Dr. Matthew Karowe: 'Colorectal Cancer is Preventable'
Boulder Community HomeCare
Jul 29, 2021
Colorado - Boulder County
Email US
Click to Email Us
"This cancer is extremely common and lethal. The good news is that its preventable, said board-certified gastroenterologist Matthew W. Karowe, MD, of Gastroenterology of the Rockies during a free online lecture.
In fact, we have made significant strides in preventing CRC and CRC-related deaths. In 2000, deaths decreased significantly in those older than 50. This coincided with the increase in CRC cancer screenings, said Dr. Karowe.
Throughout his presentation he explains how to reduce your risk of and potentially prevent CRC.
What is Colorectal Cancer?
Our colon and rectum make up our large intestine (or large bowel) and are a part of our digestive system. Colorectal cancer is a cancer that begins in the colon or rectum.
The cancer will begin as small, noncancerous (benign) clumps of cells called polyps that form on the inside of the colon. Over time, explained Dr. Karowe, some of these polyps can grow and become cancers. It has a clear progression from a normal cell, to a polyp, to a cancer. He added, We estimate that it takes 10 to 15 years for an abnormal cell to grow into cancer. This is why we can schedule colonoscopies at 10-year intervals.
The Stages of Colon Cancer
Stage 1is the earliest stage. At this point the cancer is contained within the colon and its not spreading. For stage 1 we can expect 80 to 95 percent of patients to survive five years from the diagnosis.
Stage 2is when the cancer extends into the layers of the colon wall, but it still has not spread significantly.
Stage 3is when we unfortunately see that the cancer has spread to the patients lymph nodes.
Stage 4is when the cancer has metastasized. This means the cancer cells are spreading to the liver, lung or elsewhere. For stage four, the five-year survival rate decreases to less than five percent.
Colorectal Cancer Risk Factors
Dr. Karowe explained that both men and women have the same lifetime risk of CRC, which is about five percent. Although no one knows the exact cause of the cancer, you should pay attention to these identifiable risk factors:
Family history
According to Dr. Karowe, family history is by far the most important indicator of colorectal cancer risks. If you have a first degree relative (parent, sibling, child) who has had CRC at any age, your risk is about two-and-a-half times more than for the general population. And, if that relative was younger than 50 years, your risk can be as much as four times more.
The more relatives you have who have had CRC and/or if you have a heredity abnormality, the greater your risk is for getting the cancer, Dr. Karowe noted. As your risk increases so too does the intensity of screening so that we can help to prevent this disease.
Other risks include:
Lifestyle
Being obese or overweight
Not getting enough physical activity: We recommend 30 minutes of physical activity each day, said Dr. Karowe.
Smoking
Alcohol consumption even mild to moderate
Diet
Eating too much red/processed meat
Not getting enough daily fiber
Not eating enough of fruits and vegetables
Age over 45
CRC becomes more common as people age. Studies show rates of colorectal cancer among people younger than 50 years are on the rise. As a result, experts have determined that screening starting at 45 years could help save more lives.
Failing to Get Screened
Far and away the biggest risk factor for developing and dying from colorectal cancer, said Dr. Karowe, is failing to get screened. Screening is essential for detecting early cancer and potentially preventing it from developing.
At What Age Should You Get Screened?
Screening guidelines for those at average risk for colorectal cancer
The American Cancer Society (ACS) has guidelines for CRC screening and recommends people at average risk for colorectal cancer begin screening at age 45. (Average risk means you have no personal family history of polyps or cancers or inflammatory bowel disease.)
Dr. Karowe noted, In the past, age 50 was the recommended age to begin screenings. However, we are seeing cancers and polyps increasing for this younger age group. Experts have determined that screening starting at 45 could help save more lives.
Screening is recommended to continue to age 75, with screenings for those between ages 76 to 85 individualized, depending upon health status, family history and history of polyps.
Screening guidelines for people at higher risk for colorectal cancer
If you have a first degree relative parent, brother, sister or children who has had colorectal cancer, talk to your provider about getting screened at age 40 or 10 years before the age that your family member was diagnosed with colon cancer, whichever is earlier. Dr. Karowe added, The more relatives that you have who have been diagnosed with colorectal cancer, the more often you should be screened.
Individuals with certain hereditary syndromes will develop polyps and cancers at much younger ages and will want to start their annual screening much earlier, as young as 12 to 25 years old.
The Best Screening is the One That Gets Done
There is more than one way to get screened for CRC.
Stool screening tests. According to Dr. Karowe, stool-based screening tests can help identify large polyps and cancers. However, they are less sensitive and less specific than other tests. They are not great for identifying small or moderate polyps. They can miss a lot and have a high incidence of false positives. he said.
There are three types of stool tests that Dr. Karowe describes in detail in his lecture. He said, Generally, the fecal immunochemical test (FIT) and Cologuard are all equal. If the screening test comes back positive, your health care provider will recommend that you schedule a diagnostic colonoscopy.
Sigmoidoscopy. This is a visual examination; however, it only provides imaging of the left side of the colon. Its Dr. Karowes opinion that the colonoscopy is the better option for screening, as it provides a more complete picture of your colons health.
Computer Tomography (CT or CAT scan) Colonography. This is a CAT scan; it does use radiation and requires the same prep as for a colonoscopy. The benefit of this test is we can see everything outside of the colon and it also sees other organs, said Dr. Karowe. He added, If an abnormality is identified, a colonoscopy would be recommended as the next step.
Colonoscopy. A colonoscopy is a visual examination that evaluates the entire inside of the colon. The advantage of a colonoscopy screening is that it can both find and remove polyps all in a single test. Its prep can be difficult, but the preps are getting better, Dr. Karowe said.
Current Insurance Coverage
Colorado follows the U.S. Preventive Services Task Force (USPSTF) guidelines that recommend screenings starting at 50 years old. Dr. Karowe explained, This means your insurance may not cover your CRC screening if you are younger than 50. Dr. Karowe does believe this will be changing and that those 45 years and older will be covered in the future.
Dr. Karowe ended his lecture as he had started it. He emphasized that colorectal cancer is common, lethal, but most importantly preventable. He urges everyone to get screened and said, Any type of screening will decrease our incidence of CRC and deaths related to CRC.
Other Articles You May Like
You might be done with school, but you still need to take some testS
Working adults and retirees may be far removed from school and the stresses that come with high-stakes testing.No matter our age, though, were not done taking tests. Unlike the pop quiz in English literature, algebra or world history, the tests we take as older adults are some of the most important exams in our lives.Colorectal cancer is one of the most common cancers and the second-most common cause of cancer death in the U.S. and worldwide. The American Cancer Society estimates that two-thirds of colorectal cancer deaths occur in patients over 65. However, if caught early, cancer of the colon is highly treatable and often curable.In 2021, the U.S. Preventive Services Task Force lowered the recommended testing age for colorectal cancer from 50 to 45 due to an increase in its incidence among younger individuals. Gen Xers, Baby Boomers and older generations who are up to date on their testing likely have already completed a colonoscopy, the gold standard of testing for this dangerous cancer. This screening test is highly important because colorectal cancer often doesnt have symptoms in the initial stages.The screening uses a scope to look for polyps, a small clump of cells that forms on the lining of the colon. Most colon polyps are harmless, but some can become cancerous. When cancer forms in a polyp, it grows into the wall of the colon and eventually can spread to distant parts of the body. During a colonoscopy, the doctor can remove colorectal polyps to help prevent cancer.While the test itself is done under general anesthesia, the preparation for a colonoscopy is often what people dislike. To make sure doctors can see polyps, the colon must be clean and empty before the procedure. That means everything in your bowel must go, which is accomplished by drinking large volumes of water mixed with a laxative the day before, and sometimes the morning before, the procedure. The liquid results in diarrhea and considerable time in the bathroom as your colon is cleared. You will also be on a clear-liquid diet the day of the procedure.The preparation can be unpleasant. Perhaps that is why four in 10 Americans aged 45 and older are not up to date on their colorectal cancer screenings, according to the American Cancer Society.But there is good news. People who dont have other risk factors generally only need to have a colonoscopy every 10 years. Also, a lot has changed in recent years. Today, the preparation liquid (often a gallon) does not need to be consumed in one sitting and may be taken the night before and the next morning, making it more tolerable. The solutions are also better-tasting than they once were.Also, there are some alternatives, including lower-volume solutions and a pill prep involving 12 tablets taken twice with large amounts of water. In addition, the FDA has approved three types of stool tests to screen for colorectal cancer at home. They should be completed every one to three years. If a stool test is positive, which doesnt always mean cancer is present, a follow up colonoscopy is necessary. There are things we can do to prepare for a colonoscopy to make the preparation less unpleasant: The less you have in your stomach before colonoscopy preparation, the easier it will be. Start eating smaller portions and reducing fiber five to seven days in advance. The week before a colonoscopy, avoid nuts and seeds, popcorn, red meat, raw vegetables, corn, peas, broccoli, cabbage, dried beans, whole grain bread and pasta, brown or wild rice, fruit with skins, fried foods and cereals like oatmeal, shredded wheat and granola. Chill any liquid preparation, as it is often easier to drink when its cold. Use a straw to bypass the tastebuds in your mouth as you drink the preparation. Suck on lemon slices or sugar-free menthol candy while you drink or after each sip to help with the taste. Mix in sugar-free water flavorings that are clear, not red, blue or purple. If nausea was an issue during a previous preparation, ask your doctor for anti-nausea medicine in advance. While age is a risk factor for developing colorectal cancer, increasing physical activity, maintaining a healthy weight, not smoking and limiting alcohol can reduce the risk of developing colorectal and other cancers. Even if you were inactive in your younger years, becoming active when you are older can lower your risk.Your primary care doctor can help you keep track of preventive services, like screening tests and vaccines, as well as help make lifestyle recommendations such as diet and exercise to help reduce risk for illness.About the AuthorJaimenee Jaime Khemraj is chief medical officer for Healthcare Network, which has practices throughout Collier County offering family care, dental care and pharmacy as well as behavioral health counseling. For more information, visit HealthcareSWFL.org, or to schedule an appointment, please call 239-658-3000.
Community Benefit Statement at Via Mobility
You may have first experienced our nonprofit organization as a provider of paratransit services to the elderly and people with temporary or permanent disabilities. Or perhaps you became familiar with Via without even knowing who we are as you rode on the City of Boulder HOP bus route. This service has been operated and maintained by Via since 1994. Initially envisioned by the City and Via, the route makes it possible to get from the University of Colorado campus to the historic Pearl Street shopping district, and the 29th Street shopping and entertainment area without getting into a car. Via has also operated FlexRide, formerly Call-n-Ride, and Access-a-Ride services for RTD for many years. We also operate well-loved commuter micro transit routes such as the Lyons Flyer, HOP to Chautauqua, RideFree Lafayette, and the Omnibus for the City of Littleton. While initially headquartered and focused in Boulder County, Via has grown into Broomfield, Larimer, Weld Counties, and in 2020, on short notice, we took over from a Wheat Ridge based nonprofit that provided services to the mobility handicapped throughout the Denver metro area that had decided to end its paratransit service. This brought Vias signature door-through-door service to the four-county Denver area. When local government contracts with Via for shuttles or other public transit, there are several unique benefits that we provide at no additional cost.These include:1. REINVESTMENT IN COMMUNITY PARATRANSITVia directs the earned income from our contracts into affordable paratransit services for that community. This revenue, combined with other funding, is used to leverage additional federal and state grants, vastly increasing the services provided to our communities. This is unique to Via, as no other service provider reinvests its earned income to increase and expand necessary mobility services to our most vulnerable community members.2. PUBLIC DOLLARS REMAIN IN THE COMMUNITYAs a community-based nonprofit organization, Via works hard to be an efficient and cost-effective operation. We invest over 85 percent of our resources on direct program support; our revenues are reinvested in our communities, our employees, our facilities, and our sustainability programs and are not diverted to remote shareholders.3. CRISIS RESPONSE & COMMUNITY SAFETYWhen local government contracts with Via we offer our First and Second Crisis Response services. Via provided emergency response evacuations to residents during the 2013 floods and multiple wildfire events over the years, including the Marshall Fire in 2022. Via has been recognized by the Boulder County Sheriffs Office as a heroic and vital component of the Office of Disaster Management. Via is not paid for these services, but we underwrite the costs as a community reinvestment.4. PUBLIC ACCESS PARTNERSHIPSA further community benefit of working with Via includes access to our facilities: our 12-acre east Boulder campus is available to be used as a crisis center and public meeting space. In the aftermath of the horrific King Soopers killings, Via quickly organized our facility into a crisis response center where families could meet privately with law enforcement, counselling, and other critical resourcesVia is there for the community.5. ENVIRONMENTAL SUSTAINABILITY LEADERSHIPVia has been a leader in and is committed to Environmental Sustainability and will be fully converting our fleet to zero emission vehicles. We are also partnering with the City of Boulder and Boulder County to continue to build out our on-site solar microgrid. We coordinate closely with our local government partners to ensure that we represent their policies and priorities in the services we offer and the way we conduct our business.6. WORKFORCE TRAINING & DEVELOPMENTVia recently launched a relationship with CareerWise Colorado to begin our first auto mechanic apprenticeship program in 2024 with student employees. It is our goal to mentor and train young people in the newest emerging battery electric and hydrogen technologies, and then be able to offer a full-time, market-based position following graduation.Why Partner with Via Mobility Services?Via Mobility Services is a vital partner for your local government.Despite our many strengths, it would be increasingly difficult for Via Mobility Services to compete head-to-head with national and international for-profit companies intent on entering the market with a strategy of losing money but gaining market share. This is a reality that we face, but when local and county governments fully understand our business model and policy direction, the advantages of a partnership with Via Mobility Services are clear. Thank you for choosing to work with us!
Resources for Social Distancing
Older adults and people with disabilities experience the adverse side effects of social isolation at a higher rate than the average American. Humans are social creatures, and plenty of those we serve are already far too familiar with the struggles of social isolation. Access to affordable, accessible transportation removes one of the many barriers to staying connected that people limited mobility options face. But transportation is only one part of a more extensive network of services that people need.As we being to face the realities of the novel coronavirus, COVID-19, we are all being encouraged to practice social distancing to help stop the spread of this disease. Were acutely aware of the challenges that those in isolation, whether by choice or necessity, face, and we understand that this is an uncertain and stressful time. At Via, we have already seen a decline in ride requests as our riders decide to stay home. Over the past week, senior and recreation centers, adult day facilities, and public events and spaces have made the difficult decision to close or reduce hours as a precaution to help minimize the effects of this outbreak in our community. You can learn more about Vias response here. We have compiled a list of resources to help you and your loved ones access the services you need, and weve included some other ideas of how everyone can stay connected and engaged.If you have any resources that you would like to share, we would love to hear from you! Please email your ideas and resources to via@viacolorado.org so we can add them to this list.