Screening for colon cancer (or colorectal cancer, bowel cancer)

[daylatedollarshort]

This isn't a screening test, but this diet swap study (traditional African vs. Western diet) shows the impact diet may have on one's risk for colon cancer within just 2 weeks of a diet change.

"Perhaps even more importantly, a change in diet from a westernized composition to a 'traditional African' high fiber low fat diet reduced these biomarkers of cancer risk within two weeks, indicating that it is likely never too late to change your diet to change your risk of colon cancer." - Diet swap has dramatic effects on colon cancer risk for Americans and Africans -- ScienceDaily

Swap Your Diet, Swap Your Cancer Risk - https://www.forbes.com/sites/aliceg...ur-diet-swap-your-cancer-risk-new-study-finds " The Americans ate the typical low-fat, high fiber diet of South Africa: Foods included hi-maize corn fritters, salmon croquettes, and spinach, red pepper and onions for breakfast; hi-maize corn dogs or veggie dogs, homemade tater tots, and mango slices for lunch; and okra, tomatoes, and hi-maize meal; corn muffins, black-eyed peas, pineapple and black tea for dinner. Meanwhile, people in South Africa ate an “American” high-fat, low-fiber diet: Foods included beef sausage links and pancakes for breakfast; hamburger and French fries for lunch; and meatloaf and rice for dinner."

ETA: More info and recipes for traditional African diets here - https://oldwayspt.org/traditional-diets/african-heritage-diet

 

[daylatedollarshort]

Platelet count may also be a less invasive biomarker (simple blood test) for not only colon but other types of cancer as well, especially lung and colorectal cancer - Raised blood platelet levels 'strong predictor' of cancer -- ScienceDaily

 

[RAE]

This isn't a screening test, but this diet swap study (traditional African vs. Western diet) shows the impact diet may have on one's risk for colon cancer within just 2 weeks of a diet change.

"Perhaps even more importantly, a change in diet from a westernized composition to a 'traditional African' high fiber low fat diet reduced these biomarkers of cancer risk within two weeks, indicating that it is likely never too late to change your diet to change your risk of colon cancer." - Diet swap has dramatic effects on colon cancer risk for Americans and Africans -- ScienceDaily

Interesting study, but my guess is that swapping the traditional Western Diet with just about ANY diet that is lower in processed junk foods would have achieved a similar result. Here is the Western Diet as they described it:

"people in South Africa ate an “American” high-fat, low-fiber diet: Foods included beef sausage links and pancakes for breakfast; hamburger and French fries for lunch; and meatloaf and rice for dinner."

This diet is high in ultra-processed grains (pancakes, burger buns); industrial seed oils (french fries); and sausage links are a processed meat product. And my guess is that the condiments on the burgers contained some unhealthy ingredients as well, like soybean oil. Ketchup on the fries contains high fructose corn syrup. Maple syrup (probably fake) on the pancakes would contain lots of either sugar and/or high fructose corn syrup. Replacing those things with just about ANY unprocessed, whole foods would certainly improve the diet, and probably reduce the risk for colon cancer. So I don't necessarily think the takeaway message from this study should be that Americans should eat less fatty foods, or that we should eat exactly like Africans do. What we should be doing is replacing unhealthy fats (industrial seed oils) with healthy fats, and seeking out whole foods (vegetables, even baked potatoes, fish, grass-fed meat) rather than junk foods such as french fries and processed meat products.

 

[daylatedollarshort]

Interesting study, but my guess is that swapping the traditional Western Diet with just about ANY diet that is lower in processed junk foods would have achieved a similar result. Here is the Western Diet as they described it:

"people in South Africa ate an “American” high-fat, low-fiber diet: Foods included beef sausage links and pancakes for breakfast; hamburger and French fries for lunch; and meatloaf and rice for dinner."

This diet is high in ultra-processed grains (pancakes, burger buns); industrial seed oils (french fries); and sausage links are a processed meat product. And my guess is that the condiments on the burgers contained some unhealthy ingredients as well, like soybean oil. Ketchup on the fries contains high fructose corn syrup. Maple syrup (probably fake) on the pancakes would contain lots of either sugar and/or high fructose corn syrup. Replacing those things with just about ANY unprocessed, whole foods would certainly improve the diet, and probably reduce the risk for colon cancer. So I don't necessarily think the takeaway message from this study should be that Americans should eat less fatty foods, or that we should eat exactly like Africans do. What we should be doing is replacing unhealthy fats (industrial seed oils) with healthy fats, and seeking out whole foods (vegetables, even baked potatoes, fish, grass-fed meat) rather than junk foods such as french fries and processed meat products.

There are all sorts of simple tests one can do now like platelet count (not raised), IGF-1 and gut microbe testing so whatever diet gets all your bacteria and biomarkers in check is probably a good diet for you.

The Role of the Gut Microbiome in Colorectal Cancer - PubMed (nih.gov)

 

[gcgang]

Just had my third colonoscopy (age67) today.

The prep had changed, taking 4 dulcolax at 5 pm, drink a diet Gatorade with 1/2 bottle Miralax at 6 pm, then repeat the Gatorade/miralax at 2am (6 hours prior to procedure). Rough night.

They found and removed three small polyps and I’m awaiting the biopsies.

 

[KarenC]

Wow, that's awful, so sorry. Did the colonoscopy just miss a cancer that was there? How was it finally detected? So glad you are in remission now.

Thank you for the kind thought. Regarding the first part, I simply don't know. The cancer was detected after I was hospitalized for a bowel obstruction, at which point they did another colonoscopy and found a tumor.

 

[RetMD21]

Actually I did not see them recommending any particular screening methods. Did I miss something?

Right, 3 options no gold standard.

 

[sengsational]

^ That's interesting! Doesn't stop all the guys who make money operating the scope saying it's "gold standard", though.

 

[Montecfo]

Right, 3 options no gold standard.

Again, the report offered description and pros/cons of each procedure.

Health care prodessionals' main objective is to encourage people to get screened. People who object to colonoscopy for whatever reason are encouraged to use other methodologies.

Most importantly, get screened!

 

[LRDave]

Had colonoscopies at 50 & 60 as recommended - all clear.

I'm 63 - pondering whether to do it again at 70.

 

[harllee]

Had colonoscopies at 50 & 60 as recommended - all clear.

I'm 63 - pondering whether to do it again at 70.

I am like you --had the ages 50 and 60 colonoscopies, no problems and I just had the age 70 one a few months ago, again no problems. I was told I would not need to have another one unless I developed "problems." My doctor recommended that I have the age 70 colonoscopy and so I did it.

 

[H2ODude]

I had clear colonoscopy at about 55, finally got DW to get one a few years later, they got several fairly large polyps out and she has been clear since. I was about 67 when they pulled 3 precancerous polyps out and said come back in 3 years. I did and they found another precancerous so I guess I'm on the 3 year plan.

So I guess for us 55 isn't too early based on DW's experience but keeping watch would seem be in order. In my case a clear colonoscopy can be followed by precancerous polyps that want to return. In this case what the doctors recommended seemed to be pretty appropriate. Since DW's mother had full on colon cancer at 81 (no prior testing other than low blood cells thanks to bleeding) and had 1/3 colon removed with no return, we've told both of our kids that given family history they probably should at least follow the new guidelines, which I think is first at 45.

 

[oaklanding]

Booster of Colonoscopies

When I was 40, I had blood in my stool. I wanted to ignore it, but I didn't. My doctor immediately ordered a colonoscopy. From the colonoscopy I learned I had rectal/colon cancer and had immediate surgery that saved my life. I have been cancer free for over a decade. I now get the colonoscopy every three years. I'm a very big believer in them.

 

[Cobra9777]

Screening colonoscopies are free in US (If you have ACA compliant insurance and meet age thresholds.)...

They are "free" (covered 100% by insurance), if you have zero history of any kind of previous disease process. Even family history can turn a preventive screening into a diagnostic test...

I'm confused about this. I had my first at 53... one polyp removed. Insurance paid 100%. I was put on the 5-year plan. Second at 58... clean. Insurance paid 100%. Now on the 10-year plan.

DW had her first at 55... one small polyp removed. Insurance paid 100%. She was put on the 5-year plan. Second is scheduled in about 2 weeks. The GI office is telling her that it's coded as diagnostic not preventative due to the polyp 5 years ago.

We both use the same GI doctor. She even mentioned to the office manager about my case, but they had no explanation why it was coded differently. I suggested she ask her PCP to refer her to a different GI doctor but she's not willing to do that.

Does anyone know more specifics about this? Is is up to the discretion of the GI office how it's coded? Is it the type or number of polyps?

 

[RetiredHappy]

^ That's interesting! Doesn't stop all the guys who make money operating the scope saying it's "gold standard", though.

That has been my experience with my GI doctor as well. He said colonoscopy is the gold standard. In reality, a colonoscopy screening is only as good as the doctor who is doing it. GI doctors do miss seeing growths because it is based on what they see and their interpretation. Both FIT and Cologuard use quantative measurement. I was told by my GI doctor that Cologuard can have false positive. Heck I will take false positive over false negative. If Cologuard is positive, I can always have a colonoscopy to further diagnose.

I told my PCP that I am not going to have a colonoscopy unless I am getting a positive with Cologuard. He had been pushing for colonoscopy but he agreed that they are all good screening options. He has no issue with our continued use of Cologuard.

 

[Montecfo]

That has been my experience with my GI doctor as well. He said colonoscopy is the gold standard. In reality, a colonoscopy screening is only as good as the doctor who is doing it. GI doctors do miss seeing growths because it is based on what they see and their interpretation. Both FIT and Cologuard use quantative measurement. I was told by my GI doctor that Cologuard can have false positive. Heck I will take false positive over false negative. If Cologuard is positive, I can always have a colonoscopy to further diagnose.

I told my PCP that I am not going to have a colonoscopy unless I am getting a positive with Cologuard. He had been pushing for colonoscopy but he agreed that they are all good screening options. He has no issue with our continued use of Cologuard.

I think you are validating colonoscopy as the gold standard via your stated strategy.

 

[RetiredHappy]

I think you are validating colonoscopy as the gold standard via your stated strategy.

I see it as getting multiple data points. The GI doctor would know to look harder for growth with a positive FIT or Cologuard test. Several people whom I know had clear colonoscopies, only to find out that they had colon cancer a couple of years later.

 

[Montecfo]

I see it as getting multiple data points. The GI doctor would know to look harder for growth with a positive FIT or Cologuard test. Several people whom I know had clear colonoscopies, only to find out that they had colon cancer a couple of years later.

I see the logic there. I think you take some risk if you are doing the Cologuard in lieu of colonoscopy as it is less effective, though also not invasive.

But your strategy assumes doctor is not competent. So maybe find a well regarded doctor.

I do like Cologuard for folks at below average risk. And I have owned the stock for quite a while, Exact Sciences (EXAS).

 

[sengsational]

The comment about colonoscopy effectiveness to detect problems "is as good as the doctor performing the procedure" is probably a pretty good way to look at it.

They actually time and track the process of retracting the cope. If it's getting close to tee time, the doctor might get the scope all the way in, take that all-important picture of the cecum (the $ shot), then yank it out without looking too closely. They also track "ademoma detection rate", but as with most things in the medical field, there is no official reporting requirement, so as a shopper, we're left in the dark. Some practices will publish their data, and those are probably the ones you should use.

An adenoma detection rate is a reportable quality measure that indicates the proportion of screening colonoscopies performed by a physician who detects at least one histologically confirmed colorectal adenoma or adenocarcinoma. Professional societies recommend adenoma detection rates of 15 percent or higher (female patients) and 25 percent or higher (male patients) as indicators of adequate colonoscopy quality.

 

[RetMD21]

I think you are validating colonoscopy as the gold standard via your stated strategy.

No the colonoscopy is to confirm and then remove polyps. None of the approaches with noninvasive testing end there. Are really invested in colonoscopy as a gold standard ?

 

[Montecfo]

The comment about colonoscopy effectiveness to detect problems "is as good as the doctor performing the procedure" is probably a pretty good way to look at it.

They actually time and track the process of retracting the cope. If it's getting close to tee time, the doctor might get the scope all the way in, take that all-important picture of the cecum (the $ shot), then yank it out without looking too closely.

And then they just put stock photos of your colon in the report?

 

[Montecfo]

No the colonoscopy is to confirm and then remove polyps. None of the approaches with noninvasive testing end there. Are really invested in colonoscopy as a gold standard ?

I am just staying fact-based. I am not sure why you would want to avoid a free procedure once a decade which is best able to detect cancers at the highest level.

And if found, remove them.

Unless you believe you are at very low risk or have a great fear of doctors.

People who would do nothing if colonoscopy were only choice should definitely do Cologuard. That is what it is for. Less effective but easier.

And far better than nothing.

 

[harllee]

Many of my friends who have had colonoscopies have polyps removed as part of the colonoscopy and they are told that those polyps likely would have turned into cancer. What I don't understand about the Cologuard test is whether it detects polyps that are not yet cancerous but could develop into cancer. Seems to me that one of the benefits of a colonoscopy is that the polyps are removed before they are cancerous.

 

[rodi]

BIL had never had a colonoscopy because he thought it was icky. Last summer, in his mid 60's, he had some issues (constipation) that was bad enough to send him to the doc and he ended up getting his colonoscopy. Stage 3 colo-rectal cancer. He died in April.

I was on the frequent scope plan for a while - had some minor blood in my stool and mentioned it, when asked, at a physical. Was referred to a sigmoidoscopy... Polyps too big to remove with that limited scope were found. Had to prep again for a full colonoscopy. 5 polyps (benign) were removed. I was only 42. Had to rinse and repeat at age 47 and 52... both were polyp free so back on the 10 year track... except - I had an iron deficiency that was unexplained and primary doc referred me again (age 56). GI doc thought he saw something at the top of my intestines that he couldn't identify - so once again I got to prep twice because they did a follow up colonoscopy/endoscopy combo. Nothing found. (Thank goodness.)

But... as I mentioned in another thread on PSA tests... My family is a 'cancer cluster'... so if a doctor suggests a cancer screening - I'm going to say yes.

I really think family history should play a role in the guidelines. I'm doing a bit more aggressive mammograms because of my mother's ovarian cancer. (risks of breast and ovarian cancer are related). I am advising my sons to do PSA screenings when the time comes because of my cousin and father's prostate cancer history. My husband is getting more frequent colonoscopies given his brother's colorectal cancer.

 

[sengsational]

The GI office is telling her that it's coded as diagnostic not preventative due to the polyp 5 years ago.
...
Does anyone know more specifics about this? Is is up to the discretion of the GI office how it's coded? Is it the type or number of polyps?

You're not the only one confused. It's our lovely medical system doing what it does best: obfuscation about costs.

And then they just put stock photos of your colon in the report?

Mine was timestamped. From cecum to "the end" was 7 minutes and 39 seconds.