With Bahamians riveted by the global spread of the COVID-19 pandemic, and The Bahamas recording its first case among the 174,995 worldwide confirmed cases, Dr. Amaresh Hombal reminds people to not be so focused on the one disease to the exclusion of all else. With that in mind, the radiologist reminds people that this month is International Colorectal Awareness Month, and that early detection and removal of polyps prevents colon cancer and saves lives.
The consultant radiologist at the Imaging Center Bahamas says anyone over the age of 45 or people at an increased risk for colon cancer should receive a virtual colonoscopy.
“March is observed as International Colorectal Awareness Month, which focuses on imparting knowledge about colorectal cancer and discussing about its screening/prevention by early detection and encouraging patients, survivors and the family members to share their experiences,” said Hombal.
Dark blue ribbons are worn through the month to support colon cancer awareness and spread the word.
“We believe that sharing information is the most essential and powerful tool during this Colon Cancer Awareness Month and for that reason, we are putting out some of the most important information you and your family should know about colorectal cancer,” he said.
Busting common myths
Common myths, he said, include people saying they’re 45, which means they’re too young to get colon cancer; it can only happen to men; colonoscopies are dangerous; and painful and intolerable.
According to Hombal, age 45 is no longer too young to be tested for colon cancer.
“While it’s true that more than nine out of 10 instances of colorectal cancer occur in people over the age of 50, the American Cancer Society (ACS) has recently changed their guidelines to recommend screenings starting earlier, at age 45.”
He said this is due to the sharp rise in the number of young adults diagnosed with colorectal cancer annually.
Hombal said the ACS recommends that men and women with average risk factors undergo screening for colon cancer beginning at age 45 with a regular colonoscopy once every 10 years, or a virtual colonoscopy once every five years. And individuals at increased risk or with a family history of colon cancer start screening earlier at age 40 and may be screened at shorter intervals.
The myth that colorectal cancer only happens to men, he said, is also untrue.
“Age is a much bigger risk factor than sex. The overall lifetime risk of developing colon cancer for women [one in 24] is only slightly lower than it is for men [one in 22].”
His advice to women is to not ignore.
As for the myth that colonoscopies are dangerous, he said like any other medical procedure, a colonoscopy can have complications.
“Very rarely, this procedure can create perforate bowel or trigger infection. However, the complication rate is estimated to be less than one percent. Your doctor will go through these risks with you before the procedure, but in most cases, the potential benefits outweigh the potential risks.”
As for the myth that colonoscopies are painful and intolerable, the doctor said it’s not exactly pleasant, but not as bad as some people may think it is.
“Most people only need one every 10 years – and in case of virtual colonoscopy, once every five years.”
The radiologist said colonoscopy is the most common screening test where a flexible tube is inserted into the rectum and beyond to visualize the insides of colon. Virtual colonoscopy (also called VC/CT Colonography) is a non-invasive alternative imaging test, which uses a CT scanner to produce images of the large intestine.
“After a CT scan of the abdomen is obtained, the computer generates a detailed three-dimensional (3D) model of the colon, which the doctor uses to view in a way that simulates traveling through the colon. This is why the procedure is called a virtual colonoscopy. This test can be used to help detect cancers and other bowel conditions.”
Hombal said VC is more comfortable and non-invasive than conventional colonoscopy because it does not involve inserting a tube all the way into the colon. And no sedation is needed in VC, and the patients can immediately return to their normal activities after the test. The lack of sedation, he said, also lowers the risk of the complications associated.
“It typically takes less time than either a conventional colonoscopy or a Barium X-ray exam. The entire study is usually completed within 15 minutes. VC also provides an added benefit of revealing diseases or abnormalities outside the colon as seen on the CT scan,” he said. “However, VC is strictly a diagnostic procedure, and if any significant polyps or growths are found, they will have to be biopsied or removed by regular colonoscopy. The ability of VC to differentiate stool from artifacts and detect smaller polyps may not be as good as that of conventional colonoscopy.”
He said there is also a small risk of getting cancer from exposure to radiation from VC, but the benefits, he said, far outweigh the risk.
Colon cancer symptoms
The major risk factors for colon cancer include a history of polyps or having a family history of colon cancer. The signs and symptoms of colon cancer include a persistent change in bowel habits, presence of blood in the stool, abdominal discomfort or pain, bloating and unexplained weight loss.
Some colorectal risk factors, according to the radiologist, are modifiable like obesity, smoking, lack of exercise, heavy alcohol intake, and high red meat consumption. But he said most of the other factors are non-modifiable. He encourages people to talk with their doctor about the risk factors and whether early screening is right for them.