Dr. Emily Scott
Dr. Emily Scott is currently a second-year family medicine resident at the Washington Health System. She was born and raised in Moon Township, attended Duquesne University for her undergraduate degree where she earned her bachelor’s of science in biology with a minor in psychology and voice performance. She then attended the Kentucky College of Osteopathic Medicine and returned closed to home for her residency at WHS. When she isn’t working, she enjoys running with her 4-year-old black lab mix Cece, cycling, yoga, hiking, watching live music, and attending Pittsburgh sports events.
Colorectal Cancer Awareness
March is Colorectal Cancer Awareness month, which marks a good reminder for appropriate screening for colorectal cancer. Colorectal Cancer Awareness month started in 2000 under President Clinton. Annually, approximately 50,630 Americans die of colorectal cancer annually, accounting for 8% of all cancer deaths. The rate of colorectal cancer deaths has been steadily declining due to increased awareness and screening.
Who is at risk?
While everyone is at risk for colorectal cancer, certain populations have higher risk. Lifestyle factors that can increase your risk include lack of physical activity, consumption of red meat, obesity, cigarette smoking, alcohol use. Lifestyle factors that decrease your risk include consuming plenty of vegetables, fruits, and fiber. Other factors that decrease your risk include consuming multivitamins that contain folic acid, taking aspirin and other NSAIDs like ibuprofen, postmenopausal hormone use, calcium supplementation, and selenium. See below for a further discussion of who is at increased risk.
Who should be screened, and when?
All adults, both male and female, should be screened at age 50 and up to age 85. Screening recommendations change if you have any of the following:
- Immediate family history of colorectal cancer or polyps – get screened at age 40 or 10 years before the age of the youngest immediate family member (mother, father, sibling)
- Genetic link to colorectal cancer such as familial adenomatous polyposis (FAP), lynch syndrome or hereditary nonpolyposis colorectal cancer (HNPCC) – get screened before age 50
- Personal history of cancer – get screened before age 50
- Personal history of ulcerative colitis, Crohn’s disease, or inflammatory bowel disease – get screened before age 50
- African American patients should be screened starting at age 45 without other risk factors as recommended by some studies
These special populations as listed above are generally not candidates for FIT testing as discussed below, and should be screened with colonoscopy only. If you are experiencing symptoms such as abdominal pain, blood or other irregularities with bowel movements, talk to your doctor immediately regardless of your age or family history.
How does screening work?
There are 2 most widely used tests, the colonoscopy and the Fecal Immunochemical Test (FIT or FIT-DNA). The colonoscopy is a safe procedure that requires a 1-day dietary restriction and preparation solution. A gastroenterologist then uses a long tube with a light and camera to look for abnormalities such as polyps. The benefit of the test includes the ability to remove polyps or biopsy abnormalities seen during the procedure. The frequency of this test varies based on the results of the colonoscopy but can be done up to every 10 years.
The FIT test is a take home test in which a stool sample is placed on a card, is sent into the lab, and detects the presence or absence of blood. This test is done annually if it remains negative. If the test becomes positive, a colonoscopy is then recommended.
Colonoscopy remains the most sensitive test, while FIT testing is the most specific, however, the United States Preventative Task Force (USPSTF) rated these tests as equivalent for screening.
What if I have an abnormal screening test?
If you have an abnormal FIT test, it is recommended that you undergo a diagnostic colonoscopy. Your primary care will recommend a referral to a gastroenterologist for this. If you have an abnormal colonoscopy, your gastroenterologist will recommend the next steps based on the findings. The next steps should include a discussion of treatment, when to re-screen, and subsequent risk for your family members.
If you or a loved one is due for screening, don’t wait! Later diagnosis can have fatal outcomes. For more information, talk with your family doctor or visit ccalliance.org. To join in supporting Colorectal Cancer Awareness month, you can wear blue throughout the month of March!