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Getting a colonoscopy is nobody’s idea of a fun time, but did you know that in 2023, an estimated 4,220 New Jersey residents will be diagnosed with colorectal cancer (also known as colon cancer)? The astonishing (and positive) news is that most cases of colon cancer can actually be prevented with screenings — and that means a colonoscopy.

By year’s end, NJ can expect to lose 1,360 people to this preventable disease. By getting a colonoscopy, all of that can be changed. Current guidelines recommend screening for colorectal cancer at age 45 and older. And now, with new legislation signed by Gov. Murphy to expand access to screenings through insurance, there’s no reason to put off this important test.
Howard S. Hochster, MD, FACP, the associate director for Clinical Research and director of the Gastrointestinal Oncology Program at Rutgers Cancer Institute, director of Oncology Research at RWJBarnabas Health and distinguished professor of medicine at Rutgers Robert Wood Johnson Medical School, spoke with New Jersey Family about these important developments as we begin Colon Cancer Awareness Month in March.

New Jersey Family: Why is this new legislation that will expand access to colon cancer screenings so important?

Dr. Howard S. Hochster: One of the problems is a lot of insurance companies require people to have symptoms to pay for a colonoscopy. That has historically been a problem with people getting tested. The new legislation says that when you get a colonoscopy according to the age guidelines, which has been lowered to 45, now your insurance cannot deny you reimbursement.

NJF: Why is a colonoscopy so important?

HH: Colon cancer is largely preventable. The process is that a normal cell can turn into a polyp, which can then turn into cancer. It can take anywhere from 3-5 years for a polyp to turn into cancer. During a colonoscopy those polyps are removed and removing the polyps prevents cancer. So, we really need people to have that colonoscopy.

NJF: What are some reasons to have a colonoscopy before age 45?

HH: If anyone in your family has had colon cancer. Overall, the incidence of colon cancer is going down possibly due to colonoscopies. We especially need young people if they have symptoms, to get a colonoscopy. Any changes in your bowel habits, blood in the stool, unexpected weight loss, or abdominal pain that persists for a certain time period should trigger a visit to your doctor and possibly a gastroenterologist.

NJF: Are there any groups of people that should be more concerned?

HH: We are seeing more people in their 30’s diagnosed, and that’s because doctors don’t think of colon cancer when it comes to that age group. Black people may have a slightly higher rate. That’s why it’s important that if you start having any of those symptoms to see a gastroenterologist.

If you have average risk — that means no first-degree family members [with colon cancer] and no other risk factors, the advice is to begin screening at age 45. How often you go back depends on what they find. It could be every 3-5 years.

NJF: What happens if polyps are found?

HH: A lot of them are just inflammatory – what we are concerned about are adenomas. That is something that could have become cancer. If you detect colon cancer early when it can be cured surgical treatment is very effective. But we want to prevent that with a colonoscopy.

NJF: What are some things people can do to prevent colon cancer?

HH: Eating well and getting exercise are things we know can help prevent cancer in general. Those apply to colon cancer as well.

NJF: Why do so many people hate getting a colonoscopy?

HH: During the colonoscopy, they put you to sleep. The most unpleasant is the clean-out beforehand. You need to have a clean colon so they can get a good look. That means that you must purge all the fecal material, so that involves no eating and taking laxatives. That’s not the most pleasant thing but it’s something that’s very doable.

NJF: Are there any other screening tools?

HH: Another one is Cologuard. It’s a test that uses a stool sample – it’s a good test to see if you need a colonoscopy. It’s not a substitute for a colonoscopy, but it can be helpful. If it’s negative, the chance of finding something are lower, or you might find out you need a colonoscopy. It’s a pretty accurate test.

NJF: Should people be concerned about false positives with colonoscopy?

HH: If a trained gastroenterologist can see the colon, they can do a good job picking up any polyps. From there they will be sent to pathology. They could come back as non-malignant or dysplasia, which is a step closer to cancer. Often that can be treated endoscopically.

NJF: What else should people know?

HH: Colonoscopy should be covered by insurance and the billing office of your doctor’s office can help you. I want to emphasize that colonoscopy is not only a diagnostic test but also a preventative one. If they take out the polyps, that eliminates the possibility of them turning into cancer. If more people got colonoscopies, it’s possible we could eliminate 90 percent of cases of colon cancer.

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