If you’re a woman or a man aged 45 years or more, you should consider scheduling a screening colonoscopy. It’s your first chance at preventing this silent killer: colon cancer.

Be brave, like Ryan Reynolds

Early screening for colon or colorectal cancer (CRC) is vital for both men and women and is a very effective way to detect cancer or precancerous growths before they have advanced to a malignant and incurable stage.

CRC is one of the top three cancers affecting both sexes in South Africa, as reported by the Cancer Association of South Africa (CANSA). According to the National Cancer Register, in 2019, one in 77 men and one in 132 women were diagnosed with CRC. It ranks third in women, following breast and cervical cancer, and second in men after prostate cancer.

Dr Botes suspects, however, that colorectal cancer is even more prevalent in South Africa than the statistics indicate. “Unfortunately, a lot of colon cancers in South Africa present so late, at stage four, that they may not get the histology (pathology tests of the tissues and organs) attached to them, and thus, the death is not attributed to colorectal cancer.

In 2022, United States health authorities reduced the recommended colorectal cancer screening age for average-risk adults to 45 years, instead of the former 50.

“Colorectal cancer is a big problem, and not many people know about it. There hasn’t been the same kind of global marketing push that there has been with breast and prostate cancers, for example,” says Dr Jaco Botes, a specialist surgical gastroenterologist from Mediclinic Durbanville.

Dr Botes notes that the most high-profile attention CRC has received so far was in 2022 when actors Ryan Reynolds and Rob McElhenney, in partnership with the Colorectal Cancer Association’s Lead from Behind campaign, documented and shared their colonoscopies on YouTube in the year they turned 45. With tongue firmly in cheek, the campaign urged people on social media to “let your behind be the leader it was born to be”.

The ins and outs of colonoscopies

A colonoscopy is one of the most accurate ways of detecting cancer or precancerous polyps in a patient’s large intestine (colon) and rectum, and simultaneously removing these. An adenomatous polyp is a small and typically harmless tumour at first that develops in the glandular tissue of multiple organs throughout the body. Some adenomas may be precancerous and grow into cancer – adenocarcinomas – over about 10 years if not surgically removed, notes Dr Botes.

The day before a colonoscopy, a patient is put on a restricted diet and given a laxative to drink to rinse the colon of faecal matter. The actual procedure involves the insertion of a long flexible tube called a colonoscope into a patient’s rectum under sedation or anaesthesia. This is guided by the surgeon along the colon. A tiny camera with a light at the end of the tube enables the surgeon to view the colon in detail. Polyps and abnormal tissues are then removed during the colonoscopy by tools within the colonoscope, as was done during the procedures for Reynolds and McElhenney.

Saving lives with colonoscopies

Colonoscopies conducted every 10 years have been shown to save lives through the detection and removal of polyps. “If you prevent the cancer from growing in the first place, you also save on the cost of any cancer treatment, which is extremely expensive,” says Dr Botes. Currently, colonoscopies are usually covered by South African medical aids for patients aged 45-75 years, and it is recommended that they are conducted every 10 years.

More than 40% of adults over the age of 50 have precancerous polyps in their colon, according to the American Society for Gastrointestinal Endoscopy.

“With colorectal cancer, the earlier you catch it, the better and easier the treatment outcome. What is unique about a colonoscopy screening is that we can prevent the disease entirely,” says Dr Botes, noting that the colonoscopy is the most effective and reliable screening option for CRC. Other tests to screen for this kind of cancer include computed tomography (CT or CAT) colonography (every five years), faecal occult blood tests (FOBT) and faecal immunochemical tests (FIT), and stool DNA tests (one to three years).

There is a 90% survival rate for patients with CRC that is detected at an early stage, when the cancer is still localised and has not spread to other areas or organs in the body, according to the Colon Cancer Foundation.

Hope after CRC

Dr Botes notes that the best treatment for CRC is the removal of the cancerous growths through robot-assisted surgery, done laparoscopically (‘keyhole’ surgery), which is available at Mediclinic Durbanville.

“The benefit of this approach is less trauma to the tissues compared to open surgery and, depending on the type of surgery, the patient can often go home the same day or the day after the surgery, compared to spending a week in hospital after open surgery,” says Dr Botes.

“The benefit of the surgeon using a robot during surgery is that the robot has articulating wrists, which gives the surgeon the ability to do much more complicated movements with their hands. Robot-assisted surgery is also minimally invasive: the robot also allows the surgeon to work in dark, tight areas like the pelvis without damaging any nerves, for example. This is particularly critical in the pelvic area where the nerves control continence and sexual function. Post-operative nerve function is significantly better with robot-assisted surgery than with open or normal laparoscopic surgery, leading to a better quality of life.”

CRC prevention is very much related to one’s lifestyle and is usually associated with older age.

“Colorectal cancer is linked to carcinogens in our diets and lifestyle, which cause long-term inflammation or DNA damage in the colon, leading to cancer. Balanced diets with sufficient fibre are seen as preferable to a more processed diet – wholewheat bread, for example, instead of white bread.”

There are also compounding factors, such as genetics and one’s family history, to take into account. If you have a family member with a history of colon cancer, you should have a colonoscopy 10 years earlier than the age at which your relative was diagnosed with CRC.

“Having a regular colonoscopy can have a significant impact on patients not dying from colon cancer. Studies from the US show that a single colonoscopy can reduce the colorectal cancer mortality rate by 68%,” says Dr Botes. Knowing this dramatic statistic should make it a ‘no-brainer’ for us to remember our colons and schedule the procedure every 10 years from the age of 45.