Close-ups

A Patient’s Perspective

Learning About Prevention the Hard Way



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Am Fam Physician. 2010 Jun 1;81(11):1320.

In July 2007, I was diagnosed with colon cancer. I was 71 years old and enjoying very good health. I exercised regularly and was careful about what I ate. I thrived on lots of fruits and vegetables, and ate only lean chicken and fish. My diagnosis was a great shock to me, and a fearful surprise for my family and friends.

Six months before my diagnosis, I was having unusual stomach cramps. Given my history of good health, I did not take it seriously, thinking that the cramps were just because of gas in my stomach. The symptoms persisted and eventually became so unbearable that I sought medical attention. My doctor sent me for a CT scan after his own thorough examination.

The scan showed an inflamed colon. The gastroenterologist was puzzled—there was no blood in my stool, and I didn’t have diarrhea. He recommended immediate colonoscopy. This was my first time having a colonoscopy, and I was 71 years old! The colonoscopy revealed a cancerous mass on the right side of my colon and precancerous polyps on the left side. Within 10 days of the diagnosis, I had surgery. The final pathology indicated stage II cancer. The surgeon told me this was good news, because the colonoscopy results made her expect a worse outcome.

I now appreciate the need for regular checkups. I had gotten my regular mammograms and Pap smears, but when it was recommended, I did not get a colonoscopy because of fear and because I lived a healthy lifestyle. I have been given a new lease on life, and I can pass on to others the important lesson of the need for regular checkups.—a.j.

COMMENTARY

My role as a family physician is to recommend and encourage patients to be current with age-appropriate screenings. Although A.J. had a scheduled colonoscopy, she did not follow through with it. Patients may not get screened for many reasons, including unfamiliarity with screening guidelines and options, and high cost if they are uninsured.

Five regimens are currently recommended for colon cancer screening, providing physicians and patients with a variety of screening options, including a high-sensitivity fecal occult blood test (FOBT) every year; flexible sigmoidoscopy every five years; colonoscopy every 10 years; air-contrast barium enema every five years; and a combination of FOBT with flexible sigmoidoscopy, each at their usual intervals.1

A.J.’s experience supports the initiative for patients to be current with their age-appropriate colon cancer screening, which aids in identifying a preventable disease.

DOLAPO BABALOLA, MD

REFERENCES

1. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149(9):627–637.

RESOURCES

For patients

Centers for Disease Control and Prevention (Web site: http://www.cdc.gov/cancer/colorectal/)

Lab Tests Online (Web site: http://labtestsonline.org)

For physicians

Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58(3):130–160.

U.S. Preventive Services Task Force (Web site: http://www.ahrq.gov/CLINIC/uspstfix.htm)

Wilkins T, Reynolds PL. Colorectal cancer: a summary of the evidence for screening and prevention. Am Fam Physician. 2008;78(12):1385–1392. (Web site: http://www.aafp.org/afp/2008/1215/p1385.html)

Close-ups is coordinated by Caroline Wellbery, MD, associate deputy editor, with assistance from Amy Crawford-Faucher, MD; Jo Marie Reilly, MD; and Sanaz Sara Majd, MD.

A collection of Close-ups published in AFP is available at http://www.aafp.org/afp/closeups.

The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.


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