Lynch syndrome is one of the most common hereditary cancer syndromes and the most common cause of inherited colorectal cancer (CRC) in the Unites States. An estimated one out of every 300 people could be a carrier. Given these statistics, it would seem that if testing is readily available (it is) and affordable (it is), it should be routinely performed (it isn’t).
The safety and comfort of patients undergoing colonoscopy is of paramount importance to hospitals, providers, and of course, the patients themselves. But what about the physicians performing the procedure? It might be news to those outside the field, but gastroenterologists are commonly injured on the job. A review of current literature found that musculoskeletal complaints are extremely common among GIs; the incidence of pain and injuries ranges from 29% up to 89%. Another study indicated that 45% of endoscopists undergo physical therapy to combat pain, 26.8% get steroid injections, and 13.3% require surgery.
Observational studies indicate that colonoscopy lowers colorectal cancer (CRC) rates and mortality in the general population. In support of these findings, a large-case control study showed that the procedure can significantly reduce the incidence of CRC and CRC-related mortality. However, colonoscopy may not be optimally effective for right-sided lesions. This might be due, in large part, to sessile serrated adenomas (SSAs).
If Colonoscopy Is the Gold Standard, Why Is Compliance So Low?
In 2018, 50,630 people in the United States will die of colorectal cancer, according to the American Cancer Society. It is the third leading cause of cancer-related deaths in men and women in this country.
Does FIT Measure up to Colonoscopy?
How do fecal immunochemical tests (FITs) stack up to colonoscopy, the gold standard for colon cancer screening? Admittedly, FIT might sound pretty good—no special diet, no colonoscopy prep, no hospital gown. But everything that shines is not gold.
In terms of quality, safety, and patient satisfaction, screening colonoscopies performed by nurse practitioners (NPs) are equivalent to those of physicians, according to the Journal of Clinical Gastroenterology and Hepatology. Given proper training, NPs could improve the sub-par colorectal cancer screening compliance rates in the United States with procedures that cost less and are equally safe and effective.
Have you heard? The American Cancer Society’s new screening guidelines for colorectal cancer recommend starting screening at age 45 instead of 50. That’s great news for Americans worried about the increased risk of colorectal cancer in young adults. But maybe not for endoscopy nurses, who are already in short supply.
Earlier this week, the American Cancer Society blew up the Twittersphere (at least in GI / colon cancer circles) with their updated guidelines for colon and rectal cancer screening; the ACS now recommends that adults at average risk get screened beginning at age 45 instead of 50, as was previously recommended.
To increase the chances that people will adhere to the new recommendation, the ACS is asking physicians to offer patients a choice of screening options:
- Colonoscopy every ten years
- Computed tomography colonography (CTC) or "virtual colonoscopy" every five years
- Flexible sigmoidoscopy every five years
- Multitarget stool DNA test every three years
- Take-home fecal immunochemical test once a year
- Take-home high-sensitivity guaiac fecal occult blood test once a year
If results for any of the screenings other than colonoscopy are positive, a colonoscopy is typically performed anyway. So why not get one in the first place?
The Gold Standard
According to the Colon Cancer Coalition (and most experts in the field), “Colonoscopy is considered the gold standard for detection of colon cancer.” Although it may be the most effective test, the ACS believes that any screening is better than none—thus the variety of options presented to patients.
Three Reasons Why
There are a variety of reasons to go for the gold. Here are our top three.
- It’s a one-stop shop. Screening for cancer is an important first step, but treating and preventing it are also essential. You should know that colonoscopy is the only way do all three in one procedure. Colonoscopy allows doctors to find and remove any precancerous growths (polyps), preventing cancer before it develops.
- We said it before, and we’ll say it again. Alternatives to colonoscopies can be effective in detecting colon cancer. But when any abnormalities are found, doctors usually recommend a colonoscopy.
- See you in ten years! If a colonoscopy doesn’t find polyps or cancer and you don’t have risk factors, your next test should be in ten years. Some of the other screens must be performed as frequently as once a year.
We Know It’s Not Tons of Fun
Yes, limiting your diet for a day or so and drinking a laxative prep are not at the top of everyone’s list of fun things to do, but consider this: in the United States, colon cancer is the third most common cancer and the second most common cause of cancer-related deaths. The good news is that it is typically slow-growing and predictable. Caught early when a tumor is limited to the colon, it is quite curable. While colonoscopies make take more effort on your part, they’re worth it.
The best thing about getting a colonoscopy? It just might save your life.