Blogs
Advocacy at a Young Age: Family, Heredity and CRC
Friday, May 17, 2013
Editor’s Note: Shane and Alexandra Plavin are high school students at Riverwood International Charter School in Sandy Springs, GA. The siblings are advocates for Preventing Colorectal Cancer and have written this article in hopes of highlighting the relationship between heredity, colorectal cancer (CRC) rates and the importance of screening.
What is the likelihood that we will get diagnosed with colon cancer? What does it mean if a great uncle has the disease? Does it increase our chances of having the disease? What are some resources to learn more about symptoms and healthy choices that may help prevent CRC?
An estimated 142,820 Americans will be diagnosed with colon cancer in 2013, which is approximately one in every 17-18 individuals. That is why we would like to focus on educating our friends and family members about the prevalence of CRC and the importance of screening. A cancer prevented is better than a cancer cured. The opportunity to remove polyps before they become cancerous exists when patients receive the "gold standard" screening, a colonoscopy.
My sister and I were discussing heredity and why certain traits and diseases run in families. We have always had a close knit and supportive family and wanted to look more closely at the relationship between CRC and family histories. This issue is very important to us as we have several family members who have been diagnosed with CRC and were concerned that our immediate family could also be at an increased risk due to genetics; so we decided to do a little reading.
Gathering data from reliable and reputable sources, we found there is a strong family history and genetic component with regards to colorectal cancer. People who have a first-degree relative (parent, brother, sister, or child) with CRC or adenomatous polyps at a young age (defined as before 60), or have two first-degree relatives diagnosed at any age, should begin screening for colon cancer earlier, typically at age 40, or 10 years younger than the earliest diagnosis in their family, whichever comes first. This should be repeated every five years.
For first-degree relatives who have had CRC or adenomatous polyps at age 60 or older, or two or more second-degree relatives (grandparent, aunt, uncle) with CRC should begin screening colonoscopy at age 50 and should be repeated as per average risk patients.
People with a second-degree relative or third-degree relative (great-grandparent or cousin) with CRC are considered to have average risk of colorectal cancer.
Some of the earliest studies of family history with colorectal cancer were based in Utah, where families reported a higher number of deaths from CRC (3.9%) among first-degree relatives of patients who had died from CRC than among sex-matched and age-matched controls (1.2%). These studies have been reproduced on many occasions.
Genetics also play a significant role in CRC and have shown to have a specific component in about 5% of all colorectal cancers. One of those specific genetic susceptible subsets is called Hereditary Nonpolyposis Colorectal Cancer (HNPCC), also known as Lynch Syndrome. The average age in which Lynch Syndrome presents is typically around age 45, and over 70% of people with HNPCC will experience CRC by age 65.
Familial adenomatous polyposis (FAP) is an uncommon condition that increases the risk of CRC. Nearly 100% of people with this condition will develop CRC during their lifetime, and most of these cancers occur before age 50. FAP causes hundreds of polyps to develop throughout the colon.
It is our understanding that PCC will devote upcoming newsletters to furthering the discussion of genetics and testing options and new frontiers in the diagnosis of CRC.
So how can kids stress the importance of “closing the loop” and educate our friends and family members? It is our hope that through articles like this and talking to our friends that we can advocate and perpetuate the process of learning. Using the family unit as a force from within the home, we can hopefully provide that benefit to each of our own family members. My sister and I sometimes feel like we are invincible and don’t realize how many young patients and family members can be afflicted with CRC.
Alexandra and I hope that we were able to share a bit of ourselves and know that as siblings, families can be the greatest messenger for education and advocacy for prevention and diagnosis of CRC and other diseases.
Not All Colonoscopies Are Created Equal
Wednesday, March 27, 2013
Colonoscopies are performed as a method of screening for colorectal cancer – removing polyps before they have a chance to become cancer, and detecting malignancies early while there is a high probability of complete removal and cure.
Colonoscopy can also be employed as a diagnostic tool to evaluate symptoms such as abdominal pain and change in bowel habits, as well as monitor patients with inflammatory bowel disease. Recent news reaffirms what has been widely believed for years by gastroenterologists: that no other test is as effective at preventing colorectal cancer. To achieve these results, however, it is crucial to receive a quality screening. In fact, one should consider a number of quality indicators.
What factors aid in making certain a patient has a complete and quality examination?
Many factors, including adequacy of prep, sedation, the latest equipment and the experience and technique of the colonoscopist, help ensure a quality colonoscopy. Let me expand on each of these points:
- Prep: Adequacy of the bowel prep is probably the single most important factor in ensuring a complete and quality colonoscopy. This is vital in maximizing the detection, recognition and removal of flat, potentially pre-cancerous growths in the colon known as sessile serrated adenomas. These lesions are often found on the right side of the colon, and though tiny, may have significant pre-malignant potential.
- Sedation: This factor is important for many reasons. PCC research has determined that fully sedated patients experience higher polyp detection rates as well as a more comfortable experience.
- Equipment: The latest technology includes colonoscopes and screens with high-definition (HD) imaging, giving a sharper and more detailed picture that can help clinicians find polyps they would have otherwise missed. Patients should not confuse these advances in technology with well-publicized CT Colonography, a radiology procedure that does not show any benefit for flat lesions and is not therapeutic.
More information about technique and experience:
Polyps should be detected in 15% to 25% of adults for routine screening. Increasingly, it appears that the time the doctor spends looking at the colon, and his/her experience combined with the prep, equipment and sedation, are all important to maximizing detection and removal rates. In fact, a recent study reports that retroflexion in the right colon can increase polyp detection rates safely and successfully in 95% of patients.
Why is intubating the cecum so important?
Intubation of the cecum means advancing the instrument all the way to the right side of the colon and obtaining an excellent view of this anatomy. With current techniques, the physician should be able to intubate the cecum in more than 90% of cases when screening a healthy adult. This is important because, as noted below, the right colon has a disproportionate percentage of flat, but possibly pre-malignant, polyps.
Colonoscopies are known as the gold-standard in the prevention and detection of colorectal cancer. PCC would like to stress the importance of doing your research and seeking out a professional who maintains gold-standards within their practice so the colonoscopy is as effective as possible.
President, Atlanta Gastroenterology Associates