The Cancer That Can Be Prevented!

The process of looking for colorectal cancer or its precursors before symptoms develop is called screening. It has been proven that screening can reduce the rate of death from colorectal cancer². Yet while 71 percent of women over 40 have had a mammogram to screen for breast cancer and 80 percent have had a pap smear to screen for cancer of the cervix, less than 30 percent have a had a screening test for colorectal cancer³.

Colorectal cancer is particularly amenable to prevention and early detection since it remains in a pre-malignant form (polyp) for many years and the colon is an easily accessible organ. By identifying and removing polyps in a timely fashion, colorectal cancer should be preventable in almost all cases.

The most accurate way to examine the colon is by colonoscopy⁴. The colonoscope provides a direct view of the lining of the colon and rectum and enables the operator to biopsy any abnormality and, in most cases, remove any polyps identified. The estimated reduction in death from colorectal cancer provided by colonoscopy screening is at least 59%⁵. The American College of Gastroenterology now recommends a colonoscopy examination every ten years beginning at age of 50 as their preferred colorectal cancer screening strategy⁶.

The Pezim Clinic is the first free-standing lower gastrointestinal diagnostic and treatment centre in British Columbia. It has been designed exclusively to meet the needs of patients with disorders of the lower gastrointestinal tract and those who wish to prevent intestinal disease. Our colorectal surgery staff has performed over 3,500 safely conducted colonoscopy examinations. We offer state-of-the-art screening programs for those at normal or high risk for colorectal cancer.

The Pezim Clinic offers colorectal cancer screening programs for patients with normal risk, and for those with increased risk:

Pezim Clinic normal risk colorectal cancer screening programs
Beginning at age 50 either:
Colonoscopy every 5 years (optimum program)
or
Flexible sigmoidoscopy every 5 years supplemented by yearly testing for stool blood (faecal occult blood test). If any occult blood stool test is positive, full colonoscopy. If any flexible sigmoidoscopy test reveals a polyp, full colonoscopy, either immediately or within a few weeks of the flexible sigmoidoscopy.

The advantage of the full colonoscopy program is that nothing else has to be done between examinations, and the risk of missing anything significant is very low. The advantage of the flexible sigmoidoscopy program is that sedation is not generally needed for flexible sigmoidoscopy so the patient can have the test and go drive right back to work. Flexible sigmoidoscopy and stool testing is frequently recommended as the most rationale choice for colon screening, particularly by government agencies and insurance companies, since up front costs are less for them to bear than would a full colonoscopy program. However, patients should be aware that up to 25% of advanced lesions may be missed on a flexible sigmoidoscopy and stool testing program. For more information on the results of either of these programs, read the accompanying article on colorectal cancer screening.

Pezim Clinic increased risk colorectal cancer screening programs
a) For those with one first-degree relative (parent or sibling) with colorectal cancer onset > 55 years
-Colonoscopy every 5 years beginning at age 40

b) For those with one first-degree relative with colorectal cancer onset < 55, or two first-degree relatives on the same side of the family regardless of age of cancer onset
-Colonoscopy every 5 years beginning at age 40 or beginning 10 years earlier than the youngest age of onset of colorectal cancer in the family

c) For those in hereditary non-polyposis colon cancer families (HNPCC, Lynch Syndrome 1), special programs including early colon examination, genetic testing and counseling will be offered. HNPCC is an autosomal dominant inherited trait that can lead to adenomatous colon polyps and colorectal cancer. You may have this disorder if you have:

a. Three or more relatives with colorectal cancer;
b. Colorectal cancer involving at least two generations; or
c. One or more cases of colorectal cancer diagnosed before age 50 with one being a first-degree relative of the other two.

d) For those with Familial Adenomatous Polyposis (FAP/Gardner's Syndrome), early colon examination, genetic testing and counseling, and early surgery will be offered. FAP is an autosomal dominant inherited trait that can lead to adenomatous polyps and colorectal cancer at an early age - often by the age of 25 and always by the age of 40. If you have a family history of a parent or older brother or sister who had colon polyps and colon cancer and who died from colon cancer before the age of 40, you may have FAP.

In either program, screened patients are entered into the online Pezim Clinic Colonoscopy Registry that provides password-protected online access to the colonoscopy results to give you the most accurate and timely means by which you and your medical providers can keep track of your colon health.

All Pezim Clinic screening programs will be individualized according to age and general medical condition. Screening may not be appropriate for individuals with significant medical problems or a life expectancy of less than ten years.

Colorectal cancer screening - which test is best?