Colon cancer is a major public health problem in the United

States.

An ounce of prevention…• Is really worth a pound of cure• The “take home” message tonight is:

– GET YOUR SCREENING COLONOSCOPY!• Easy to do• Proven risk reduction

Known risk factors

• Age• Race• Gender• Family history of colon cancer• Personal history of colon

polyps• Inflammatory Bowel Disease

• Cigarette smoking• Excessive alcohol intake• Obesity• Sedentary lifestyle• Diabetes• Radiation exposure

Age • Advancing age is a major risk factor

– 90% of colon cancers are diagnosed in people over age 50

– Screening recommended for the general population at age 50

Ethnicity• African-American • Ashkenazi Jews

Gender• Males have a higher incidence of adenomas• Studies suggest higher incidence of colon cancer

in men– However, screening guidelines do not currently vary

between men and women

Family history• First-degree relative

– Parent, sibling or child– Cancer or polyps increase risk– Genetic syndromes

• HNPCC (Lynch Syndrome)• FAP • Others

Personal history of polyps• Predisposition to develop malignancy• Closer endoscopic follow-up

Inflammatory Bowel Disease (IBD)• Ulcerative colitis• Crohn’s disease• Require more frequent screening/surveillance

Cigarette smoking• Is noted to be an independent variable for

increasing colon cancer risk

Excessive alcohol intake• Variation in what constitutes “excessive”

– Generally >2 alcoholic beverages per day

Obesity• BMI>25 considered “overweight”• BMI>30 considered “obese”

Sedentary lifestyle• May be related to obesity and other risk factors• Marathon runners can get colon cancer

Diabetes• Major health problem in the United States• Mostly related to obesity and lack of exercise

Diet• Generally thought that a high-fat, low-fiber diet

(think: Horseshoe) increases the risk of developing colon cancer

• Difficult to conduct studies of this nature

Radiation exposure• Particularly, survivors of childhood malignancy

who received abdominal radiation

The random nature of colon cancer

• Approximately 85% of colon cancers are “sporadic” in nature– No family history of colon cancer– “Healthy” patients

Incidence of colon cancer in the U.S.

• 5-6% over a lifetime– So if six Americans out of 100 will get colon cancer

in their lifetime, how can we reduce that risk?

Screening• Tests that aim to prevent the development of colon

cancer– Polyps lead to cancer, and removing polyps stops

that progression• Can be applied to the general population• Screening reduces risk, but does not completely

remove risk

Screening tests• Colonoscopy• Stool studies

– DNA– Occult blood

• Radiographic (XRAY) studies– Barium Enema– “Virtual” Colonoscopy

Double-Contrast Barium Enema• Bowel prep• Liquid barium enema• Insufflation with air via rectum to distend colon• Plain films of colon• Looking for abnormalities

– Narrowing– Polyps

Image of Barium EnemaWebMD, LLC

Advantages of barium enema• No sedation, can drive yourself• Less expensive than colonoscopy

Problems with Barium Enema• Requires bowel preparation• Radiation exposure• Uncomfortable• May be inconclusive, hard to define flat polyps• Colonoscopy needed if abnormality is noted• Negative exam follow-up is five years

Virtual Colonoscopy• a.k.a. CT colonography• Bowel prep• Air insufflation• Read by radiologist• Requires radiation dose for images

Problems• Significant radiation exposure• Uncomfortable• Requires endoscopy if pathology is found• Negative exam follow-up is five years

Stool DNA• Pretty good for detecting cancer• Worse at detecting polyps• Can be done at home• Relatively less expensive

Fecal Occult Blood Testing• Based on concept that colon cancers and large

polyps typically bleed• Must be done annually• Relatively inexpensive• May be done at home• Positive test is indication for colonoscopy

Optical colonoscopy• Still considered the “gold standard”• “One-stop shopping”

– Diagnosis and removal of polyps• High patient satisfaction• Long follow-up period if negative (10 years)• Proven to reduce risk of dying from colon cancer

ColonoscopeZgrumm.com

Negatives• Requires bowel preparation• Typically, requires time off from work• Risks of bleeding, perforation and missed lesions

Nuts and bolts• When to start screening

– Age 50 for most people– Age 40 (or earlier) if first-degree relative with colon

cancer or advanced polyps• When to stop screening

– Over 75 and two negative exams– <5-10 years of reasonable life expectancy

Who performs colonoscopy?• Gastroenterologists• Colon & Rectal Surgeons• Various other non-specialty physicians

How are subspeciality endoscopists different?

• Gastroenterologists/Colon & Rectal Surgeons– Fellowship-trained– High-volume endoscopic practice– Meet accepted standards of care– Springfield Clinic Ambulatory Endoscopy Center

• Designated an ASGE Center of Excellence

Summary• Eating right, exercising regularly and not smoking

are all positive goals for a healthy lifestyle• Prevention of colon cancer relies on effective,

timely screening and surveillance• Colonoscopy is a proven way to reduce colon

cancer risk

How to get a colonoscopy…• See your primary care physician to discuss

screening colonoscopy• Appointment with a subspecialist to discuss the

procedure, bowel preparation and to have questions answered

• Bowel preparation• Procedure day

The outcome• Negative exam (no polyps): return in 10 years for

repeat screening• Polyps

– 3-5 year surveillance colonoscopy depending on number, size and type of polyp(s)

• Other findings– Follow-up and treatment will be discussed

Thank you for your attention.

Questions?