Grandpa on beachCMYKIf it’s time for another colonoscopy, and it’s been more than five years since your last one, you might be in for a pleasant surprise, said Sarina Kapoor, MD, of St. Luke’s Gastroenterology. Advances in preparation products and the procedure have improved effectiveness and patient comfort. The rates of colorectal cancer have been falling for people 50 and older over the past 20 years, primarily because of efforts to encourage screening tests, especially colonoscopy.

Today, the average age of diagnosis is 66 and falling, she said. Meanwhile, rates have been increasing for people under 50. Generally, screening is recommended until age 75 or 80. Colorectal cancer is the third-most-prevalent cancer for men and women in the United States and the third leading cause of cancer death. Fortunately, the cure rate exceeds 80%, and is even higher when caught early. Colonoscopy is a procedure that uses a flexible tube with a camera to enable physicians to see inside the colon. This allows them to find and remove small clumps of cells called “polyps” that could develop into cancer. The gastroenterologist also identifies and collects any abnormal-looking tissue that could be cancerous for further study.

 

“It’s important for people hesitant to get a colonoscopy to understand some of the huge scientific advancements we've made in the last couple of years,” Dr. Kapoor said. “We try to avoid giving anybody those big seawater-tasting four-liter gallon bowel preps.” Instead, Dr. Kapoor offers patients low-volume bowel preparations — laxatives — that are virtually tasteless and can be mixed with the Gatorade flavor of the patient’s choice. It is split between night and morning for a better night’s sleep and an improved cleanout. In addition, pill preparations are available for patients who cannot tolerate drinking large volumes of liquid.

“I’ll be honest,” Dr. Kapoor said. “It’s still a night of hanging out in your bathroom, but at least it’s a lot more palatable.” In addition to laxatives, patients must have a clear liquid diet the day before the procedure. Another advancement is using carbon dioxide to open the colon for the procedure. St. Luke’s hospitals and outpatient endoscopy centers use carbon dioxide rather than air because it is easier and more comfortably passed. Another innovation is Endocuff Vision, a device placed on the end of the scope that flattens the folds in the colon, enabling physicians to find hidden polyps.

Because of these innovations and excellent physicians, St. Luke’s exceeds national quality benchmarks related to colonoscopy. St. Luke’s has much higher polyp detection rates and much lower complication rates than other hospitals nationally.

Other colorectal screening tests are available, Dr. Kapoor said. The most popular ones are FIT (Fecal Immunochemical Test), that screens for blood in the stool, and Cologuard, which tests for blood and DNA markers. With these methods, patients receiving positive results must then have a colonoscopy to confirm the presence of cancer, she explained. “Colonoscopy is a very unique test,” she said. “You’re not only diagnosing cancer, you're also treating it. By removing growths that could become cancerous, you’re preventing disease, too. It just goes to show that an ounce of prevention is worth a pound of cure. I hate to use clichés, but it’s true in this case.”

“I enjoy listening to my patients to hear their personal stories about how gut health affects their daily lives,” she said. “I am honored that they trust me to help them improve their lives. That is what drives me — each and every patient encounter.”

In addition, Dr. Kapoor is interested in the role of the gut microbiome in one’s health. The microbiome is the collection of microorganisms including bacteria, viruses, and fungi, found within the gut. “GI has had an explosion of scientific data that is coming our way regarding the microbiome and our ability to diagnose and prevent disorders,” she said. “We think the microbiome is kind of like your second DNA. Gut bacteria may be the reason that one person can eat whatever they want and not gain weight and the other person gets diabetes, and another has coronary artery disease.”

Have your adult children ever encouraged you to get a colonoscopy?
If yes, and they are now 45 or older, it’s time to turn the tables, said Dr. Kapoor. The U.S. Preventative Services Task Force in May 2021 revised its colorectal screening cancer guidelines, now requiring insurers to cover colorectal screening beginning at age 45, five years younger than prior recommendations.

Statistics showing increased numbers of younger people diagnosed with colorectal cancer drove the change. “Someone born in 1990 has twice the risk of colon cancer in their lifetime than someone born in 1950, and a four-time increased risk of developing rectal cancer,” added Shannon Tosounian, DO, of St. Luke's Gastroenterology. “That's a pretty staggering statistic.”

According to the American Cancer Society, about 12% of colorectal cancer cases are diagnosed in people under 50. Rates have been increasing since the mid-1980s in adults 20 – 39 years, and since the mid-1990s in adults ages 40 – 54, with the younger age groups experiencing the steepest increase. Experts speculate today's more sedentary lifestyles and increased consumption of processed food may be causing the increase in colorectal cancer in younger people, she said.

However, there’s another theory. The guidelines also recommend that the first-degree relatives — children, siblings, and parents — of someone diagnosed with colorectal cancer should begin screening 10 years earlier than their relative’s age at diagnosis. For instance, if your father was diagnosed at 50, you should start screening at 40. Some believe earlier detection may also contribute to the rising number of people being diagnosed with colorectal cancer at a younger age.

When do you need colorectal cancer screening?

If you’re not sure, Dr. Kapoor suggests you confer with your gastroenterologist or primary care physician to determine the best timing and type of screening for you. She offers the following general guidelines.


All screening methods
• Everyone should have their first colonoscopy at age 45.
• If you have a first-degree relative — parent, sibling, child — begin colorectal cancer screening when you are 10 years younger than the age your relative was diagnosed.
• You have any of the colorectal cancer warnings signs:
•Anemia
•Rectal bleeding
•Blood in the stool
•Abdominal pain without another cause
•Unintentional weight loss

Colonoscopy
• Whether polyps were found during your last colonoscopy determines when you should have your next one.
• No polyps, you're good for 10 years.
• One or two polyps, 5 – 7 years
•Three or more polyps, three years
• If you're under age 75 and you've never had one, it's not too late to schedule your first colonoscopy.
• Generally, you should stop getting colonoscopies between age 75 and 80.

FIT (Fecal Immunochemical Test)
• Once a year
• If the test is positive, you will need a colonoscopy.

Cologuard
• Every three years, if normal
• If the test is positive, you will need a colonoscopy.
To schedule an appointment with Dr. Kapoor, contact St. Luke’s Gastroenterology at 484-526-6545.

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