(And why they shouldn’t)
BY MARY L. PEPPERS
Just the thought of having a colon cancer screening makes most men head for the door. But which is worse — getting a medical test or being told too late that you have cancer? The answer is clear.
Last year, an estimated 73,000 men learned that they had colon cancer. More than 90 percent of those cases could have been prevented had the men undergone routine screenings. Colorectal cancer screenings are widely recommended for everyone ages 50 and older. In a recent medical study of 49,000 male patients, however, 37 percent of men 50 and older had not gotten such a screening.
For medical experts, these numbers are frustrating but not surprising. Colorectal screenings involve inserting an instrument inside the rectum — an area that many men consider “offlimits”
for discussing, much less examining. In trying to spare their dignity, men are gambling with their health — and even their life.
“Colon cancer screenings not only find cancer, they actually prevent cancer,” explains Durado Brooks, M.D., director of prostate/colon cancers for the American Cancer Society. “In the colon, cancer starts with the growth of a polyp — a grape-like tumor. Most polyps start out benign but can turn cancerous. If we find polyps early, we can remove them, which markedly increases the person’s chances of avoiding colon cancer.”
Though colon cancer is the second leading cause of cancer deaths in the United States, the disease is highly treatable when caught early, before it spreads. “A screening that finds cancer
early is a life-saving procedure, not a death sentence,” Brooks says.
The American Cancer Society recommends colorectal cancer screenings for all men and women ages 50 and older. (Women are equally at risk for developing this disease and need the same screenings as men do.) Anyone with a family history of colorectal cancer or polyps (benign or cancerous) or a personal history of chronic inflammatory bowel disease is at higher risk and should consider being screened earlier than age 50. In the early stages, colorectal cancer often causes no symptoms, but warning signs may include rectal bleeding, general stomach discomfort, very thin stools, constipation or diarrhea.
Sometimes ignorance is bliss. But often, your imagination is more frightening than reality. Knowing exactly what happens during screening tests can help ease your mind. The four most effective colon cancer screening methods are described below. Your doctor may use one or more, depending on your medical history or level of risk. Most tests, except for the fecal occult blood test (FOBT), can be uncomfortable, but they are not painful.
Fecal occult blood test: Polyps that grow in the colon or rectum may bleed slightly, leaving traces of hidden (occult) blood in the stool. FOBT is a take-home test requiring patients to place a tiny stool sample from three separate bowel movements onto a special card. The card is then sent to a lab for chemical testing. If blood is detected in the stool, follow-up tests are ordered.
Recommended schedule: Once a year
Flexible sigmoidoscopy: This procedure allows the doctor to view the lining of the rectum and the lower part of the colon to check for polyps. Before the test, the patient has an enema to clean out the lower part of the colon. During the test, the patient lies on his or her side on a table in the doctor’s examining room. The doctor inserts a flexible lighted tube, about the thickness of a finger, through the anus, moving it carefully into the rectum and partway up the colon. The doctor then examines the colon through the tube.
Time involved: 10 to 15 minutes
Recommended schedule: Once every five years, in combination with a yearly FOBT
Double-contrast barium enema: This X-ray test is an alternative to the sigmoidoscopy and must be done in the hospital by a radiologist. In this procedure, a well-lubricated tube is inserted in the anus, through which dye and air are injected into the rectum and colon. X-rays of the colon are then taken.
Time involved: 30 to 60 minutes
Recommended schedule: Once every five years, in place of the sigmoidoscopy
Colonoscopy: This procedure is very similar to the sigmoidoscopy, except the doctor uses a longer instrument in order to view the entire colon. This procedure is done in the hospital, and the patient is given a sedative beforehand to relax. Some patients are asleep during the exam. The doctor views images of the colon and rectum on a video screen and may remove polyps or take a sample of them for testing.
Time involved: 15 to 30 minutes for the test itself, but two or three hours total, including preparation and recovery
Recommended schedule: Once every 10 years
Scheduling a colorectal cancer screening is a smart, simple way to boost your odds for a long and healthy life. If the idea still seems far-fetched, think about doing it for the loved ones who need you in their life. Need another nudge? See if you recognize your excuses below.
People avoid colon cancer screenings for a reason. What’s yours? Find it here, then read a second opinion.
Excuse #1:
That’s got to hurt.
Fact: Ignore the “roto-rooter” jokes. The instruments used for sigmoidoscopies and colonoscopies are flexible and appropriately sized to fit safely inside you. Most patients say that a sigmoidoscopy is not painful, just uncomfortable. Colonoscopy patients are given a sedative beforehand, so they feel even less.
Excuse #2:
It’s way too embarrassing.
Fact: This is a private part of your body, but cancer grows there anyway. You don’t have to talk about the screening — just do it. Millions of American men ages 50 and older get these procedures; you won’t be the first. To feel more in control, ask your doctor exactly what will happen and why the screening is so important. Remember the stakes. Embarrassment is easier to handle than regret later on, should cancer develop.
Excuse #3:
Some things I just can’t do.
Fact: Attitude is everything. The same mental toughness that sees you through problems on the job or at home can get you through a medical procedure. A colon cancer screening is a win-win deal. If the results are normal, your next screening won’t be for five to 10 years. If they aren’t, you’ve caught a problem that can be treated.
Speaking of prevention, should men be getting a yearly prostate cancer test? Not necessarily, say the experts. According to a recent report by the
U.S. Preventive Services Task Force, the benefits of routine prostate cancer screenings are too uncertain to recommend them across the board for all men. This view is shared by other medical organizations, including the American Cancer Society (ACS), which urges men 50 and older to talk with their doctor about whether to get tested.
Cancer of the prostate — the walnut-sized gland near the bladder that produces fluid for semen — is the most common cancer among men. Most cases are diagnosed after age 65. African Americans and men with a family history of prostate cancer are at greater risk for developing it.
Doctors can use two screening tests to identify a prostate problem: the digital rectal exam (DRE) and a blood test called the prostate-specific antigen (PSA) test. What concerns experts is the lack of test sensitivity and reliability of these tests, says Durado Brooks, M.D., director of prostate/colon cancers for the ACS. “The DRE only picks up about 25 percent of prostate cancers. The PSA only picks up about 75 percent of cancers. So about 25 percent of men will have a normal PSA reading but will, in fact, have cancer.” In addition, men may receive an abnormal PSA test score only to learn that they have benign prostate enlargement, not cancer, which causes unnecessary biopsies and unnecessary anxiety.
Adding to the questions about screening are issues about prostate cancer treatment. Because the disease typically affects older men and is slow-growing, “not every cancer needs treatment,” notes Brooks. “If it is growing slowly, not causing any problems and the man’s life expectancy is less than 10 years, then watchful waiting can be a reasonable way to respond.” When diagnosed with cancer, there are risks here too, says Brooks. Surgery or radiation treatment can lead to impotence or incontinence.
The ACS recommends that doctors offer prostate screening tests to men 50 and older, discussing benefits and limitations. Men at high risk for prostate cancer should get screened every year, beginning at age 45. You are at high risk if you are African American or have a father or brother with prostate cancer. Ask your doctor if and when you should have these tests.
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