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Wednesday, March 4, 2015

Dr. Van Bussel talks about colorectal cancer screening

Dr. Jared Van Bussel at Pincher Creek Associate Clinic

Toni Lucas

March is National Colorectal Cancer Screening Awareness month. Pincher Creek is fortunate in that we have Dr. John Rottger and Dr. Jared Van Bussel available in our area for screening at the Pincher Creek Associate Clinic.  Colorectal Cancer occurs in the rectum or large intestine. Dr. Van Bussel explained that some of the symptoms of this cancer include rectal bleeding of bright red blood or black tarry stools, weight loss, anemia, change in bowel habits.  "Those are the types of things to be looking for, something you have to present, no matter what your age, to your doctor. They can decide whether or not they need to explore and look for colon cancer as a cause for that."  He said that "most people would fit into an average risk category".

Pincher Creek Associate Clinic physicians and staff
"There is a difference between screening, and diagnostic. When we're looking for disease, and someone is showing symptoms of disease, that's different."   Dr. Van Bussel said "If we are dealing with all of those symptoms, it would really make us suspicious for colon cancer. Any one of those symptoms is enough for us to say, 'We need a firm understanding of why this is going on, what's going on.' Included in that would likely be looking for colon cancer, so that's when we would consider colonoscopy." Age, and other factors including previous and current health factors would be considered before taking that step. "When we are really looking at 'Could this be colon cancer?'  Once we ask that question, we usually want to find out the answer."

"Screening is looking for disease in people that we don't think actually have disease.  If there are no other risk factors, no family history, and no other history of advanced adenomas, (benign tumors) and no symptoms,  then age 50 is when we would start screening."

"Anytime we talk about screening, we are talking about a lot for a very little," Dr. Van Bussel said, also explaining that screening starts on someone who most likely will be healthy. "We are trying to use that to tease out among that group of people who is the higher risk, and who's not."

"When we look at entire populations of people, then there is certainly advantages to doing screening."  One of the tests to start looking for this cancer is the fecal immunochemical test (FIT).   "It is a laboratory test. It is a simple test looking for human blood within the stool." He explained that this replaces the guaiac fecal blood test (gFOBT). "We think that this new test, the fecal immunochemical test is both more specific, and more sensitive."

"A positive test is frequently not a colon cancer, or not an advanced adenoma, but it is a good first step. It's non-invasive, it's not a test that's going to cause any harm, in and of itself. that test then tells us who should follow up for doing a colonoscopy. The utility of the FIT test is that we are able to do it every one to two years.  That, combined with the colonoscopy as a follow up is primarily how we do screening here." Another option that Dr. spoke of was a sigmoidoscopy, which does not go as far along the digestive tract.  Some risks include a previous family history, smoking, drinking, and obesity. Diets that are high in red meat, or low in fibre can also contribute to the chances of increased risk. 

"Why screen at all, why find the cancers in the first place? We know that colon cancers are much more difficult to treat when we find them later." Dr. Van Bussel explained that there is a 90% success rate of removing the cancer caught early, but when it has been in the body for 5 years survival rates go down to approximately 65%.

"Early diagnosis seems to matter. That's where we get our overall benefit with the screening. Being able to find it a little bit earlier, intervene a little bit earlier, and get a net benefit."

Related link: Pincher Creek Associate Clinic

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