Current Colon Cancer Screening Guidelines Might Miss Some Patients

FRIDAY, Oct. 25 (HealthDay News) -- Current U.S. colon cancer screening guidelines may result in 10 percent of colon cancers being missed in people with a family history of colon polyps that can lead to cancer, a new study suggests.

"The biggest surprise was the percentage of missed cancers under the current guidelines. We figured there would be a few percent, but 10 percent is a large number," study author Dr. N. Jewel Samadder, of the Huntsman Cancer Institute at the University of Utah, said in a university news release.

Colorectal cancer is the third most common cancer in the United States and the second deadliest.

Samadder's team looked at data from nearly 127,000 people, aged 50- to 80, who underwent colonoscopy in Utah between 1995 and 2009. They found that first-degree relatives -- parents, siblings, children -- of people with adenomas (polyps linked to cancer) or advanced adenomas had a 35 percent to 70 percent increased risk of developing colon cancer than relatives of patients without these growths.

Second-degree relatives (aunts, uncles, grandparents) and third-degree relatives (cousins, nieces, nephews, great-grandparents) of people with adenomas were also at increased risk for colon cancer, according to the study published online Oct. 25 in the journal Cancer.

"We expected to see increased risk in first-degree relatives, but we weren't sure the risk would also be higher for more distant relatives in multiple generations," Samadder said.

Current national guidelines for colon cancer screening recommend colonoscopy every 10 years starting at age 50 for the general population. But first-degree relatives of people diagnosed with either colorectal cancer or advanced adenomas before age 60 should have a colonoscopy every five years beginning at age 40, according to the guidelines.

However, screening recommendations for second- and third-degree relatives of people diagnosed before age 60 are the same as for the general public.

So, the new findings "raise the issue of whether some level of more aggressive screening should be considered, not only for first-degree relatives of patients with polyps diagnosed at or below age 60, but also for those first-degree relatives of patients diagnosed above age 60," Samadder said.

One expert not connected to the study said the findings may be important, but it's often difficult to assess a patient's family history when it comes to colon cancer.

"This information is important not only to specialists who treat colon and rectal and cancer but all primary care providers who recommend screening programs for their patients," said Dr. Jerald Wishner, director of colorectal surgery at Northern Westchester Hospital in Mount KIsco, NY.

However, he added that, "It will be difficult to apply this information in everyday clinical practice. I regularly see patients who know their relatives have had surgery for cancer don't know the type. Finding out if their relatives have had adenomas or advanced adenomas will be very difficult. This will be further complicated as we seek information about second or third degree relatives."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Jerald Wishner, M.D., director, colorectal surgery, Northern Westchester Hospital, Mount Kisco, N.Y; University of Utah, news release, Oct. 22, 2013

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What You Need to Know About Your Colon

No one likes to discuss colon health. But it’s serious business, and learning about it—and what you can do to take care of your colon—can help ensure you and your loved ones lead healthier lives.

Here, Benjamin Hopkins, MD, a Duke Medicine colon and rectal surgeon, touches every condition you don’t want to talk about – from hemorrhoids, and fecal incontinence to anal pain and diverticulitis.

Q. What’s the most important thing to do for colorectal health?

A. The best approach to good colorectal health is to maintain a high-fiber diet and drink plenty of water. Eight glasses of water a day helps prevent constipation. A high-fiber diet will help prevent complications of hemorrhoids and anal tears and will help to prevent diverticulitis.

Q. Most people know that surgery is used to treat colorectal cancer, but what other conditions do you treat with surgery?

A. Surgery is necessary to treat recurrent or complicated bouts of diverticulitis and inflammatory bowel diseases that don’t respond to other treatment. It is also used to treat benign problems of the anus and rectum when conservative management fails.

Q. Can surgery really cure these conditions?

A. Yes! That’s why I love my job so much.

Q Does surgery leave an ugly scar?

A. We specialize in minimally invasive surgery, including robotic, laparoscopic, and single-site surgeries, which leave patients with smaller scars, less pain, and a faster recovery. There is no scar from transanal endoscopic microsurgery since all work is done through the anus.

Q. What are hemorrhoids, exactly, and how do you know if you have them?

A. Everyone has hemorrhoids—they are part of our anatomy. It’s just a question of whether they’re bothering you. Hemorrhoids can become aggravated with changes in bowel habits, such as diarrhea and constipation. Over the years, they can pull away from the underlying muscle, prolapse, and bleed. Prolapse means something is hanging out “down there.” Typically, hemorrhoids cause people to experience itching, bleeding, and prolapse. Pregnancy can also cause hemorrhoids to become engorged because of the increased pelvic pressure.

Q. How are hemorrhoids treated when they become aggravated?

A. Initial management includes increasing the amount of fiber and water in the diet. Most of my patients find that’s all that is needed. Be sure to increase fiber slowly: I tell people to increase daily intake by 5 grams for a week, then another 5 grams for another week, until they reach 20 to 25 grams per day. That way they avoid bloating and gassiness. If adding fiber to your diet doesn’t work, there are simple and painless office procedures to treat hemorrhoids. If these fail, surgery may be the next step. One of the procedures my colleague, Linda Farkas, MD, and I perform is a transanal hemorrhoidal de-arterialization (THD). It is a less-painful way to treat hemorrhoids than a standard hemorrhoidectomy. Not all hemorrhoids can be treated with a THD; treatment depends on the severity of the hemorrhoids.

Ben Hopkins, MD, is part of the team at Duke Colon and Rectal Surgery of Raleigh. To make an appointment, call 888-ASK-DUKE (275-3853).

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