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Sunday, April 20, 2014
Am I being too concerned about colon cancer?
I`m 54 and healthy, but I have not undergone colon cancer screening other than the blood test that my doctor does every year or so. I have had a recent change in bowel habits regarding both consistency and color. I have a family history of colon cancer (my mom got it at 57 and my sister at 53). I mentioned getting a colonoscopy at a recent office visit, and my doctor sort of shrugged the question off. My friends all say nobody asks for this test, but am I really being obsessive if I just call and get one?
You are not being obsessive or over concerned. You should be proud of the fact that you are taking your health matters into your own hands. National recommendations advise beginning screening at age 50 in a normal risk individual for colon cancer. Screening with occult blood testing is considered acceptable if it also includes a flexible sigmoidoscopy starting at age 50. However, by today's standards this is considered inferior to screening with colonoscopy. The gold standard is to have a colonoscopy starting at age 50 and one every 10 years if it is normal, have no symptoms, and no other family history that changes your risk status. Colonoscopy is considered so important to screening and prevention, that last year Medicare eliminated the deductible for all of its enrollees who receive a colonoscopy.
Now you ARE NOT an average risk individual. The fact that you have two first degree relatives with colon cancer (sister and mother) put you into a high risk category. All national organizations including, but not limited to, the American Society of Colon and Rectal Surgeons and the American College of Gastroenterologist advise that individuals with a SINGLE first degree relative with colon cancer begin screening at age 40 with a colonoscopy.
Your family history, your changes in bowel character and color, mandate a colonoscopy immediately. In fact, your family history specifically raises the issue of inherited colon cancer and polyps - something referred to as HNPCC (Hereditary non-polyposis colon cancer). This gene defect runs in families and even without genetic testing, can be identified with clinical criteria in individuals who have two or more first degree relatives with colon cancer, in at least two generations, and one with colon cancer around the age of 50.
You and all of your siblings age 40 should have a colonoscopy, and in fact the normal surveillance for you changes to every 5 years if it is normal.
Do not wait and do not waste time seeking other advice. Seek out a gastroenterologist or a colorectal surgeon and get a colonoscopy immediately.
James I Merlino, MD
Assistant Professor of Surgery
School of Medicine
Case Western Reserve University