March is soon upon us, and I have the privilege of discussing Colorectal Cancer Awareness Month with you. But first a story. A word of caution, if you don't want to hear a long speech, don't ask a physician to tell you a story. Once started, it's hard to get them to stop.
I've been in practice for about 25 years. Early on in my practice, Bill came in as a new patient. He was in his late fifties at the time, and very active. On his first visit, we discussed his prior health screening and he had never had colon or prostate cancer screening before. He agreed to have a digital rectal exam performed as I assured him that if it was any consolation, it was no more pleasant from my end.
Unfortunately for him, or fortunately depending on how you look at it, I found microscopic amounts of blood in his stool. I referred him for a colonoscopy and he was found to have an early stage of colon cancer. He had a successful partial colectomy and did very well.
For the next 25 years, I saw Bill about once every three months. We would talk about how he went out square dancing every weekend, and every visit, he thanked me for the fact that he was still alive. He was always matter-of-fact about it. He had a great life, always telling me about his experiences square dancing each weekend where he was quite a hit with the ladies. He passed away recently, and the fact that he lived life fully for a couple of extra decades is something that gives me great satisfaction.
While most of medicine is quite rewarding, other aspects are incredibly difficult. No textbook or medical school adequately prepares you to give people awful news. After all these years, it remains the hardest thing I have to do. When the report comes in, I immediately get a sinking feeling in my stomach. It's hard to sleep, knowing what you have to tell the patient the next morning. When you sit with them and say "it's cancer", most everything you say afterwards gets tuned out. In the scheme of things, performing a digital rectal exam is infinitely more pleasant than trying to comfort someone during one of the most traumatic moments of their life. It is made even worse knowing that, despite all your admonitions, they skipped basic screening that could have prevented it or caught it much earlier.
That brings me to Colorectal Cancer Awareness month.
If you are fifty years old or older, you should be getting routine screening for colon cancer. As opposed to most other cancers, colon cancer is largely preventable. While not all colon polyps turn cancerous, most cancers start as polyps. These typically take years to turn cancerous. When found early, they can be easily removed, thus never developing into cancer. If screening does detect cancer, it tends to find it in earlier, treatable stages.
There are several common ways to screen for colon cancer:
1. Yearly testing for occult blood through testing of stool specimens
2. Sigmoidoscopy ( looking with a short scope every five years
and the gold standard
3. Colonoscopy every ten years.
If you have a first degree relative (parent, sibling or child) with colon cancer or adenomatous polyps before the age of 60, or two first degree relatives diagnosed at any age, screening should start at age 40 or 10 years younger than earliest family member's diagnosis, whichever comes first. Some patient's, like those with Familial Adenomatous Polyposis or Inflammatory Bowel Disease need even more aggressive screening, and should be seeing their physician regularly.
For those members who take the initiative to get screened, post here and you will get a neat badge next to your name. I believe that those who participated last year get one as well. I'll get the satisfaction of knowing that I helped convince a few members of this great place to get checked. If even one of you gets a couple extra decades as productive as Bill's were, this will have been the best post I've ever written here.
I've been in practice for about 25 years. Early on in my practice, Bill came in as a new patient. He was in his late fifties at the time, and very active. On his first visit, we discussed his prior health screening and he had never had colon or prostate cancer screening before. He agreed to have a digital rectal exam performed as I assured him that if it was any consolation, it was no more pleasant from my end.
Unfortunately for him, or fortunately depending on how you look at it, I found microscopic amounts of blood in his stool. I referred him for a colonoscopy and he was found to have an early stage of colon cancer. He had a successful partial colectomy and did very well.
For the next 25 years, I saw Bill about once every three months. We would talk about how he went out square dancing every weekend, and every visit, he thanked me for the fact that he was still alive. He was always matter-of-fact about it. He had a great life, always telling me about his experiences square dancing each weekend where he was quite a hit with the ladies. He passed away recently, and the fact that he lived life fully for a couple of extra decades is something that gives me great satisfaction.
While most of medicine is quite rewarding, other aspects are incredibly difficult. No textbook or medical school adequately prepares you to give people awful news. After all these years, it remains the hardest thing I have to do. When the report comes in, I immediately get a sinking feeling in my stomach. It's hard to sleep, knowing what you have to tell the patient the next morning. When you sit with them and say "it's cancer", most everything you say afterwards gets tuned out. In the scheme of things, performing a digital rectal exam is infinitely more pleasant than trying to comfort someone during one of the most traumatic moments of their life. It is made even worse knowing that, despite all your admonitions, they skipped basic screening that could have prevented it or caught it much earlier.
That brings me to Colorectal Cancer Awareness month.
If you are fifty years old or older, you should be getting routine screening for colon cancer. As opposed to most other cancers, colon cancer is largely preventable. While not all colon polyps turn cancerous, most cancers start as polyps. These typically take years to turn cancerous. When found early, they can be easily removed, thus never developing into cancer. If screening does detect cancer, it tends to find it in earlier, treatable stages.
There are several common ways to screen for colon cancer:
1. Yearly testing for occult blood through testing of stool specimens
2. Sigmoidoscopy ( looking with a short scope every five years
and the gold standard
3. Colonoscopy every ten years.
If you have a first degree relative (parent, sibling or child) with colon cancer or adenomatous polyps before the age of 60, or two first degree relatives diagnosed at any age, screening should start at age 40 or 10 years younger than earliest family member's diagnosis, whichever comes first. Some patient's, like those with Familial Adenomatous Polyposis or Inflammatory Bowel Disease need even more aggressive screening, and should be seeing their physician regularly.
For those members who take the initiative to get screened, post here and you will get a neat badge next to your name. I believe that those who participated last year get one as well. I'll get the satisfaction of knowing that I helped convince a few members of this great place to get checked. If even one of you gets a couple extra decades as productive as Bill's were, this will have been the best post I've ever written here.
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