Young Circus Performer Has Aggressive Polyp Removed During First Colonoscpy
- Francesca Arminio underwent first colonoscopy at 33 years old after finding blood in her stool, and scheduling an appointment with a gastroenterologist who determined she needed the procedure.
- The U.S. Preventive Services Task Force recently drafted new recommended guidelines which state colon cancer screenings should begin at 45-years-old.
- Many insurance companies still do not cover the cost of screenings for those below the age of 50.
- The best and most complete way of screening is a colonoscopy every 10 years, with differing guidelines depending on a person’s risk category.
At age 33, she's in excellent health, eats a clean vegetarian diet, a non-smoker and not much of a drinker.
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Still, here she was, five months after seeing that blood in her stool, appearing for her doctor's appointment with a gastrointestinal specialist."I was ready to be my own advocate and demand to have my symptoms taken seriously," she wrote. "Being under the age of 45, I am not at the recommended screening age. I was prepared for a fight."
Luckily, Arminio did not have to put on her boxing gloves.
After a thorough conversation, the doctor recommended a colonoscopy.
"I was shocked, thrilled, relieved, and nervous," Arminio wrote. "In less than a week, I would have some answers."
What is a Colonoscopy?
A colonoscopy is a procedure that is used to screen for colon cancer by looking at the inside of the colon. It requires that the colon be "cleaned out" so that the gastroenterologist performing the procedure can have a clear look to evaluate if any polyps or masses are present.
To prepare for the procedure, a doctor will prescribe a "bowel prep" to drink or take in pill form the night before the procedure. This prep is a laxative that will cause multiple loose stools prior to the colonoscopy. It may be one of the most uncomfortable parts of the process, but it's one of the most important.
A colonoscopy can be a life-saving procedure, as it can detect a colon cancer at an early stage while it is still curable or find polyps that can be removed before they progress to cancer.
One in 23 men and 1 in 25 women will be diagnosed with colorectal cancer, and young-onset is on the rise, according to the Colorectal Cancer Alliance.
Colon cancers start out as a polyp, or small growth, in the colon that causes no symptoms. Although polyps can't be felt, they can be picked up by screening tests before they cause a problem. It takes up to 10 years for a colon polyp to become a full-blown cancer, which gives doctors time to remove the polyp before it causes a problem.
Conflicting Screening Recommendations
The U.S. Preventive Services Task Force recently drafted new recommended guidelines which state colon cancer screenings should begin at 45-years-old. This is in response to the increase of colon cancer diagnoses in younger adults.
However, many insurance companies still do not cover the cost of screenings for those below the age of 50. In the past, the disease had predominantly been found in adults 50-years or older, but for those predisposed to get it at a younger age, these new guidelines could potentially help catch it at an earlier stage.
While most major national organizations put no upper age limit on colonoscopy screening, government guidelines suggest people 76 and over talk to their doctor about whether further screening is needed.
The best and most complete way of screening is a colonoscopy every 10 years. In general, the latest recommendation is for a person to be get their first colonoscopy at age 45.
Still, the guidelines differ depending on a person’s risk category.
If you have a close relative who had colon cancer, a rule of thumb is to get screened 10 years prior to their age of diagnosis to make sure any growths or cancers are caught early. If you have several family members who had colon cancer, or family members who got it at less than 50 years old, it may be necessary to undergo genetic screening. And if you have a lot of polyps on your colonoscopy or if you yourself have had colon cancer previously, you will need a colonoscopy every 3 to 5 years.
At-Home Screening
There have been a lot of stories in the news about an at-home colorectal cancer screening kit called Cologuard. Many have gone as far as to say that they are a good replacement for a colonoscopy. But that isn't true. Cologuard is not a good replacement for a colonoscopy, according to Dr. Heather Yeo, Surgical Oncologist and Colorectal Surgeon at Weill Cornell Medicine and NewYork-Presbyterian.
Cologuard is an at-home test that helps with some parts of colorectal cancer screening. To use it you order a kit, which instructs you to give a stool sample. Then, you send the stool sample back to the company, which runs some tests to see whether there are any signs of cancerous cells that can be detected in the stool. But stool samples aren't enough when it comes to colorectal cancer screening.
"There has been some news lately about at home stool tests saying that they are as successful as colonoscopy in picking up early cancers. It's not quite true. They're really good at picking up more advanced cancers or cancers, but unlike colonoscopy, they can't pick up the pre-cancerous lesions called polyps that we need to take out to prevent cancer," says Dr. Yeo.
Cologuard's information touts the fact that there are no preparations in order to take the test. "There is no special prep or need for time off. Plus, you don't have to make any changes to your diet or medication," says Cologuard's information. In this way, it's supposed to be a lot less invasive to your daily routine than a colonoscopy, which requires a brief change to your diet and medication that helps to clean out your bowels.
Arminio was given the pill version of the required prep for a colonoscopy, combined with instructions to flush her system with a large amount of water and low fiber foods.
But being a vegetarian made it challenging.
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"I already drink a lot of water, so that part was a piece of cake," she wrote. "As someone who doesn't eat meat or dairy, changing my diet to be low/no fiber was the most difficult part of the prep experience."
She added, "vegetables make up 90% of what I eat and there aren't many resources for how to prep for your colonoscopy as a vegetarian/vegan."
White bread, tofu, peanut butter, and rice crackers were her 'go-to' foods.
The actual procedure involved nurses giving Arminio an IV to sedate her to sleep.
"When I woke up, my doctor was there waiting for me," Arminio said. "He found and removed three small polyps, two in my rectum and one in my transverse colon."
All were removed with the recommendation that Arminio return for a follow-up in five years at the age of 38, still under the recommended colonoscopy screening age of 45.
A few days later, Arminio received a call with the pathology report that revealed two of the polyps were serrated and likely would not have turned into anything.
But one was concerning.
"It was a traditional serrated adenoma, which according to my pathology report are 'aggressive lesions' and should be treated as advanced adenomas for screening purposes" she wrote. "What would have happened if I hadn't taken the step to get screened?"
Arminio's doctor reassured her the polyp of concern was removed completely, but updated her record for her to return for another screening in three years, instead of five.
Her advice?
"Get checked," she wrote. "Cancer doesn't care about your health."
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