Colorectal cancer remains one of the most curable cancers—if it’s detected early. The U.S. Preventive Services Task Force (USPSTF) recently renewed its advice stating that screening for colorectal cancers should begin at age 50 and continue to at least age 75.
For people age 76 to 85, the USPSTF noted that for some individuals, the benefits of screening to diagnose colorectal cancers are smaller, and the potential for harm greater. (The guidelines don’t apply to people who’ve never been screened, so if you haven’t, discuss the options with your doctor.) Colorectal cancers can include cancer of the colon but also cancer of the rectum.
If you are in the 76-to-85 age group, be guided by your life expectancy—and keep in mind that it takes about 10 years for a new polyp to develop into cancer. This means that if you’re 85 and have been regularly screened and given the all-clear, you’re done with colorectal screening, since it is very unlikely any polyp you have would ever reach the stage where it needs treatment. If you have symptoms, however, like bleeding or iron deficiency, you may need a diagnostic colonoscopy.
Despite the success of screening for colorectal cancers, many people who may benefit still aren’t getting screened. People who avoid colonoscopy likely do so because of its invasive nature, and the fact it involves avoiding solid food and just drinking clear liquids for 24 hours, as well as taking laxatives.
There are screening options that are not invasive; the fecal occult blood test (FOBT) and fecal immunochemical test (FIT) check for the presence of blood in the stool. These tests are performed annually, can be done at home, and don’t require bowel preparation beforehand.
You also can opt for flexible sigmoidoscopy. Carried out every five years, this test is similar to a colonoscopy but doesn’t require a full bowel prep. It also is slightly less invasive—however, it examines only about one-third of the colon, and any potentially cancerous growths that are higher up will be missed. I prefer colonsocopy personally, because the entire colon is visualized, and if something is seen it can be removed or biopsied right then.
There isn’t a way around the fact that colonoscopy is invasive. However, you will be given a mild sedative to relax you, and there are some things you can do to make colonoscopy prep easier.
Firstly, make sure you will have the privacy you need—if you take care of your spouse or an elderly parent, arrange for extra help. Stock up with clear broths, fruit juice, and/or soft drinks to consume while you are off solids (usually the day before the procedure)—it’s vital to stay hydrated at this time.
Also consider purchasing incontinence bed pads to protect your mattress, along with wet wipes and a soothing ointment (such as Vaseline) for use after taking the laxative. When it comes to the latter, pace yourself—aim to consume a glass every 20 to 30 minutes. (Holding your nose, and using a straw placed on the back of your tongue can help make it easier to drink the solution.) Once you’ve ingested the laxative, stay near the bathroom.
Colorectal Cancers: Prevention Tips
You also can protect yourself from colorectal cancers by addressing risk factors like smoking, excessive alcohol intake, obesity, and a sedentary lifestyle. Eating a healthful diet also is associated with less risk for colorectal cancers, so increase your consumption of fiber-rich whole grains, fruits, and vegetables, and limit saturated fat.
In any individual there may be considerations that support screening, but at the moment, for most of us colonoscopy comes ’round once a decade. It may not be the most pleasant experience, but it’s infinitely preferable to cancer. And yes—in this instance, I practice what I preach!
Rosanne Leipzig, MD, PhD, is Professor and Vice Chair of the Brookdale Department of Geriatrics and Adult Development at the Icahn School of Medicine at Mt. Sinai in New York, N.Y. She also serves as Editor-in-Chief of the monthly publication Mount Sinai School of Medicine Focus on Healthy Aging. Visit her website at rosannemd.com.