Give Yourself a Lifesaving 50th Birthday Gift

Author: Tim Sowerby, MD, Gastroenterologist, Marin Gastroenterology Chief of Gastroenterology

Are you one of millions of Americans who have just celebrated the “Big 5-0?” Did you get the obligatory teasing from friends and family about being “over the hill?”

With improvements in nutrition, medicine, and quality of life, our life expectancy has increased significantly and reaching 50 more often means getting a new lease on life. As Mark Twain once said, “Age is an issue of mind over matter. If you don’t mind, it doesn’t matter.”

Reaching your 50th birthday does matter when it comes to colon cancer. Before then, the risk of colon cancer is low. After 50 risk increases, doubling by age 60 and continuing to double every subsequent decade. That’s why major health organizations recommend most people, men and women, begin screening at 50. (African Americans have a higher risk and should start screening at 45.)

The importance of colon cancer prevention and screening cannot be overstated. In the U.S., of those cancers that affect both men and women, colon cancer is the second most likely to cause death. Fortunately, having a colonoscopy every 10 years, starting at 50, will reduce the risk of getting colon cancer by more than 80% and risk of dying from colon cancer by more than 90%. Colon cancers are slow growing and do not cause symptoms until they are often so advanced that they are incurable. Early detection leads to early treatment which means a cure is far more likely.

While early detection is great, prevention is much better. More than 20% of women and 30% of men over 50 have benign growths in their colons called polyps. While not all colon polyps turn into cancers; almost all colon cancers start as polyps. It takes about 10 years for a pre-malignant polyp to form and turn into cancer. If, during those 10 years, we detect and remove colon polyps, we can prevent the formation of cancer.  Recently, we’ve seen a significant decrease in new colon cancers and colon cancer deaths. This occurred after the introduction of large scale, routine colon cancer screening and prevention procedures.

Several screening and prevention tests are available, including colonoscopy, stool tests for blood and cancer DNA, and CT scanning. However, only colonoscopy screens for existing cancers and prevents cancer by identifying and removing polyps during a single procedure.   

Colonoscopy involves a one-day “prep” consisting of a clear liquid diet followed by laxatives. It is performed with short-acting, deep sedation so is painless. Any polyps found are removed during the procedure. 

Another option, CT colonography or “virtual colonoscopy” is as accurate in detecting cancers and large polyps as regular colonoscopy. However, CT colonoscopy requires the same “prep” as regular colonoscopy, uses radiation, and involves the placement of a balloon catheter in the rectum. 30% of patients undergoing CT colonography have positive findings. These patients then must undergo another “prep” and regular colonoscopy.

Two stool tests are available to detect existing cancers. The Fecal Immunochemical Test (FIT) looks for microscopic amounts of human blood in the stool. FIT detects 74% of colon cancers (missing more than 1 in 4). The Cologuard test identifies tiny fragments of cancer DNA in the stool. Cologuard detects 92% of cancers (missing almost 1 in 10). If either test is positive the patient must have a colonoscopy. Few patients chose FIT or Cologuard over colonoscopy since both are less accurate for screening and detect too few polyps to be effective for cancer prevention.

As part of the Healthcare Reform Act, most insurance plans and Medicare cover colon cancer screening and prevention without applying deductibles or a co-payment.

Despite the enormous value of colon cancer screening and prevention, one third of Americans aged 50 to 75 have not been screened. Don’t be among them. If you’ve already turned 50 and haven’t been checked, talk to your doctor about the test he or she recommends based on your age, health, and family history. You’ll be giving yourself a lifesaving 50th birthday gift.