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Monday, May 20, 2013
Should I Get Screened for Colon Cancer?
I`m a 49 year old guy in basically good health except for the recent onset of alternating constipation/diarrhea and some rectal bleeding. I haven`t had a primary care doctor until this year (went to urigi-care centers etc as needed); my father died from colon cancer a a young age. I mentioned the rectal bleeding to my doctor (usually bright red, but ocassionally very dark-when I have the constipation symptoms) and she said that it was probably hemmorhoids and did a FOBT test whch was positive. It was positive again on the next visit and I again mentioned that I was concerned about the possibility of colon cancer, but was told again that I needed to do nothing. I got the impression that I was being a pest. Is there a more tactful way to request a screening (my insurance pays for anything), or am I just being obsessive? My father had the flex screening, but had cancer higher up, so I`m thinking that I would get a colonoscopy; the office nurse said it`s not bad, but my doc said that she would never get one herself. Thanks
Yes, you need a colonoscopy immediately. If your father was diagnosed at or before age 50 with colon cancer, it puts you into a high risk group. Even having a first degree relative with colon cancer - mother, brother, sister, father - you are also higher risk. The recommended age to start screening is age 50, that drops down to age 40 with a first degree relative positive, and even earlier if the first degree relative was much younger than 50 when diagnosed.
Even if there was no family history, someone with a significant, acute change in bowel habits (constipation), or the development of warning signs (rectal bleeding), merits immediate endoscopic evaluation of the colon. For your particular circumstance, FOBT - regardless of result, is inadequate evaluation. You should have a full colonoscopy.
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James I Merlino, MD
Assistant Professor of Surgery
School of Medicine
Case Western Reserve University