifestyle as well can contribute to the risk factors of colon cancer.
Dr. McKenna: Exactly.
Bill: So why are colorectal screenings so important?
Dr. McKenna: Well because luckily, colon cancer is one of the tumors that is most open to being screened for and can help prevent people from experiencing very bad health outcomes. The two main reasons that colon cancer is susceptible to this kind of intervention is one, because it takes a very long time for colon cancer to grow. So it can take a couple of decades. So by identifying it early on, you can remove the cancer, or even pre-cancerous lesions that have a risk of turning into cancer. They can be removed and actually prevent the cancer from occurring at all.
And then secondly, people don't think about this very much, but actually the inside of the colon is outside of the body. So obtaining information about what's going on there, it doesn't require a lot of invasion of people's bodies. Not like having to do a breast biopsy for breast cancer, or screening for lung cancer where you actually have to go into people's chest. You can actually get to material that's in the colon. It may sound strange to people, but you can actually find out what's going on along the lining of the colon much easier than any other organ in the body.
So it's a common tumor, it commonly is a cause of cancer death, and yet it can be identified very early on and make a huge difference in people's health by taking care of the tumor early in the process.
Bill: That is so true. So when should someone get screened, and how often?
Dr. McKenna: Well the current recommendations are, for an average risk person, someone who doesn't have one of the major risk factors I talked about - a family member, or a major disease of the colon - those people should talk to their individual doctors about when to start. But for the average American, the recommendations are to start around fifty years of age. And then the frequency of testing depends on what test you are screened with. There's a variety of tests that have been found to be effective, and they kind of fall into two major categories.
One is where the actual anatomy or structure of the colon is evaluated either through an x-ray testing, or actually putting a tube into the colon and looking at the inside to see if anything is going on. And then there's the other sort of test that involves obtaining some stool, and looking to see if there's any blood or any evidence of cancer components in the stool. The test that involves looking at the structure of the colon, sort of the anatomy, the one that's the most advanced is called colonoscopy. That's where they do what I described, put a tube into the colon, and look through the entire colon. People who have that done, and it's normal, only need to have it done every ten years. As I said, this is a very sensitive test, very accurate, and the tumor grows so slow that if you don't have any evidence of any problems the first time, you don't need to have it looked at again for another ten years. Many of the other tests are somewhere in between one to five years depending on which test you have executed.
Bill: And Dr. McKenna, let's talk about the colonoscopy. I think one of the things that scares people away is the prep. Can you tell us about that? Because I've had a colonoscopy, and I can tell you, it's not that bad.
Dr. McKenna: Yeah. Yeah, I mean as you were alluding to, the worst part of it for people is what's called the prep. You're given basically a jug of- close to about a half-gallon of fluid to drink- actually you're given some powder and you mix it up into a fluid, and then you drink that all down, and you then have to have an induced kind of diarrhea for several hours to clean out the colon. The actual procedure itself, generally one night you'd have the cleansing occur, and then the next day you go in for the procedure. Everyone is under anesthesia. I mean, they don't even remember when it happens. From that's standpoint, it's a fairly benign procedure. People go in, they go to sleep, they have it done, they wake up, and they go home the same day for the most part. That's what most people experience.
I do though want to say that the prep is a very short-term, several hours of unpleasant time on the toilet, but some folks do find that objectionable. So we do want to emphasize that almost all of the screening tests that I talked about have been shown very good studies to be effective and can decrease some risk of getting colon cancer or dying from colon cancer. So if people just find the idea of having to go through the prep so awful, we don't want to discourage them from looking at some other alternatives. It's always good to have options.
Bill: Alright, let's talk about those options. What about the screening test where the specimen is collected at home? We see the commercials on TV all the time. Dr. McKenna, what about those?
Dr. McKenna: Yeah, for the one you're seeing advertised the most is one that is a test where they actually can identify genetic material from a tumor. You know, tumors are mutations, they're cells in our body that mutate and change the genes, and they have a test that can identify those genetic changes as the tumor sort of sheds those genetic material into the stool. And that's the one you see advertised the most. That has been found to be of accurate and sensitive tests, not as accurate as the colonoscopy, but in fact people who go through that test only need to have testing done if it's normal every three years, as opposed to some of the other stool tests which are annual tests.
The major drawback to the one you see advertised the most on TV is that it is very expensive, and different people's insurance pay different amounts of that particular test. Some people's insurance don't cover it. By law they have to cover the colonoscopy as a screening test. Under the Affordable Care Act, almost all of these tests are approved by the government body that sort of evaluates preventative services and they have to have these preventative services free of charge. But the Cologuard test, which is the one you see advertised, it's every three years. It is accurate but it has not been sort of endorsed by that governmental organization, so some people's insurance will pay for it, and some people's insurance won't.
Bill: Okay, that's really good to know. And of course the colonoscopy is the gold standard, but like you say, if you're scared away from the prep, talk to your physician, right? And make a decision that way?
Dr. McKenna: Yeah, I mean there's lots of other options. The thing to understand though is that if you opt for any of those other tests and they're abnormal, you're going to get a colonoscopy. It is the gold standard. I mean it is the most accurate screening test, and it is the diagnostic test to verify what the other tests identify as potential abnormalities.
Bill: And last question for you, Dr. McKenna. Where can someone go to get screened? Or is it go to your physician first and then go from there? How does that work?
Dr. McKenna: Yeah, usually it's best to talk to your doctor about your interest in this test, and most physicians have referrals to centers that are doing this. I mean, we here at Emory have a very efficient system that people, once they get a referral, they're contacted and scheduled, they get instructions in the mail, and their basically bucket of powder that they mix up the night before, and they go in and have the procedure done.
Most places have really set up very efficient systems for being able to get people screened, and again, it's the type of thing you can discuss with your doctor about other options they might be able to provide you.
Bill: Great information, Dr. McKenna. And for the person listening to this podcast right now, I've had one done, it's easy, do it. It's better than getting cancer, let me tell you. So Dr. McKenna, thank you for your time today. For more information about colonoscopies, et cetera, please visit www.emoryhealthcare.
Bill Klaproth (Host): Of all cancers affecting both men and women, colorectal cancer - cancer of the colon or rectum - is the second leading cause of death from cancer in the United States. Fortunately, the death rate for colorectal cancer is declining, and one reason for this decline is an increase in preventative screening. Here to talk with us about colorectal cancer screening is Dr. Matthew McKenna, Division Director Department of Family and Preventative Medicine, Division of Preventative Medicine at Emory Healthcare. Dr. McKenna, thank you for your time. So first off, can you tell us about colon cancer, and who is most at risk?
Dr. Matthew McKenna, MD, MPH (Guest): So you already discussed colon cancer is the second leading cause of cancer death in the United States. People who are most at risk are persons who have a family member, first degree - mother, father, brother, sister - who's had colon cancer. People who have certain diseases of the colon such as Crohn's Disease. But there's also some risk factors that are behavioral that are related to it such as being obese, not engaging in regular physical activity, and having a low fiber, low plant-based kind of diet. Those are all things that can put people at an increased risk of colon cancer.
Bill: So having a family member who has had colon cancer, someone potentially with Crohn's Disease, or even lifestyle as well can contribute to the risk factors of colon cancer.
Dr. McKenna: Exactly.
Bill: So why are colorectal screenings so important?
Dr. McKenna: Well because luckily, colon cancer is one of the tumors that is most open to being screened for and can help prevent people from experiencing very bad health outcomes. The two main reasons that colon cancer is susceptible to this kind of intervention is one, because it takes a very long time for colon cancer to grow. So it can take a couple of decades. So by identifying it early on, you can remove the cancer, or even pre-cancerous lesions that have a risk of turning into cancer. They can be removed and actually prevent the cancer from occurring at all.
And then secondly, people don't think about this very much, but actually the inside of the colon is outside of the body. So obtaining information about what's going on there, it doesn't require a lot of invasion of people's bodies. Not like having to do a breast biopsy for breast cancer, or screening for lung cancer where you actually have to go into people's chest. You can actually get to material that's in the colon. It may sound strange to people, but you can actually find out what's going on along the lining of the colon much easier than any other organ in the body.
So it's a common tumor, it commonly is a cause of cancer death, and yet it can be identified very early on and make a huge difference in people's health by taking care of the tumor early in the process.
Bill: That is so true. So when should someone get screened, and how often?
Dr. McKenna: Well the current recommendations are, for an average risk person, someone who doesn't have one of the major risk factors I talked about - a family member, or a major disease of the colon - those people should talk to their individual doctors about when to start. But for the average American, the recommendations are to start around fifty years of age. And then the frequency of testing depends on what test you are screened with. There's a variety of tests that have been found to be effective, and they kind of fall into two major categories.
One is where the actual anatomy or structure of the colon is evaluated either through an x-ray testing, or actually putting a tube into the colon and looking at the inside to see if anything is going on. And then there's the other sort of test that involves obtaining some stool, and looking to see if there's any blood or any evidence of cancer components in the stool. The test that involves looking at the structure of the colon, sort of the anatomy, the one that's the most advanced is called colonoscopy. That's where they do what I described, put a tube into the colon, and look through the entire colon. People who have that done, and it's normal, only need to have it done every ten years. As I said, this is a very sensitive test, very accurate, and the tumor grows so slow that if you don't have any evidence of any problems the first time, you don't need to have it looked at again for another ten years. Many of the other tests are somewhere in between one to five years depending on which test you have executed.
Bill: And Dr. McKenna, let's talk about the colonoscopy. I think one of the things that scares people away is the prep. Can you tell us about that? Because I've had a colonoscopy, and I can tell you, it's not that bad.
Dr. McKenna: Yeah. Yeah, I mean as you were alluding to, the worst part of it for people is what's called the prep. You're given basically a jug of- close to about a half-gallon of fluid to drink- actually you're given some powder and you mix it up into a fluid, and then you drink that all down, and you then have to have an induced kind of diarrhea for several hours to clean out the colon. The actual procedure itself, generally one night you'd have the cleansing occur, and then the next day you go in for the procedure. Everyone is under anesthesia. I mean, they don't even remember when it happens. From that's standpoint, it's a fairly benign procedure. People go in, they go to sleep, they have it done, they wake up, and they go home the same day for the most part. That's what most people experience.
I do though want to say that the prep is a very short-term, several hours of unpleasant time on the toilet, but some folks do find that objectionable. So we do want to emphasize that almost all of the screening tests that I talked about have been shown very good studies to be effective and can decrease some risk of getting colon cancer or dying from colon cancer. So if people just find the idea of having to go through the prep so awful, we don't want to discourage them from looking at some other alternatives. It's always good to have options.
Bill: Alright, let's talk about those options. What about the screening test where the specimen is collected at home? We see the commercials on TV all the time. Dr. McKenna, what about those?
Dr. McKenna: Yeah, for the one you're seeing advertised the most is one that is a test where they actually can identify genetic material from a tumor. You know, tumors are mutations, they're cells in our body that mutate and change the genes, and they have a test that can identify those genetic changes as the tumor sort of sheds those genetic material into the stool. And that's the one you see advertised the most. That has been found to be of accurate and sensitive tests, not as accurate as the colonoscopy, but in fact people who go through that test only need to have testing done if it's normal every three years, as opposed to some of the other stool tests which are annual tests.
The major drawback to the one you see advertised the most on TV is that it is very expensive, and different people's insurance pay different amounts of that particular test. Some people's insurance don't cover it. By law they have to cover the colonoscopy as a screening test. Under the Affordable Care Act, almost all of these tests are approved by the government body that sort of evaluates preventative services and they have to have these preventative services free of charge. But the Cologuard test, which is the one you see advertised, it's every three years. It is accurate but it has not been sort of endorsed by that governmental organization, so some people's insurance will pay for it, and some people's insurance won't.
Bill: Okay, that's really good to know. And of course the colonoscopy is the gold standard, but like you say, if you're scared away from the prep, talk to your physician, right? And make a decision that way?
Dr. McKenna: Yeah, I mean there's lots of other options. The thing to understand though is that if you opt for any of those other tests and they're abnormal, you're going to get a colonoscopy. It is the gold standard. I mean it is the most accurate screening test, and it is the diagnostic test to verify what the other tests identify as potential abnormalities.
Bill: And last question for you, Dr. McKenna. Where can someone go to get screened? Or is it go to your physician first and then go from there? How does that work?
Dr. McKenna: Yeah, usually it's best to talk to your doctor about your interest in this test, and most physicians have referrals to centers that are doing this. I mean, we here at Emory have a very efficient system that people, once they get a referral, they're contacted and scheduled, they get instructions in the mail, and their basically bucket of powder that they mix up the night before, and they go in and have the procedure done.
Most places have really set up very efficient systems for being able to get people screened, and again, it's the type of thing you can discuss with your doctor about other options they might be able to provide you.
Bill: Great information, Dr. McKenna. And for the person listening to this podcast right now, I've had one done, it's easy, do it. It's better than getting cancer, let me tell you. So Dr. McKenna, thank you for your time today. For more information about colonoscopies, et cetera, please visit www.emoryhealthcare.