Don’t Forget About Your Colon!

When I turned 50 years old a few years back, I knew that I was due for colorectal cancer screening. Having spent more than eight years having scans, biopsies, surgeries, and taking medication for metastatic lung cancer, however, I wasn’t too eager to have another invasive procedure. Instead, I put getting a colonoscopy off for a while, having heard many friends and family members complaining about the dreaded “prep” and need for anesthesia.

Learning about colorectal screening

Recently, I had my annual visit with my primary care physician, and she told me that the guidelines around colorectal cancer screening have changed recently. It is now recommended that screening start at 45 years old instead of 50 for people with average risk. This change actually happened nearly a year ago, but since it occurred during the COVID pandemic, many people like myself are unaware. According to the American Cancer Society (ACS) website, the age guideline was “lowered … to start screening because studies show rates of colorectal cancer among people younger than 50 are on the rise. ACS experts have determined that screening starting at 45 could help save more lives.”¹

After emphasizing the importance of screening to prevent colorectal cancer, my doctor convinced me that I should be screened. Since I wanted to avoid an in-office colonoscopy procedure if possible, she suggested that I have a Cologuard test instead. She warned me that the test is not as accurate as a colonoscopy and told me there could be a chance of a false positive which I would need to follow up with a colonoscopy. I decided I would take the chance. According to the Cologuard website, “[f]alse positives and false-negative results can occur. In a clinical study, 13% of people without cancer received a positive result (false positive) and 8% of people with cancer received a negative result (false negative).”²

My experience with the Cologuard test

The Cologuard test was indeed very easy — I just picked up my poop and mailed it to a lab in a special, prepaid box.  A little over a week later, my results came back — positive — so I needed to schedule a follow-up colonoscopy. While waiting for my colonoscopy date, I reasoned with myself that I likely had a false positive since I didn’t have any symptoms of colorectal cancer. On the other hand, I didn’t have any of the typical symptoms of lung cancer when I was diagnosed either, so a small part of me was still somewhat concerned. I learned that benign colorectal polyps could also cause positive readings, so I hoped that if the positive results were true, I would just have some easily removable polyps.

What are colorectal polyps?

What are colorectal polyps? According to the Mayo Clinic, “a colon polyp is a small clump of cells that forms on the lining of the colon. Most colon polyps are harmless. But over time, some colon polyps can develop into colon cancer.” The good news is that most polyps that are found with screening can be fully removed during a colonoscopy, preventing them from turning cancerous. Polyps are often completely asymptomatic, and most polyps are found in people 50 years old or older.³

Back to my situation — I woke up at 3am one morning and performed the prep for my colonoscopy. To be honest, it wasn’t fun, but it also wasn’t the worst thing I’ve ever experienced. I think many things pale in comparison to living with lung cancer! It turned out that my Cologuard results WERE NOT a false positive. In fact, I had four benign, yet potentially pre-cancerous, polyps removed that were fairly large in size, ranging from 10 to 16 millimeters. My gastroenterologist (yup, a new healthcare professional to add to my team) explained that once polyps are found and removed, there is an increased likelihood that more will grow, so he recommended that I return in two years for another colonoscopy.

Reflections on my experience

How do I feel about all this? Well, I am definitely very glad that I had colorectal cancer screening! It worked for me exactly as designed. I would much rather have a colonoscopy that can detect pre-cancerous changes and prevent me from developing cancer upfront than avoid screening and actually develop colorectal cancer.

I really encourage everyone out there living with lung cancer who is eligible for colorectal screening to talk to their oncologist and consider getting screened as soon as possible. You can try a stool test like Cologuard, but if you opt to go straight for a colonoscopy, just know that it is very low risk, can be performed on an outpatient basis, and you can usually get your results immediately. Don’t forget about your colon!