Q&A with Dr. Freeman Farrow on colon cancer
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While colon cancer is one of the most preventable cancers, it is currently the second leading cause of cancer deaths in the U.S. In Indiana, it is also one of the deadliest cancers after breast cancer in women and prostate cancer in men.
To increase screening rates, Colon Cancer Awareness Month is observed yearly in March. With colon cancer rates rising, particularly among younger adults, awareness and proactive health measures are more important than ever.
Inside INdiana Business spoke with Dr. Freeman Farrow, a family medicine physician at Beacon Medical Group La Porte, on the importance of early detection, common risk factors, and the role of lifestyle choices in preventing colon cancer. This article has been edited for brevity and clarity.
What exactly is colon cancer?
Colon cancer is something that can kill you if untreated. It is something that many people will be at risk for as we get older, and it is something that is preventable if you catch the precursors early
What are those precursors?
With the screening for colon cancer, we are looking for polyps. They are the precursors of cancer, which, if you leave them, can become cancer. If you take them out early, you have avoided having colon cancer, the potential damage and potential death from untreated colon cancer. That’s why I recommend colonoscopy over any other screening methods. There are two primary screening methods. There are others, but those are more exotic and and less likely to be the first line of action. So there’s the colonoscopy and then there’s the box.
The box allows you to send in a stool sample to a laboratory for analysis and with a colonoscopy, you are literally looking at the lining of the colon. The gastroenterologist doing the procedure can take out the polyps before they become colon cancer.
What do you think about the current colon cancer screening rates?
Well, the current screening rates are not as high as they should be and not as high as medical providers across many different specialties recommend. Current recommendations are to start screening at 45 years old. The screening used to be recommended at 50 years old, until a few years ago because people were showing up at 48/49 with colon cancer. These were people without a family history of colon cancer, without a particular known high risk.
The main reason I recommend colonoscopy over any other screening method is because when the prep is done well, the gastroenterologist takes the colonoscope, goes in and looks and if they see polyps, they can take them out.
Most people are concerned about getting the colonoscopy, or they complain about the colonoscopy but if you listen to them carefully, they’re not complaining about the colonoscopy. They’re complaining about the prep. Most people don’t even remember the colonoscopy. They basically make you go to sleep, what I call twilighting. By the time you wake up an hour later, the colonoscopy is done. In fact, the reason they have someone drive you to and from the colonoscopy is because with the medicine they give you, there’s some relative amnesia for about four hours.
If there are a lot of polyps, they will take out the most advanced looking ones and then have you come back later to get the others. Your next appointment will depend on what the gastroenterologist sees, but the longest you should go without the colonoscopy is 10 years.
Dr. Farrow speaks about current screening rates and why the age for screening was moved down
What about the prep stresses people out?
So you take medication to make you clean out your colon. The prep is better now and shorter. The prep used to be three days and now the prep is down to two doses of medication and that takes about a day and a half. The prep works pretty well, as long as people do what their gastroenterologist tells them to do. So it’s not as onerous as people might think.
Are there any options for people who may not be insured?
The box is about $90 and a colonoscopy is about $900. But when you do the box, you have to do it essentially every year, in 10 years that comes up to $900. Meanwhile, even though the colonoscopy is $900, most people do it once every 10 years. That’s the relative cost these days. As things get more expensive, it’ll go up over time.
What can be done to increase the rates of screening?
People have to be willing to talk about the danger of not getting screened. The precursors of colon cancer could be picked up relatively easily. People have been told to be afraid of the colonoscopy but there’s nothing to be afraid of. On the other hand, they should be very afraid of developing colon cancer that is very avoidable. That’s the message that has to get out.
Talking about people who are insured, the insurance company would love for you to do the box, because it’s only $90, even if you have to repeat it year after year. Your first test is called your screening, whether it’s the colonoscopy or the box. If it’s the box and it comes back positive, you’ll need a colonoscopy. But now instead of it being a screening colonoscopy covered by your insurance, it is now a diagnostic colonoscopy that is usually not covered by insurance. Aside from the science of it, that’s another reason why I recommend colonoscopy more than any other testing method. I highly recommend going straight to colonoscopy, because it is not just the gold standard. It’s the gold standard for some very good reasons.
Are there any lifestyle habits that either contribute to or reduce the risk of developing colon cancer?
Yes. Reducing risk involves all the healthy stuff you know already, eat healthy, don’t smoke, exercise regularly, control your weight, all of that stuff is good. Smoking is bad for just about everything, it adds to risk for many cancers, including colon cancer. Drinking a lot of alcohol, eating a lot of red meat etc. Eating your veggies, your roughage, your fiber is good for many different reasons. It does a gentle scraping of the colon as it goes through, which might stop polyps from even forming in the first place because it was scraped and pooped out. All those things go into decreasing the risk. Even if you need some surgery done, the healthier your body, the better the result during the surgery and easier recovery afterwards.