Home screening for colorectal cancer is easy, and doctors say any test is better than none
March is National Colorectal Cancer Awareness Month, but that’s not the reason Fuad Afifi is speaking out about his first colonoscopy experience.
The 60-year-old retired chef typically prefers to be more private, but he’s opening up about the importance of cancer screening after losing his sister to the disease earlier this year.
“She was in her early 60s,” he says. “A very vibrant, outgoing person. Very athletic.”
They had no family history of colorectal cancer, he adds.
Colorectal cancer is the third most commonly diagnosed cancer in men and women in the United States. The American Cancer Society estimates nearly 105,000 new cases of colon cancer and more than 45,000 cases of rectal cancer will be diagnosed in 2021.
There are often no symptoms of colorectal cancer until the disease has progressed. “If you don’t feel symptoms, you think that you’re OK,” Afifi says.
Before undergoing his first colonoscopy this year, Afifi previously opted for the fecal immunochemical test, or FIT, a non-invasive at-home test that requires laboratory submission of a tiny stool sample to be analyzed for traces of blood. The FIT must be performed annually.
“It’s better to have any screening as opposed to no screening,” says Kevin Ghassemi, MD, a gastroenterologist with UCLA Health. “The fecal immunochemical test is a very reasonable test to look for blood in the colon, which, if present, will highlight the need for colonoscopy.”
Afifi did the FIT in 2018 and again in 2020. The first time, the results were negative for blood. But last year, they came back positive, indicating further exam was needed.
Around the same time, his sister died.
“She was diagnosed six months ago and it had already metastasized to the liver,” Afifi says. “That gave me a clue. It helped me put some sense into it. And I decided I really wanted to do the colonoscopy.”
Colonoscopy requires dietary preparation beforehand to clean out the colon and sedation during the procedure. The exam uses a tiny camera on a scope to view the colon and remove any polyps, which are growths on the colon lining that can sometimes become cancerous.
Polyps do not generally cause symptoms, Dr. Ghassemi says, and they don’t always bleed, “which is why the stool test does have some limitations.” In Afifi’s case, though, the FIT led to a colonoscopy, which in turn led to the discovery of polyps.
“It was really a blessing that he decided to get this form of screening,” Dr. Ghassemi says.
Dr. Ghassemi removed five pre-cancerous polyps during Afifi’s exam.
“I’m glad I did it,” Afifi says. “That’s what I know.” Now that he’s experienced a colonoscopy, Afifi calls it “a very simple procedure.”
“It opened my eyes, actually,” he says. “Because a lot of people don’t want to do it, either because of some personal reason or they don’t want to drink the things to clear the colon. People might consider colonoscopy an invasive surgical procedure or a personal thing, and there’s a lot of people who don’t want to expose themselves to that.”
Despite evidence that screening reduces colorectal cancer cases and deaths, screening participation in the U.S. among adults 50 and older was only 67% before the pandemic, with even lower rates among people of color. Rates of colorectal cancer are higher among Black Americans than among whites. Black people are 20% more likely to be diagnosed with the disease and 40% more likely to die from it.
Current recommendations call for screening to begin at age 50, though the U.S. Preventive Services Task Force is recommending the age be lowered to 45 due to an increased incidence of colorectal cancer in younger people. Those with a family history of the disease should begin screening even earlier.
For those hesitant to have a colonoscopy, the FIT might be a good place to start, Dr. Ghassemi notes. But Afifi now swears by the more thorough exam.
“It’s awareness,” he says. “You have to be aware of your body. And you have to remove the fear. I’m not afraid of dying, but I am afraid of not taking the right precautions and doing what’s necessary to keep this body going.”
Afifi says he hopes sharing his experience might prevent others from needlessly suffering the loss of a loved one, as he did with his sister.
“I think she died unnecessarily,” he says. “I am doing this in her memory, because if I can save one life with my story, it means we save humanity.”
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