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Colon cancer screenings updated

Dr. Ralph McKibbin, a local gastroenterologist with Blair Gastroenterology Associates in Altoona

Cancer is one of those words we never want to hear from our family, friends and especially from our doctor. But if there was a way to prevent one of the most prevalent types of cancer, you’d think we’d jump at the chance.

“Colon cancer is the most treatable, most preventable cancer there is,” said Dr. Ralph McKibbin, a local gastroenterologist with Blair Gastro-enterology Associates in Altoona.”But it’s also the No. 2 cancer killer, lung cancer is No. 1.”

The key is early detection, which is why McKibbin supports a recent change in screening guidelines that he helped to develop. The new recommendations, offered by the American Cancer Society, suggest people of average risk — such as those who don’t have a family history of colorectal cancer — are screened at age 45. The previous recommendation was to start screening at age 50.

He said many people are reluctant to get checked because they don’t like to deal with “anything below the belt. … Nobody wants to talk about the bowels.”

But he hopes people will overcome their hesitation and schedule a screening.

Consult your doctor to find out what risk category you are in.

McKibbin said there are several factors that affect risk in addition to family history, such as environment and lifestyle.

“There’s no such thing as no risk anymore,” he said.

In recommending the age change, the society reviewed data that indicated an upward path in the number of cases of colorectal cancer in young and middle-aged people, said Brian Gulish, communications director for the society’s northeastern Pennsylvania region.

“The guideline has been updated in order to save more lives through early detection, when treatment and removal of polyps is more likely to be successful in the prevention of colorectal cancer,” he said.

The society commissioned a study that took an analysis done in 2016 of screening recommendations and factored in the proposed age change to see the possible effects, he said.

“There was an improvement in life years gained compared with starting screening at age 50,” he said.

But the change did not come without controversy, said McKibbin. Insurance companies and Medicare, who are usually billed for the screenings, often view them as unnecessary.

“It costs money because you have about 22 million more people who need to be screened,” he said.

The new recommendations suggest several screening options from a high-sensitivity stool-based test to a less-invasive visual examination of the colon called a sigmoidoscopy to a colonoscopy.

But if the stool-based test shows positive results, then a colonoscopy is recommended.

According to the website bankrate.com, a typical screening colonoscopy cost about $3,000 in 2016 nationwide, but that figure varied widely according to the region of the country and whether the procedure was performed in a hospital or freestanding outpatient center.

Patients with deductibles paid anywhere from nothing to co-payments of about $1,000, according to the website. Those on Medicare usually paid 20 percent of the approved amount of the doctor’s fees plus a co-payment of other fees from the facility.

The debate with insurers to get them to pay for the tests is complicated because medical experts have limited data to back up their beliefs that the screenings are necessary, McKibbin said. Medical experts know that when they started screening people at age 50, the number of cases dropped, both due to impro-vements in treatment and screenings.

According to the society’s data, from 1975 to 2012 for the age group 50-plus, the number of diagnosed cases for men dropped from a little less than 250,000 nationwide to a little less than 150,000. For women during the same period, the number of cases dropped from about 165,000 to a little over 100,000.

“It’s there, it looks like it’s going to work,” McKibbin said. “It seems reasonable that if you flip it, (the age recommendation), it will work. If you wait five years to test it out, how many more people are going to die in the meanwhile?”

He added that high-profile cases like Darryl Strawberry, the former professional baseball player who was diagnosed with colon cancer at age 36, help draw attention to the need for even young, healthy people to get screened.

It’s all about a change in the way people think,” McKibbin said. “Before, people were thinking, ‘I have a little bleeding, it’s probably hemorrhoids.’ Now they’re thinking, ‘I have a little bleeding, I’d better get it checked.”

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