Colonoscopies remain best way to detect, prevent colorectal cancer, explains Justin Maykel

Despite newer options available to detect the presence of colorectal cancer, including noninvasive stool tests that detect blood and, in some tests like Cologuard, cancer-related cell DNA changes, colonoscopy is still the gold standard, according to Justin Maikel, MD.

“It has definitely been shown to prevent colorectal cancer,” Dr. Meikel said Joseph M. Streeter and Marie Streeter DeFeudis Chair in SurgeryProfessor of Surgery and Head of the Department of Colorectal Surgery.

The U.S. Preventive Services Task Force recommended in 2021 that adults ages 45 to 75 be screened for colon cancer, lowering the previous recommended starting age from 50. Meikel said studies from the 1990s show that screening in people over 50 led to a decrease in the rate of colorectal cancer in that age group. But rates of colon and rectal cancer are rising in people under 50.

In fact, one in 10 colorectal cancer patients seen at UMass Memorial Health is under the age of 50, Meikel said. And when patients under 50 get cancer, the cancer tends to grow faster and is more aggressive.

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Meikel said a colonoscopy, in which a thin, flexible scope is inserted into the rectum and entire colon, can detect cancers, but it can also find and remove precancerous polyps. Stool tests do not have this preventive ability.

“We estimate that 90 percent or more of colon cancer is preventable, despite the fact that it is the third most common form of cancer in the United States,” he said.

Colon cancer is the second leading cause of cancer death. The survival rate for stage I cancer is still greater than 90 percent, which is why early detection is crucial.

Maikel took issue with the news published in the magazine New England Journal of Medicine which suggested that the benefits of colonoscopy were unclear, calling the study “poorly designed.”

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The study compared rates of colon cancer among people who were offered a colonoscopy with a control group who were not offered a colonoscopy. But only about 40 percent of them offered a colonoscopy received one.

“Basically, the takeaway from the study is that we need to do a better job of educating and convincing people to get screened,” Meikel said.

The obstacle for many people is the commitment to preparing for the exam, which includes fasting and cleansing the colon so that the lining of the colon can be seen. Another is the fear that cancer might be found. The procedure itself, which is performed under sedation, is “really simple and low-risk,” Meikel says.

UMass Chan physicians also report differences in screening rates by socioeconomic background and ethnicity.

Maikel and his colleagues launched an effort to educate UMass Chan and UMass Memorial Health employees in all job categories about the importance of colorectal screening.

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“We’ve had a lot of success in getting employees to sign up for screenings and we’ve identified a number of employees with precancerous polyps,” he said. “Already through the program, one patient has been identified with early colon cancer,” which is easier to treat than advanced stages.

Meikel urged anyone with symptoms associated with colorectal cancer to tell their primary care physician and get a colonoscopy. Symptoms include blood in the stool, changes in bowel habits, unexplained weight loss, and abdominal pain that does not go away.

Science for Life features UMass Chan School of Medicine experts’ perspectives on the research behind health news headlines. If you have ideas for topics you’d like to see explored, please send them to [email protected].

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