One of the goals of high quality health care is prevention of serious disease, particularly cancer, through early detection and aggressive treatment when appropriate. I was thinking recently that I have not had a death from either prostate or colon cancer in my practice, except for one case, in over 20 years. That case was a gentleman who had some rectal bleeding and, in spite of every convincing argument I could think of, absolutely refused to have colonoscopy or other testing. He eventually died of his colon cancer which could well have been treated and he might be alive today.
In 2008, colon cancer was the third most common cancer diagnosed in American men and women and the second most common cause of cancer deaths in the United States. By the removal of precancerous colon polyps using colonoscopy, the potential progression to cancer can be prevented, or if diagnosed early, cure is possible. If everyone over age 50 had regular screening for colon cancer the annual deaths from this disease would be cut in half.
Earlier or more frequent testing is important in anyone who has a previous history of either colorectal cancer or the type of polyps known as adenomatous. If there is a personal history of Crohn's disease or ulcerative colitis there is also a higher chance of getting it. The risk of colon cancer is much greater if there is a history of colorectal cancer or polyps younger than age 60 in a parent, child or sibling or in two close relatives at any age. This is one reason why paying attention to family history is very important.
Colonoscopy is the preferred screening method and, in experienced hands, is highly accurate. When the test is perfectly normal and there are no other risk factors no repeat is necessary for 10 years. Other less expensive options effective for early detection include a simple annual chemical test for blood in the stool, flexible sigmoidoscopy (partial colonoscopy) or an x-ray called double contrast barium enema done every 5 years. After age 50 I also recommend a yearly PSA blood test for prostate cancer and look either for an elevated level or a number that goes significantly higher from one year to the next. This test combined with a rectal exam has resulted in early diagnosis and cure in many of my patients over the years. Prostate cancer, like colon cancer, usually has no symptoms early on and a variety of effective treatments, chosen mostly based on age at the time of diagnosis, is available.
When your doctor recommends a test that could save your life by detecting a fatal condition that has no symptoms in the early stages, it can be foolish not to take that advice. Early detection and prevention of prostate and colon cancer are two important examples.
Dr. Josh Schwartzberg practices in Lake Placid, Willsboro and Burlington. He can be reached at www.docjosh.com or 518-963-4355