Like a lot of us, Stephanie Prioleau, 48, put off routine medical appointments during the worst of COVID-19. The Charlotte-area accountant had no family history of colon cancer and didn’t think there was any harm in delaying her first screening colonoscopy.
In early 2022, she decided to roll ahead. For her initial screening, she was given the option of a colonoscopy or the newer Cologuard test kit, in which you collect a stool sample at home and then send it off for analysis.
She opted for the more thorough colonoscopy, which found two polyps. Within three days of her Feb. 18 screening, she had the results: Cancer.
“Truthfully, those results were shocking,” she said.
For years, the guidance for people of average risk of colon cancer was an initial screening colonoscopy beginning at 50. But more and more people younger than 50 have been diagnosed with colorectal cancer in recent years. So, the guideline for people of average risk has been lowered to 45. The guideline for people at higher risk of colon cancer is 40, or 10 years younger than the impacted family member was at the time of diagnosis.
On March 22, Dr. Will Chevrollier of Novant Health Charlotte Colon & Rectal Surgery - Elizabeth removed a portion of Prioleau’s colon. The cancer had not spread to her lymph nodes, so she didn’t need chemo or radiation.
During the “robotic splenic flexure resection,” the doctor cut and removed the cancerous portion of her colon – about 1.5 feet – and then reconnected the two parts of her colon. Prioleau spent two nights in the hospital, which is “on the early side of normal,” Chevrollier said. Two to five days is standard.
Most people who have the surgery can expect looser stools for a short while immediately following the surgery and, in general, one more bowel movement per day than they had before surgery. Other than that, life should be back to normal. As it is for Prioleau.
Black Americans more at risk
African Americans are disproportionately affected by colorectal cancer. They are about 20% more likely to get colorectal cancer, and about 40% more likely to die from it than most other racial or ethnic groups, according to the American Cancer Society. African Americans are also typically diagnosed with colon cancer at an earlier age than people who are white.
The reasons for the differences can be complex, but some obstacles include a lack of (or less comprehensive) health insurance or a lack of access to healthy foods.
The same has not been found among Hispanics. The ACS said they are less likely to be diagnosed with colorectal cancer than non-Hispanic whites with incidence rates being 7% lower in Hispanic men and 16% lower in Hispanic women.
Factors that increase the risk of colorectal cancer include obesity (especially in the abdominal area), a high consumption of red or processed meat, smoking cigarettes, drinking an excess alcohol or a lack of fruits and vegetables.
The prevalence of polyps
“We anticipate that around 25% of patients will have pre-cancerous polyps found during their first screening colonoscopy, and we know that those polyps will eventually turn into cancer if left untreated,” Chevrollier said. “The goal is not just to identify them but also to remove them at the time of the colonoscopy if we can.” In Prioleau’s case, the polyps were removed – but she needed another surgery since one of the polyps had already become cancerous.
Premalignant polyps (adenomas) are, in fact, expected to be found in at least 20% of women and 30% of men during a routine screening colonoscopy, Chevrollier said. “We don't necessarily expect to find cancer during screening colonoscopies,” he said, “but we certainly expect to find precancerous polyps.”
These days, people getting screened for colon cancer are offered the choice of a colonoscopy or Cologuard. There are advantages and disadvantages to each.
One advantage of the colonoscopy, which Chevrollier described as “the gold standard,” is that polyps can generally be detected and removed in the same procedure. “In that way, we consider a colonoscopy both diagnostic and therapeutic,” he said. If no polyps are found during a colonoscopy, you can generally wait 10 years before having another if you are considered to be at average risk.
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Downsides to the colonoscopy are the bowel prep for it – which Chevrollier said has improved in recent years – and the fact that you have to take a day off work, go under anesthesia and have someone give you a ride to and from the appointment.
Cologuard, on the other hand, is a noninvasive test you can do at home. There’s no prep for it. “It’s pretty good at detecting cancer, but not as good at detecting small polyps,” Chevrollier said. If you opt for Cologuard, it’s recommended that you have another screening in three years.
One potential catch: If you have a positive result with Cologuard (meaning cancer or a polyp is detected), you still need to have a colonoscopy to confirm it. At that point, some insurance companies may treat that colonoscopy as diagnostic and not screening, meaning you may have to pay for at least a portion of it. With most insurance plans, a screening colonoscopy is covered at or near 100%.
Chevrollier encourages all those 45 and up to get one form of screening or the other. “Any screening is better than no screening,” Chevrollier said.
Screening can save your life
Early detection is key since polyps are “expected,” as the doctor said, to be found, and some are expected to turn into cancer if not removed. “You can avoid chemotherapy or radiation if you're catching the cancer at an early stage,” he said. Just as Prioleau did.
“Stephanie’s case highlights the importance of the new screening guidelines,” Chevrollier said. She was asymptomatic, had no family history of colon cancer – and would never have known about her polyps had she not been screened.
She’ll need to have another colonoscopy a year from now, then three years later. If these reveal no polyps, she can then move to once every five years.
“When it comes to colon cancer, we know it's a really slow-growing process,” Chevrollier said. “It takes time to develop the first polyp. It takes time – maybe 10, 15 years – for initial growth to turn into cancer. It’s conceivable that, if Stephanie had had a colonoscopy at 45, she could’ve avoided surgery entirely. It’s also conceivable that, had she waited until she was 50, she may have had to have chemotherapy.”
“A lot of colon cancers, especially early on, are asymptomatic,” he continued. “Polyps are usually asymptomatic, as well. That's why it's important to have screening tests before you develop symptoms so that you can find either early cancers or polyps before they turn into cancer.”
Prioleau’s bottom-line message: “Take your health seriously, and get your screenings.”
“The longer you wait, the higher your risk,” she said. “If you delay your screening, you could potentially face a more serious outcome. So, get screened.”