Women’s Health

Colonoscopy

Colorectal cancer (cancer of the large intestine) is a preventable disease. About a third of the people that get this disease die of it making it the second leading cause of cancer deaths in women in the U.S. However discouraging this may sound this is almost a completely avoidable disease. Modern screening with colonoscopy makes it possible to detect existing cancers at a very early stage when treatment is highly successful. It should be noted that colon cancer, in the vast majority of cases, is a slow growing cancer that develops over many years. The vast majority of cases develop from a benign polyp that grows, develops pre-cancerous changes and eventually becomes a cancer. If left unchecked these cancers grow and spread beyond the colon eventually becoming incurable. This progression takes at least 10 years in most people.

I’ve always found it interesting, in my practice, that women religiously make their appointments for their annual mammogram (after the age of 40) but balk at the notion of screening for colorectal cancer. In 2005 the American Cancer Society (ACS) reported 56,600 deaths in women attributable to colon cancer and 40,410 deaths resulting from breast cancer. In other words, a woman is 1.4 times more likely to die of colon cancer than breast cancer.

There are a number of reasons women do not get screened as often as they should. Some studies show that women believe that they are less likely to get colon cancer than men—not true. Most women believe that breast cancer, uterine, cervical and ovarian cancers are much more potentially lethal to them than colon cancer—again, not true. Still others find the very thought of this test to be distasteful and painful. While the test may be distasteful it is not painful and it is certainly less painful and distasteful than actually getting colon cancer.

Colon cancer, when caught early, is highly curable—all the more reason to begin regular screening.

What is colonoscopy?

Colonoscopy literally means “to look inside the colon”. This procedure is done by a trained gastroenterologist. The main instrument used by the gastroenterologist is a long, thin, flexible fiberoptic lens, called a colonoscope. This instrument can be steered in almost any direction to provide a thorough view of the entire colon. Another advantage of this instrument is that it can also be used to biopsy any suspicious lesions. The vast majority of colon cancers start out as benign polyps. The gastroenterologist can remove these polyps and determine whether or not they are benign, pre-malignant or malignant.

When should I get a colonoscopy?

The American Cancer Society suggests a variety of screening tools for men and women starting at age 50. These include colonoscopy every 10 years beginning at age 50. Other screening tools are also mention including sigmoidoscopy and double contrast barium enemas. Many physicians feel that colonoscopy represents the best screening tool available.

The guidelines of the National Guideline Clearinghouse (www.guideline.gov) suggest that colonoscopy is the “preferred test for the diagnostic investigation of patients with findings on screening and for screening patients with a family history of hereditary nonpolyposis colorectal cancer”. You may also get additional information at

www.patients.uptodate.com American Cancer Society’s website www.cancer.org

As I mentioned, if you are at low risk for colon cancer you should have your first exam at age 50.

If you are at high risk for developing colon cancer your physician may suggest that you begin screening at age 40. Women at high risk for developing colon cancer may have some of the following factors:

  • a single first-degree relative (parent, brother, sister or child) that developed colon cancer before the age of 60, or two first-degree relatives that developed colon cancer at any age.
  • a history of Familial Adenomatous Polyposis (FAP)
  • a family history of Hereditary Nonpolyposis Colon Cancer (HNPCC)
  • a history of Inflammatory Bowel Disease such as Crohn’s disease and ulcerative colitis.
  • a personal history of ovarian, endometrial or breast cancer
  • Other factors that increase one’s risk include increasing age, race (African Americans have a higher risk of dying from colorectal cancer compared to white Americans), a diet high in fat and red meat and low in fiber, a sedentary lifestyle and cigarette smoking.

Where can I get additional information?

You can get some additional information at these helpful websites
www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=LRN&dt=10
www.cancer.gov/cancertopics/types/colon-and-rectal
www.nlm.nih.gov/medlineplus/healthtopics.html
www.femalepatient.com/pdf/patob_1103.pdf