Outside the Guidelines

March is Awareness Month for colorectal cancer, and we face a flurry of activity during this month.  In part I think that is great, since it generates some media.  On the other hand it seems a bit silly. After all, people are diagnosed with colorectal cancer every month of the year, not just March.

If you know much about the Colon Cancer Alliance, you know that we are in our second year of partnership with Salix Pharmaceuticals and Walgreens, the largest drug store chain in the country.  In the month of March, Walgreens has signage about screening in every one of their 6100 stores and, as part of that campaign, I participated in a series of 14 radio interviews pushing screening.  We also receive support from Amgen for our regional seminars for patients.  Amgen contracted with Joan Lunden to help with publicity, and Joan and I conducted 20 television and 3 national radio interviews.  This is where it gets interesting….

After the Joan Lunden media event, I received an email from a patient who expressed concern that the interviews gave out incorrect information.  Joan stated that the majority of people diagnosed are 50 years old or older.  In the interviews she and I both said that most people should be screened for colorectal cancer starting at that age.  This patient was much younger when diagnosed, and took exception to that message. 

How to respond to this?  We receive calls on a regular basis from people who were diagnosed before they reached 50.  The youngest patient ever to contact us was a 15 year-old girl!  Still, the data show that 90 percent of people are diagnosed later in life.  Of course, with over 150,000 new diagnoses every year, this means that 15,000 people are diagnosed before they reached the age when they should be screened.  If you are one of those 15,000 you don’t really care about data—you just wish someone had pushed you to have a colonoscopy earlier.  And, most likely you were misdiagnosed for a year or two because no-one thought a person your age could have colorectal cancer.

So what should we do?  Screen everyone at 40?  At 30?  At 15?  Clearly that is not the solution.  Seems to me that we have to look at this issue in a multi-pronged approach.  We should push to get everyone over the age 50 screened.  This will have the biggest impact for the most people.  We should also talk about other circumstances that mean earlier screening, such as a family history of cancer or polyps, being African-American, being a heavy smoker.  And, we absolutely must educate the public on the importance of being aware of your body and paying attention to things like abdominal pain, changes in bowel habits, blood in stool, etc. 

Unfortunately, even if we accomplish all of these things some people will still be missed.  I guess that this is just another proof that cancer doesn’t fight fair.

Comments

[Rotorhead]

I think you stated things correctly; however when going out to a mass audience you'll always have dissenters. As a colorectal cancer patient who defies the standard (younger than 50, healthy lifestyle) I've reviewed much of the popular literature and the consensus matches your statement. It certainly supports screening folks starting at age 50. However, I'd add that if one is diagnosed, regardless of age they should press for their familiy members to be screened as soon as possible, particularly if they are older. Likewise, learn the results of your parents' screening - I did not know one of my parents had non-cancerous polyps until I had my 'scope and started asking the questions.

Keep fighting the good fight,
RH

[Judith Novak]

"Cancer doesn't fight fair." Absolutely. I think the take-home message is to be aware of your body at any age. If something is wrong, don't be put off by "you're too young for this." Insist on testing.

As for earlier screening, the truth is that colonoscopies are not cheap. But tests for blood in your stool are cheap and readily available. Those tests can and should be done early and often. Perfect? No. But possible.

Awareness and education is the key. Keep fighting the good fight!

JN

[Kate Murphy]

Very often when I encounter someone who has been diagnosed under the age of 50 without family or personal medical risks, I find out that they were told they were "too young" or tested with a less than optimal method rather than colonoscopy. We need people to know the symptoms of colorectal cancer and insist on colonoscopy to evaluate them at any age.

The reality is that screening people with no symptoms, even with simple tests like FOBT, has risks with it. It is these risks, not the costs, that are important to let people who want earlier screening know about.