By: Ismet Lukolic, MD, Gastroenterologist with the Nanticoke Physician Network
Imagine you have been in an exam room waiting anxiously to see your doctor for your procedure results. Two weeks earlier, your primary medical doctor suggested, and somehow convinced you, to get a colonoscopy to screen for colorectal cancer. You have never had one before and were already 10 years past due. All of a sudden, the doctor comes in and greets you with a handshake and a smile. He quickly gets to the point explaining your biopsy result from the polyp he removed. It was found to be pre-cancerous. The world suddenly stops and you become numb. He pauses to allow you to process the information he just shared with you. Then he explains the colonoscopy was helpful in preventing colorectal cancer by detecting the polyp early and removing it. Removing it early meant he had avoided what could have been a catastrophic turn in life.
This happens often as I care for many of my patients. Colorectal Cancer is the third most common cancer in both men and women and is the third leading cause of cancer deaths in the US. Approximately one in twenty Americans will be diagnosed with colorectal cancer in their lifetime. African American men and women have a higher incidence rate for colon cancer. It’s also important to know that 90 percent of all new colon cancer cases and 93 percent of deaths due to colon cancer occur in people 50 years of age and older.
Many people are not aware of these somber facts. Many avoid the topic. But this information is important to discuss during routine appointments with your health care provider. To help detect colorectal cancer early, a colonoscopy is recommended for both men and women beginning at age 50, when the risk for colorectal cancer increases. However, many people perceive this test as invasive, inconvenient due to the preparation involved, and fear of what may be found.
Knowing that this is such an important screening, a lot of time has been devoted to research barriers to help providers better understand how to reach patients for colorectal cancer screenings. For patients, there may be a combination of emotional distress since they may perceive colonoscopy as a painful or embarrassing combined with a lack of the basic knowledge about the importance of a colonoscopy. Sometimes mistrust of the health care system as well as language barriers can be tremendous barriers to accessing health care. On the positive side, research shows that those who know they have a family history of colorectal cancer, know someone with cancer, or most importantly have a physician endorsement for the screening have been shown as important to deciding to get screened.
Currently, in the US about 60 percent of those recommended to have the screening have had it done despite great efforts in the past decade to eliminate barriers and educate patients about the screening. Resources to help reduce language barriers including the use of language lines in provider offices and educational literature in the patient’s native language are used by the Nanticoke Physician Network. Additionally educating primary care providers about the different modalities available for screening and creating automated reminders are also reducing barriers in our community.
Colonoscopy still remains the most useful screening exam in early detection and prevention of colorectal cancer. A colonoscopy is recommended for men and women form ages 50-75 without a family history of cancer or pre-cancerous polyps; that are not at high risk due to other medical conditions associated with colorectal cancer; or that do not have a family history of colon cancer. However, for those with a family history or for African Americans a screening at an earlier age may be recommended. Talk with your health care provider.