90% of Colon cancers are diagnosed after age 50.
Colon Cancer is the third most common malignancy in the US and is something you don’t want to get and there are many ways to test you to see if you have pre-cancer, cancer or polyps which are also risks for cancer. They advertise these tests that you can do yourself by testing your own poop. My family physician daughter advises our patients that those tests do not adequately test for pre-cancer or colon cancer. They might find a cancer, but they will miss more than they find.
90% of Colon cancers are diagnosed after age 50. The incidence of colon cancer in the US is 4.2% and if there is a family history in a close relative before the age of 50, the incidence doubles to 8.4%.
What makes a person high risk other than family history?
- Personal history of adenomas (polyps) on colonoscopy
- Large adenomas (more than 1 cm)
- Multiple adenomas
- Flat adenomas that are difficult to remove
- Adenomas that have precancerous lesions
- Ulcerative colitis increased the risk dramatically
Colon cancer can progress without many signs therefore it is important to get a colonoscopy under sedation when you are 50. After that, depending on your risk factors your doctor will tell you how often you will need surveillance.
Now, as for the other tests that you can do at home in between colonoscopies, my favorite is the stool guaiac test looking for microscopic blood. This blood doesn’t look red and is not visible. I used to do vaginal and rectal exams at the same time during gyn exams and would test the stool on my glove for microscopic blood (the guaiac test) by taking the sample, smearing it on a card and dropping a drop of developer on it. If it turns blue, there is microscopic blood and possibly cancer. I rarely had a positive, but if I did, a referral was made for a colonoscopy, and it was about 50% positive in my testing experience. The same test at home can be done on 3 successive stool samples and this should be a good test to do at home.
They have just come out with a FIT test (fecal immunochemical test) that tests for DNA mutations of colon cells. It is more sensitive and accurate than Guaiac test but not as accurate as a colonoscopy. It was determined that the best frequency was 2 x a year.
As it stands the colonoscopy is the best test, but it requires sedation and an invasive procedure, however low risk. I still recommend a colonoscopy at 50 and every 10 years thereafter. Soon I am sure this FIT do at home test will be recommended frequently to lower the number of Colonoscopies, as a matter of cost saving. High risk individuals should continue with colonoscopies until the recommendations change.
Prevention is my recommendation:
- Eat a fresh salad every day
- Drink more than 10 -8 oz glasses of water daily
- Alcohol and sodas to a minimum.
- Probiotics daily
- Vitamin D, and Vitamin C
- Report changes in your stool to your PCP
- Report any obvious blood in your stool to your PCP
- Double probiotics whenever you need to take a course of antibiotics.
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