How to Halve the Death Rate From Colon Cancer

EVEN though screening tests can prevent colorectal cancer or find it early enough to cure, the disease is still the second-leading cause of cancer death in the United States, with nearly 165,000 new cases and more than 52,000 deaths expected this year.
Rates of colorectal cancer have been declining in recent years, by about 2 percent annually, thanks mostly to increased screening. Yet fewer than half the people who should be screened bother to do so. If they did, the death rate could probably be halved, cancer experts say.

The reason this cancer is so easily prevented or cured is that most of the time it begins as a polyp in the lining of the intestine, progressing slowly and possibly turning malignant. Tests that examine the colon can find polyps, and doctors can snip them out before they become cancers. Or the tests can reveal early tumors that can also be removed.

But tests for colorectal cancer are not popular. Most adults should start being screened at age 50 (sooner for people at high risk because of family history, certain bowel disorders or gene mutations), but many put it off. Some are squeamish about the tests, which require patients to collect stool samples or have an instrument inserted into the rectum.

Screening advocates point out that the unpleasantness is a small price to pay to avoid a painful and deadly disease, and most people who have had the tests say they are no big deal. The worst part of a colonoscopy, many people find, is not the test itself, which is usually done under sedation, but the “prep,” which requires a day at home to take supercharged laxatives to empty the intestines.

“Data tells us this is a problem of people not feeling a strong impetus to be screened from their primary care physician,” said Dr. Robert Smith, the director of screening for the American Cancer Society. “Doctors think patients won’t want to do it, so they don’t bring it up. And they may be ambivalent about which test to endorse. Some patients get a referral, leave the office and the process of scheduling is so esoteric it just doesn’t happen. Everybody’s intending to do the right thing, but it doesn’t get around to taking place.”