CLEVELAND, Ohio – 50-year-old Dan Adler was about to send his sons to college, but an alarming medical condition, rectal bleeding, urged him not to suspend colonoscopy.
The practice of his doctor said he would have to wait eight weeks to have the procedure, but he pushed for an earlier appointment. After the test, he learned that an ulcerated, bleeding mass that had grown into the muscle of his colon had been found and removed. It was a cancerous polyp that had grown four to five years.
Following chemotherapy, radiation, and surgery to remove part of his rectum and bowel, Adler has been cancer-free since completing treatment last August.
I'm glad I had symptoms and listened to them, "said Adler, who lives in Westlake.
Adler's story is an example of why the American Cancer Society now recommends it to most people ̵
Age has been reduced to reverse a trend in the rate of colorectal cancer in men and women under 50, James Church, colorectal surgeon at the Cleveland Clinic.
According to cancer experts, the new recommendation could save lives through early detection. A colonoscopy, the most common type of screening, should be performed every 10 years for middle-risk individuals and every two years for high-risk individuals, regardless of age.
We are excited to support the new screening recommendation Starting at the age of 45, said Michael Sapienza, CEO of the Colorectal Cancer Alliance, a national organization that funds research, prevention and patient support programs. It is one of the few cancers that can be prevented by screening.
Colorectal cancer is the second most common cause of death among men and women in the United States, according to the American Cancer Society. It is expected that 51,000 people will die from it this year.
According to an article published in the Journal of the National Cancer Institute in 2017, colorectal cancer rates are declining overall in this country, but are rising in young adults.
Among Americans in their forties, colorectal cancer rates have risen by 1.3% a year since the mid-1990s, and rectal cancer rates have risen by 2.3% a year since the early 1990s, the Journal of National Cancer said Institutes with.
Researchers and colorectal practitioners consider the increase to be significant enough to cause concern.
Colorectal bleeding in young people is often diagnosed as a hemorrhoid, and the cancer is discovered at a later date, Church said.
A The study published this week suggests that the number of colorectal cancer-diagnosed American adults under the age of 50 has risen slightly in the past ten years, from 10 percent in 2004 to 12.2 percent in 2015.  African-American and Hispanic Adults Under 50 Also Showing Increase According to the new study, published in CANCER, an expert-reviewed journal of the American Cancer Society, the rate of colorectal cancer is higher than in non-Hispanic whites under the age of 50 ,
The researchers do not know why the rate of colorectal cancer among these patients increases among the under 50 population. The study this week indicated weight gain in combination with changes in the gastrointestinal bacteria as a possible cause. The Colorectal Cancer Alliance is funding research to find out why this is happening.
A study published in the Journal of Medical Screening this month has researchers The American Cancer Society has suggested that more screening does not fully explain the increasing incidence in people under the age of 50. Changes in the established risk factors for colorectal cancer – including obesity, alcohol consumption, smoking and physical inactivity – may also be a factor
The good news is that increased screening has lowered the overall mortality rate from colon cancer over several decades.
But not everyone who would benefit from colon cancer screening gets it. Some private insurance is not required to cover the cost of bowel examinations before the age of 50.
Then there's the trouble factor. The most common form of screening, colonoscopy, requires sometimes unpleasant preparation, where the patient has to fast before surgery and take a strong laxative. If anesthesia or sedation is used, someone must accompany the patient to drive him home. This means that probably two people have to have a day off.
There is also a fear that a tube will be introduced into the rectum.
Noninvasive screening methods that use stool samples to detect colon cancer and that can be done at home are a good alternative for those who are reluctant to undergo colonoscopy, Sapienza said.
Red meat, family history among risk factors
Some colorectal cancer risk factors can be controlled while other factors are a role of the genetic cube.
Obesity, smoking, physical inactivity, heavy drinking and eating lots of red and processed meat are habits that increase the risk of colon cancer development.
Inflammatory bowel disease (IBD)) – including ulcerative colitis or Crohn's disease – is another risk factor. Crohn's is an inflammation of the digestive tract. Ulcerative colitis causes inflammation and ulcers in the colon and rectum at the end of the colon.
Due to genetics, some people are more likely to develop colorectal cancer. A personal or family history with colorectal polyps or colorectal cancer increases the likelihood of illness.
Ken Vinikoff, 57, of Broadview Heights, knew that his father was a high risk of the disease as a survivor of colorectal cancer. When Vinikoff was 30 years old, he insisted on a colonoscopy, although his doctor said he was too young to be worried.
His screening revealed polyps against cancer. If he had been waiting for the investigation, "There's no telling what would have happened," Vinikoff said.
Since then, colonoscopy has been performed every three years. "I would much rather take care of it," said Vinikoff.
With Important Exceptions
Colonoscopy is free for most Americans with private insurance or Medicare. However, according to the American Cancer Society, fees may be charged for colon prep, sedation, lab tests and set-up fees, as well as bills from various hospital providers.
Experienced patients review their insurance plan to find out if they are doing this. Some fees are expected to be paid out of pocket, especially if they prefer to undergo screening other than colonoscopy. Alternatives include Cologuard and flexible sigmoidoscopy.
The cost may change based on the results of the screening. For some private insurance plans and Medicare, colonoscopy is considered a diagnostic test rather than a check-up if a polyp is removed during the procedure. It is associated with co-payments and deductibles. These additional fees can range from $ 50 to $ 300 per polyp, according to Sapienza of the Colorectal Cancer Alliance.
"It's very deceptive," said Sapienza. The Alliance supports the elimination of this screening barrier, which he calls the "colonoscopy gap."
Cigna, one of the largest insurance companies in the country, explained the benefits to people with no history of bowel cancer as follows: "The colonoscopies or FIT tests would be preventative. As long as the service is billed with a preventative service / wellness code, the benefit is free for the individual. Even if a polyp is identified and removed during this first screening colonoscopy, the service is considered to be preventative.
The insurance company Anthem gave this statement its benefits: "The Anthem Standard Health Plans Covers Screening Colonoscopy and FIT Screening for Consumers No risk factors from the age of 50 and from the age of 45 for consumers with risk factors. "In addition, Anthem is aware of and evaluates the American Cancer Society's new 45-year-old large-bowel study for all consumers. Most other medical communities and centers for disease control and prevention recommend 50-year checkups for individuals without risk factors and at age 45 for people with higher risk factors.
If the FIT test was positive, diagnostic colonoscopy is no longer considered preventive. If the service is not considered preventative, the standard copay or deductible / co-insurance of individual (based on their health insurance plan) would apply, "Cigna said. However, these exams are free only if the doctor accepts the Medicare reimbursement as a full payment. And if a polyp is found and removed during the colonoscopy, Medicare beneficiaries pay part of their doctor's fees and a supplement to the hospitals.
Medicaid coverage – free or low-cost health care for low-income Americans – is determined by each state. In Ohio, colonoscopies are free for Medicaid beneficiaries over the age of 50 or for high-risk individuals.
Other Screening Options
Most people are familiar with how colonoscopy works. But there are other non-invasive screening tests that examine the stool or faeces for signs of cancer. These tests can be done at home, but must be done more often than a colonoscopy. If a non-invasive test detects abnormalities, a diagnostic colonoscopy is required to detect cancerous polyps.
During a colonoscopy, a tiny video camera attached to a flexible tube is inserted into the rectum. The camera gives a view of the entire colon free. Flexible sigmoidoscopy is similar to colonoscopy but covers only the lower part.
CT or virtual colonoscopy uses a CT scan to create digital images of the colon.
Fecal Occult Blood Tests (FOBT) and Fecal Immunochemical Investigations (FIT) Look for blood in the stool, a marker for cancerous polyps. Patients will receive from their physician a test kit with test equipment, shipping envelope and instructions for taking a stool sample and returning it to a laboratory.
DNA tests such as Cologuard are looking for blood and abnormalities of cells from cancerous polyps in stool. The kit is a prescription and the instructions for use are similar to those for a FIT test.
While colonoscopy has clear benefits, there are also slight risks, says a 2012 article in the Harvard Health Letter. These include kidney damage from sodium phosphate laxative, perforation during the procedure, sedative response, and polypectomy bleeding.
In addition, about 5% of colorectal cancers, especially in the field of colorectal cancer, are the most distant from the rectum in colonoscopy, according to a Harvard article.
An 2016 editorial in the New England Journal of Medicine posed the question of whether colonoscopy is the real reason for the decline in total cancer rates in the colon.
In Canada A health care working group has found that there is insufficient evidence to justify the use of colonoscopy for routine screening for colorectal cancer. Instead, it was recommended that low-risk Canadians perform FOBT every two years or flexible sigmoidoscopy every ten years.
Adler, whose colon cancer was discovered during a screening, is still grateful that he had undergone a colonoscopy at this time. He still gets used to the life of bowel surgery and has to think more about what and when he eats. If he goes to a golf outing that lasts all afternoon, he does not eat until it's over because there are no bathrooms nearby.
"I feel really good. I'm getting used to the new plumbing that I have, "Adler said.
His cancer means that his four sons, who are between 15 and 22 years old, should contract colon cancer for the first time because of their family at the age of 39. Adler believes that they will follow this advice.
"The sooner you understand him, the easier the treatment," he said.