Ask the Doctor: Should the colon cancer screening age be reduced?
Deborah Nagle, M.D.
This year, the Colon Cancer Coalition is partnering with the American Society of Colon and Rectal Surgeons to help raise awareness and funds for colon cancer. In preparation for the Sixth Annual Twin Cities Get Your Rear In Gear 5K Run/Walk, Dr. Deborah Nagle, Chief of Colon and Rectal Surgery at Beth Israel Deaconess Medical Center, and member of ASCRS sat down to talk to us about the fitness event and to answer questions submitted by our readers.
Dr. Nagle received her medical degree at the University of Pennsylvania in Philadelphia. She completed a residency in general surgery at Graduate Hospital at the University of Pennsylvania and then went on to a fellowship in colon and rectal surgery at Thomas Jefferson University Hospital. Dr. Nagle was an associate professor of surgery at Cooper University Hospital in Camden, New Jersey before joining the team at BIDMC, where she is also a member of the Harvard Medical Faculty Physicians and an instructor in surgery.
Get Your Rear in Gear: You’ve been involved in helping the Colon Cancer Coalition and the American Society of Colon and Rectal Surgeons organize the upcoming Twin Cities Get Your Rear in Gear 5K Run/Walk. Have you been involved in 5K’s before as an organizer or participant? Are you a runner or a walker?
Dr. Nagle: My most consistent involvement in 5K’s has been as a sponsor of other runners. I’m a walker due to a knee injury in the past.
Get Your Rear in Gear: Do you enjoy other forms of activity or exercise?
Dr. Nagle: I like almost anything outdoors especially biking and boating.
Get Your Rear in Gear: I’ve read about your success with laparoscopic colectomy, a less invasive form of surgery for colon cancer. Does this procedure allow patients to get active – perhaps back into an exercise program – more quickly than traditional forms of surgery?
Dr. Nagle:Laparoscopic colectomy has several advantages for patients – one of the most important is decreased pain after surgery with much smaller scars. Typically, we expect patients to start back up with their normal activities about 2 weeks after laparoscopic colectomy. Of course, we ask them to start slowly and advance gradually. Other advantages to laparoscopic colectomy include shorter hospital stay after surgery and a decreased risk of hernia at incisions.
Get Your Rear in Gear: Do you typically recommend that patients resume or begin an exercise program after surgery? Are patients receptive to the idea of getting active after surgery?
Dr. Nagle: I recommend that patients resume or begin exercise before surgery if possible. The more fit the patient is going into surgery, the more quickly they will ‘bounce back’ afterward. Sometimes, patients are just too unwell before surgery to really exercise. For those patients, we emphasize that part of their total recovery is to be able to resume physical activity and we set small goals at each post-operative visit.
Get Your Rear in Gear: We’ve had a number of questions from readers about screening for colon cancer. One reader asks, “What is your professional opinion of changing the colon cancer screening age from 50 to 40?”
Dr. Nagle: My real wish is that all those 50 and older would get screened. Colorectal cancer is possibly the only preventable cancer where we can remove a precursor lesion (polyp) at colonoscopy and prevent a cancer from developing. Starting screening in the 40′s may not be cost effective because the incidence or occurrence of colorectal cancer is so much lower in patients under 50.
Get Your Rear in Gear: The same reader continues with two more questions: “Are there any connections between colon cancer and breast cancer? There are several of us in my support group who had colon cancer and then got breast cancer so I am wondering if there is something genetically connected.”
Dr. Nagle: We doctors often notice that too. But, medical studies do not show a significantly increased risk of colon cancer in those who have had breast cancer. I think the reason we have that perception is that breast cancer and colon cancer are both so common in the American population (both are in the top 3 cancers for men and women). Breast cancer will strike about 1 in 8 American women. Colon cancer will affect about 1 in 16 Americans. So both are common and can occur in the same patient.
“I know that remission is considered to be 5 years cancer free, but I have heard that if you get to 3 years colon cancer free, the odds of a reoccurrence are very tiny. Is this true?”
Dr. Nagle: Yes! Most colon cancers (85%) will come back within two years of treatment if they are going to recur. Therefore, patients who’ve made it two years cancer-free have only a 15% chance of recurrence in the next three years! We always celebrate the two year mark with our patients.
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Rachel Ray had a show on Colon 101 in Feb.2010.That article produced a few comments from people who were diagnosed with Stage 3 Colon Cancer at age under 50.I suggest people reading those stories.
I think that this guideline of 50 helps reduce costs for insurance companies,but anyone with Colon Cancer under age 50,has to face tough choices.
It is like buying Life Insurance at age 30-the average age(lifespan) is over 76.Then why do people age 30 buy Life insurance?The reason–is that even with small odds–it helps the kids/wife/husband.SO PLEASE THINK OF GETTING COLONOSCOPY at age 40 or early if you have any family problem or blood in stool.If Polyps are found and removed,then you have saved your life.If you find no polyps or other issue,then you have PEACE OF MIND.
Thank you Dr. Mullick – You are always so great to write to us.
I was diagnosed with TypeIIB colon cancer at the age of 34, but it was caught prior to metastisizing thanks to my doctor who was willing to further investigate despite the likelihood that I did not have cancer (no family history).
Perhaps you saw Dr.OZ program in March,2010 or read a newspaper about the connection between Colon Cancer and Obesity.Obese are higher risk of Colon Cancer.Please read the following article–Similar article appeared in Los Angeles Times also.
http://www.nlm.nih.gov/medlineplus/news/fullstory_96185.html
This article in Medline-and National Institute of Health.
The best part of this news:
1)Colon Cancer can be reduced by taking care of Obesity.
2) Colon Cancer can be prevented by EARLY SCREENING–Colonoscopy is the Golden Standard technique–helps remove Polyps -future source of Colon Cancer.
3) The new Health Care bill–makes it easier to get FREE SCREENING with NO COPAYMENT.Starting in Jan.1,2011,all Medicare insured people will NOT have to pay CO-PAYMENT for PREVENTIVE TESTS.
dear sir,
If bowel preparation still contains dirty fluid on day of colonscopy,, should the procedure be stopped ? Or if contniued, can the result be taken as conclusive under this circumstances. looking forward to your professional advice.
thnak you
dan.
Aerican College of Physcians have recently changed their guidelines for Afro-Americans from 45 to 40,based on a report from Preventative services.
If you look at CDC data–Afro Americans have much higher rate of Colon Cancer at different age groups.This data shows that White Americans–have higher rate than Asians or even Hispanics Americans.
So the argument that it is based on income,is definitely not true.
If Dr.Oz or Katie Couric’s friend Kim(white American) can have Cancerous polyp at age 50,then that is scary.Both had no symptoms.
People can view their videos.
Katie Couric is leaning to screening at 40 as 18.9% of colon Cancer patients are under 54.
The issue is affordability-as most insurance do not pay for preventative colonscopy until 50,unless doctor can prove that the patients symptoms require screening.
American Colonoscopy Center in Geneva,Il.is offering reduced prices to help people under 50 wanting to get colonoscopy and others without insurance. Call 630 232 2025 to get details of costs.
I left out Katie Couric’s friend Kim -Video.Here it is:
http://www.youtube.com/watch?v=CbUesuxT1IE
Dr.Oz video with Larry King on CNN:
http://www.youtube.com/watch?v=tS5eR0917ts
Key Point: None of them had symptoms or family history.In perfect health before Colonoscopy.
In Illinois–according to CDC report–screening rate is 15% lower than Michigan.
The death rate is also higher in Illinois than Michigan.
We need to increase screening for Colon in Illinois.
Please get screening. DO’nt wait.
Dr. Mullick,
Do you have a link to the article you reference?
American College of Physcians have recently changed their guidelines for Afro-Americans from 45 to 40