Colorectal cancer rates decline in Cortland region as more patients have colonoscopies

Caitlin Foor-Pessin, MD

Nearly 80% of the residents ages 50-64 in Cortland and most nearby counties have been screened for colorectal cancer, the current New York State health data show. That’s well above the 65% screening rate for all state residents in that age group. The region’s impressive colorectal cancer screening rates play a significant role in the declining incidence of the disease in the Finger Lakes region.

Colonoscopy has been a lifesaver for many patients by detecting colorectal cancer early when it is most treatable and often curable. With cancer screenings and removal of pre-cancerous polyps, colon cancer diagnoses today are half of the rate they were in 1970. Data show that 90% of patients are cured when their colon cancer is diagnosed at its earliest stage.

What are the types of colorectal screenings?

There are two types of screenings:

Colonoscopy. This test can identify 98% of colorectal cancers. It uses a colonoscope, which is a long lighted tube with a small camera at the end. It’s placed inside the rectum and colon, the camera sends images to a video monitor for the physician to review. If polyps or suspicious areas are seen, they can be removed and tested.

Stool-based. These non-invasive tests are done at home and require less preparation than a colonoscopy.

Alternative screening options such as flexible sigmoidoscopy and virtual colonoscopy are available and can be discussed with your gastroenterologist.

How often are the screenings done?

A patient’s risk for colorectal cancer is used to determine the optimal type of screening and its frequency. For those with a normal risk, having a colonoscopy every 10 years and a follow-up stool-based test every one to three years, depending on the type of test, is recommended. The interval for colonoscopy may change if polyps are identified.

How does a patient prepare for a colonoscopy?

Preparation before the colonoscopy usually begins with a low-fiber diet for a few days followed by a clear liquid diet on the day before the procedure. Bowel prep starts the afternoon before the colonoscopy. Bowel preparation involves using a laxative to empty the colon.

What are the pluses and minuses of each type of colorectal screening?

Colonoscopy.

• A colonoscopy screening takes 15 to 60 minutes.
• Patients usually require sedation and may need several hours to recover.
• The screening detects smaller polyps than other tests.
• Suspicious tissue or polyps can be removed and tested.

Stool-based tests.

• The tests don’t require sedation or laxatives and are done at home.
• The Fecal Immunochemical Test (FIT) detects blood in the stool and is less sensitive in detecting cancer than DNA tests.
• Stool DNA tests can detect about 90% of colorectal cancers and 40% of polyps.
• Stool-based tests detect fewer cancers and polyps than colonoscopies. Positive tests will require a colonoscopy to determine if polyps or cancer are present.

Who is most at risk for colorectal cancer?

Colorectal cancer is among the most diagnosed and preventable cancers, but it does not affect all people equally. Age and race play into this disparity. While overall colorectal cancer cases and deaths have declined in the past few decades, the rate has increased for those younger than 50. African Americans, Native Americans, and Alaska natives have the highest incidence of colorectal cancer and are more likely to die from the disease than others. The reasons for this are complex.

When should you begin screening for colorectal cancer?

Initial testing for someone of average risk is recommended at age 45 with future screenings at regular intervals. Testing at an earlier age and more frequent screenings may occur for patients with certain diseases or personal or family history of colorectal cancer or colorectal polyps.

All patients should consult their healthcare provider if they experience symptoms including a change in bowel habits, a change in the stool diameter, blood in or on the stool, abdominal pain, or unintended weight loss.

What can I do to lower my risk of colon cancer?

• Undergo colon cancer screening beginning at 45 or potentially earlier if there is a family history of colon cancer or large polyps.
• Eat a healthy diet including lots of vegetables, fruits, and whole grains. Limit processed meats and red meat.
• Get regular exercise.
• Maintain a healthy weight.
• Don't smoke. Limit alcohol intake.

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Dr. Foor-Pessin came to Cayuga Health in 2018 after completing a Gastroenterology fellowship at the University of Rochester in Rochester, NY. She received her medical degree from the Boston University School of Medicine and completed her internship and residency at the University of Michigan Health System in Ann Arbor, MI. Dr. Foor-Pessin can be reached at Cayuga Gastroenterology by calling 607-339-0788.