Has the CT Colonoscopy debate distracted us from the central purpose of screening?
Sometimes we collectively need a wake up call. Mine came three years ago when a friend and industry colleague, an imaging sales executive, tragically passed away months before turning 40, after a heroic fight against colon cancer. He was a great guy – he took excellent care of himself, he was fit, he always had a smile on his face, and he adored his wife and two young kids.
Just months later, another good friend with a young family shared with me his tragic news of colon cancer. Thankfully, the cancer was detected relatively early. After surgery and chemo, he was on the road to recovery, but now he has a life living with cancer.
Both of these seemingly healthy men were diagnosed a decade prior to the age of 50, which is the recommended age for colorectal screening by the US Preventive Services Task Force (USPSTF). USPSTF screening recommendations in 2008 were for “fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults,” from age 50-75, with those at higher risk of developing colorectal cancer encouraged to get screened earlier. What was startling to me was that colorectal is one of the slowest growing cancers, taking 8-10 years to fully develop. But once it has fully developed, metastasis is a significant risk, and that’s tough to treat. It’s the third most common cancer and the second leading cause of cancer death in the US. Screening for colorectal cancer in the U.S. lags behind other effective cancer screening tests and it has been estimated that if we did a better job, 18,800 lives could be saved annually.
When I asked my doctor to be screened, we discussed the available options. CT colonography (CTC) was discussed, but never really presented as a recommendation. I’m sure for others, with different histories and risk factors, CTC might be the right choice. I wasn’t interested in debating the merits of one approach over the other, I just wanted to be screened. My colonoscopy procedure was scheduled, I went through the prep, the procedure, and sure enough some benign polyps were removed.
Reflecting back, if I had gone the CTC route, and assuming they saw the polyps (which is an assumption), I would have had to go through an additional procedure.
If you’re at that age, or concerned, just get screened. Colonoscopy is an invasive screening procedure that does have its own set of risks and complications, and I've had relatives that experienced complications. In my personal experience, the procedure allowed me to get in a power nap, with no memory of the procedure, although the prep was not pleasant. CTC has its use cases, but until technology improves, the invasive colonoscopy ain't so bad if it saves just one life at a time.
The bigger issue is the masses need to get over the stigma behind getting tested. We've got to get more people screened, as early as possible, as this awful disease does not need to cause untold tragedy over and over again. Get screened.