In October 2022, findings from a study conducted by a team of European researchers detailing the impact of proactive outreach around colonoscopies were published in the New England Journal of Medicine. Unfortunately, the study’s most important findings were overshadowed by misleading headlines that only highlighted a portion – objectively, the least significant portion – of the research. To understand what the findings mean for your health, you should know that they reinforce what we at Sarah Cannon are acutely aware of: colonoscopies can successfully detect and reduce the risk of death from colorectal cancer.
In the blog below, Dax Kurbegov, MD, Vice President & Physician-in-Chief of Clinical Programs for Sarah Cannon, shares insights on the study and more information about colorectal cancer, including screenings, treatment options, and prevention.
A closer look
It’s important to understand that the study’s primary focus was patient engagement. It did not directly look at outcomes of patients who had a colonoscopy versus those who did not. Instead, it examined the outcomes of a group of patients who were invited to receive colonoscopies vs. outcomes for patients who did not have the procedure. And the patients that were invited lived in communities where routine colon cancer screening didn’t exist previously. Unsurprisingly, less than half of those invited actually had a colonoscopy which made the results less convincing than many were expecting. The good news is that when the authors looked at what would have happened if everyone who was invited actually got screened, they saw a real benefit to screening - the risk of colorectal cancer was cut by 31%, and the risk of colorectal cancer-caused death was reduced by 50%.
Understanding colorectal cancer
After prostate and lung cancers, colorectal cancer, also referred to as colon cancer, is the third leading type of cancer among men and women in the U.S. According to The American Cancer Society, one in 23 men and one in 25 women are at risk for having colorectal cancer during their lifetime. The cancer forms in the large intestine (the colon) or the rectum.
Awareness surrounding colorectal cancer increased in 2021 when the U.S. Preventive Services Task Force changed its recommendation for the age that individuals should be screened for the cancer from 50 to 45. The Task Force’s recommendation came following a concerning trend: new cases of the disease among Americans under 50-years-old increased year-over-year between 2012 and 2016.
Heightened visibility of colorectal cancer in recent years has yielded positive results, including an uptick in the number of older individuals screened for the disease. The CDC found that as of 2020, nearly 70% of U.S. adults age 50-75 reported being up-to-date with colorectal cancer screenings. While this data is encouraging, more must be done to drive 45-49-year-olds - as well as younger people who are at higher risk for the disease - to receive regular screenings, especially if we’re to achieve the screening goal set by the U.S. Department of Health and Human Services Healthy People 2030 initiative.
Colonoscopy myth busting
Separating fact from fiction is critical to overcoming barriers to colorectal cancer screening.
Myth: Colonoscopies are uncomfortable
Fact: Patients are sedated during the procedure – which lasts less than an hour – and therefore do not generally experience any discomfort.
Myth: There’s a significant risk of complications tied to colonoscopies
Fact: Colonoscopies are very safe and carry low complication rates. The pro outweighs the con: an individual’s risk of developing colorectal cancer is higher than their risk of experiencing a colonoscopy-related complication.
Myth: Colonoscopies are expensive
Fact: Colonoscopies are considered preventive care and are often covered, in full or in part, by the patient’s insurer.
Myth: Colonoscopies are ineffective if not administered annually
Fact: While the recommended cadence for colonoscopies varies by individual and should be physician-guided, as a general rule, patients should receive colonoscopies every 10 years beginning at age 45.
Myth: It’s best to forgo colonoscopies because there’s a chance they may result in a cancer diagnosis
Fact: Colorectal cancer is highly treatable, particularly when it’s discovered early, and colonoscopies are an effective way to detect colon cancer. And because many colorectal cancers start as polyps that can be easily removed, colonoscopies can help reduce the risk of future cancers.
Screening and treatment options for colorectal cancer
For individuals who remain wary of colonoscopies, a variety of alternative screening methods exist that have proven to be effective in detecting colorectal cancer.
At-home colorectal screening gained popularity during the COVID-19 pandemic when patients were unable to see their physicians for non-urgent care. With these fecal immunochemical (FIT) tests, patients collect stool samples that are then doctor or lab-tested. The tests look for either abnormal blood, DNA, or a combination of both.
Another non-invasive screening option is a virtual colonoscopy in which X-rays are taken of the colon. Technicians review the images to determine the presence of potentially cancerous polyps.
In concert with partners like GRAIL, Harbinger Health, and others, Sarah Cannon is also exploring non-invasive strategies that simplify the screening process and offer patients convenience. One such method is a single blood draw that screens for several forms of cancer, including colorectal cancer, simultaneously. Right now, those types of commercially available multi-cancer detection tests should only be used to supplement standard screening, not replace them.
For patients who undergo screening and receive a resulting colorectal cancer diagnosis, treatment options are available. Identified in its earliest stages, the disease can be addressed with a straightforward surgical procedure. A pioneer in novel treatments, Sarah Cannon Research Institute is participating in a wide variety of clinical trials evaluating the use of new therapies for patients with different stages of colorectal cancer. These treatments include immunotherapies to mitigate the spread of and eliminate cancerous cells in the colon, and personalized cancer vaccines.
Colorectal cancer prevention
As is the case with many forms of cancer, lifestyle modifications can be made to decrease the likelihood that colorectal cancer will be a part of one’s journey. Research shows that regular physical activity and weight maintenance, reducing red meat consumption, and carcinogen avoidance, including steering clear of cigarette smoke, are effective steps in lowering one’s risk.
The bottom line
If cancer is part of a patient’s story, catching it as soon as possible allows for the best possible chance that it can be treated and cured, and colorectal cancer screening is an important and effective step in achieving early detection – regardless of if it’s initiated by physicians or patients.
If you’re 45 or older, or have a family history of colorectal cancer, start a conversation with your physician about screening options. You can also browse our colorectal cancer education content, call askSARAH at (844) 482-4812, or visit askSARAH online.
It is important to know that the information in this post, including Sarah Cannon’s recommendations for screening, is accurate as of the publishing date.