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Tuesday, September 30, 2014         

HEALTH SCENE


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More screenings are key to reduce colorectal cancer

By Dr. Robert Decker

POSTED:



According to the U.S. Centers for Disease Control and Prevention, colorectal cancer is the second-leading cause of cancer-related deaths in Hawaii. Although preventive screening to detect and treat colorectal cancer early can result in a 90 percent survival rate, fewer than 50 percent of cases are diagnosed early enough for lifesaving treatment to be effective.

What's the reason? Colorectal cancer screening rates throughout the United States are very low. The older you are, the higher your risk for colorectal cancer. Your chance of developing colorectal cancer begins to increase significantly after you turn 50. Having a history of large polyps, or having an immediate family member (parent or sibling) under the age of 60 who has had cancer are important risk factors to consider.

Also, if you have a history of inflammatory bowel disease, such as long-standing ulcerative colitis or Crohn's disease, your risk is higher. Others factors that might increase your risk include tobacco use, alcohol use, obesity and leading a sedentary lifestyle.

Colorectal cancer can be prevented by removing precancerous polyps (abnormal growths), which can be present in the colon for as many as 10 years before any invasive cancer develops. Screening tests can help to find these precancerous polyps so that they can be removed before they become cancerous or are detected early enough in their development so they can be treated effectively.

Men and women who are at average risk for colorectal cancer should begin their regular screenings at age 50. If you are at greater risk for any of the reasons mentioned, you might need to begin at an earlier age, so consult your physician.

For many people the thought of getting screened for colorectal cancer causes a bit of anxiety. As I said, screening rates throughout the country and here in Hawaii are very low. At Kaiser Permanente Hawaii we're increasing our screening rates by offering an at-home screening kit called the fecal immunochemical testing, or FIT, also known as the immunochemical fecal occult blood test, or iFOBT.

The FIT is easy to perform and doesn't require any special diet or medication modifications. Since beginning our intensive outreach efforts in 2008, we've raised our screening rates above the national average and have met our two-year goal of reaching a screening rate in the 75th percentile nationwide, an increase of about 50,000 screenings.

In addition, according to recent data published in PLoS Medicine, a journal published by the Public Library of Science, "a computer model using published cost and efficacy data for eight different screening approaches indicated that FIT conducted annually would led to the fewest cancer cases and deaths and with the lowest cost."

This prompted researchers at the University of Calgary in Alberta to say that "screening for colorectal cancer with FIT should be considered the modality of choice for average risk patients between the ages of 50 and 75 in North America."

If everyone 50 years old or older were to be screened regularly and appropriately, we could avoid as many as 60 percent of the deaths caused by colorectal cancer. Without a doubt, more regular and consistent screening for colorectal cancer will save lives. We simply need to make it easier and more convenient to do the right thing.

Dr. Robert Decker is a gastroenterologist for Kaiser Permanente Hawaii. "Health Scene" features columns by Hawaii health care professionals.






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