HealthCommentary

Exploring Human Potential

Can We Afford Not To Do Prevention?

Posted on | July 7, 2009 | No Comments

The debate on Health Care Reform is now focused on predicting the cost accurately. Logic suggests that investing in prevention will save money long term. Besides it’s clearly the right thing to do. Take for example colorectal cancer, the second leading cancer killer in the United States.1 Some 90 million Americans are at risk of developing the disease – most from a slow process that changes silent, asymptomatic colon polyps into deadly cancers. About 150,000 Americans will be diagnosed with colorectal cancer in 2009, and some 50,000 are expected to die. Of those stricken with the disease, 58 percent are men, and 42 percent are women. Sadly, many of the cancerous tumors are discovered too late, mainly because preventive screening is not universal.2,3,4

The fact is, screening can prevent many cases of this disease because most colorectal cancers evolve from benign polyps that develop during a 10-year silent window. A single colonoscopy exam, using fiber optics to visualize the entire large bowel from the inside through a tube inserted through the rectum, can remove polyps when they are still harmless and decrease the life-long risk of colon cancer death by 31 percent.3,4 And that’s just one exam. Repeating the exam every 10 years does much more. Early diagnosis of colon cancer carries an excellent five-year survival rate of 90 percent with treatment. But late diagnosis, after the tumor has already spread, lowers the five-year survival rate to 10 percent.2

Relatively few people are properly screened for colon cancer. Fewer than 20% of adults over 50 have had a  colonoscopy in the last five years. If we separate out individuals between ages 50 and 64, the prevalence rates of these tests are lower, and they’re particularly lower among individuals who are non-white, female, have fewer years of education, lack health care coverage, and are recent immigrants. 1

Of the various screenings available, only one is thorough, diagnostic and therapeutic – colonoscopy. Preparation involves taking medicine 24 hours before the procedure to clear the colon of stool. On the day of the procedure, the patient is usually put under light anesthesia, and the exam is performed by physicians with special training. The exam directly visualizes the inside of the bowel all the way from the rectum up to the point where the small bowel meets the large bowel, a junction called the cecum. During the procedure, if a polyp or small tumor is seen, it can be removed and sent for pathologic examination.

The barriers to proper screening for colon cancer involve misperceptions, money, and mindset. The misperceptions include the thought that this disease only strikes older men. The reality is, if you are male or female, age 50 or older, you’re well within striking distance.1 Another misperception – that screening for colon cancer is terribly painful and uncomfortable. The reality – the bowel prep is somewhat annoying but quite manageable at home, and colonoscopy with light sedation is painless. The expense of the tests can be a roadblock, but insurance companies are coming on board, as they should because colonoscopy to screen for this cancer has been proven to be as cost effective as mammography for breast cancer.5

As we move toward a more organized approach to Health Care in the US, we’ll need to look at priorities, and yes, how we wish to spend our money. The key, as above, is to look at the facts, and invest long term.

For Health Commentary, I’m Mike Magee.

References

1. American Cancer Society. Colorectal Cancer: Facts and Figures. 2009.

2. American Cancer Society. Frequently Asked Questions About Colon Cancer.

3. Gorman C. Everything You Need to Know about Colon Cancer and How to Prevent it. Time Europe. 2000;155:Cover.

4. AAFP. Colon Cancer Screening: What You Should Know. American Academy of Family Physicians.

5. Podolsky DK. Going the distance – the case for true colorectal cancer screening. NEJM. 2000;343:207-208.

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