Are there any other tests that I should be asking my doctor for to detect colorectal cancer?
Great question! There are definitely some tests that you can request from your healthcare provider to decrease your risks of colorectal cancer. The current screening guidelines suggest that people aged 50-74 who are at AVERAGE risk get screened. Average risk individuals are perfectly healthy people who have no signs or symptoms of colon cancer, have no predisposing illnesses (such as Crohn’s Disease or Ulcerative Colitis) and don’t have a first degree relative (parent, child, or sibling) with a history of colorectal cancer. The recommendation for these folks is a Fecal Occult Blood Test (FOBT) once every 2 years. An FOBT is a take home test that checks for small amounts of blood in your stool. The results of this test (positive or negative) will be sent directly to you and your doctor. Most people who have a positive test DO NOT have colorectal cancer, however, it is strongly recommended that you be referred for a colonoscopy if you receive a positive test. Your healthcare provider can make this referral.
There is another option available locally for people of average risk. This test is called a Flexible Sigmoidoscopy. This is a test performed by highly trained nurses who visually inspect the bottom third portion of the bowel with a small flexible tube to check if a person has polyps (little wart like growths) which over time could lead to colorectal cancer. If polyps are found, again, a colonoscopy will be highly recommended.
For those who are NOT at average risk (i.e., those with a positive family history, Crohn’s Disease or Ulcerative Colitis) the appropriate screening test is a colonoscopy. In the case of a person with a positive family history, the colonoscopy should happen at the age of 50 OR 10 yrs before the family member’s cancer (i.e., if a Mom was 45 and developed colorectal cancer, then colonoscopy should occur at the age of 35 for her children and siblings).
If you have symptoms of colorectal cancer such as pencil thin stools, feeling like the bowel has not completely emptied, blood in the stool, changes in bowel habits, abdominal pain and discomfort, unexplained weight loss or changes to digestion – then a screening test is not the appropriate investigation. In this situation, you should talk to your health care provider about a timely colonoscopy which would require a referral.
We hope you find this information helpful.
I’m average risk, so why don’t I just have a colonoscopy?
With a cancer screening test, we are looking for a cancer that might be there, in perfectly healthy people. Each screening test has different risks and benefits for a person. The current recommendations for average risk colorectal cancer screening is to complete the at-home FOBT test (Fecal Occult Blood Test) once every two years. With repeated testing every two years it is proven to catch colorectal cancers and save lives. However, if the FOBT is positive (when blood is found in your stool), you should have a follow up with a timely colonoscopy. People who are at increased risk (first degree family history, personal increased risk such as Crohn’s Disease or Ulcerative Colitis) should talk to their doctor or nurse about when to start screening.
I don’t want to take the FOBT test, is there something else I can do?
Current recommendations for average risk individuals include the take-home test (Fecal Occult Blood Test) once every two years starting from age 50-74. In Waterloo Wellington, we have two hospital sites offering the Registered Nurse Flexible Sigmoidoscopy (RNFS) program with recommended screening once every five years. You do not have to participate in both, however, it is recommended to do so, as part of a complete bowel screening. The flexible sigmoidoscopy allows a physical look inside the lower one-third of the bowel to check for and remove any polyps. For more information contact the RNFS screening office at 519-749-6578 ext. 4046.
Why can’t I just do one FOBT test?
No screening test has 100% accuracy. The take-home test (Fecal Occult Blood Test) has increased reliability when it is done consistently every two years for average risk individuals. Most cases of colorectal cancer begin as small non-cancerous clumps of cells called polyps. On average, it takes approximately 10 years for a polyp to develop into a cancer. The FOBT test is recommended every two years, and if it is positive (when blood is found in your stool) then it is strongly recommended a person goes for a colonoscopy within the next 8 weeks.
My mother died of colon cancer when she was 47. When do I start screening for colorectal cancer?
You are considered to be at increased risk for colorectal cancer. Current recommendations are for increased risk people to begin screening with a colonoscopy at age 50, or 10 years before the diagnosis of their first degree relative (parent, brother or sister, child). In your case, screening with colonoscopy should start before you are 37 years old.
You mention it can be prevented by “timely follow up” of abnormal pap tests….Does this mean 6-8 weeks as I have been told. Is this a normal wait to find results. Thank you
Thanks for your question! If you are referring to receiving abnormal results of a Pap smear, then timely follow-up might be the recommended repeat Pap smear (also known as a Pap test) in 6 months.
If abnormal results in your question refers to an abnormal follow-up Pap test result, then waiting 6-8 weeks until seeing a Gynecologist for a test called a colposcopy seems reasonable. Know that wait times will vary for different reasons, and currently we are aware that a referral for a colposcopy locally can range anywhere from 4-13 weeks. The term “abnormal” can be misleading as not all “abnormal” tests mean the same thing or are as urgent. Your healthcare provider will usually send a copy of your Pap smear result to the specialist and often appointments are “triaged” just like in the emergency department where the most worrisome “abnormal” tests will be seen sooner then some of the other “abnormals” that are considered less worrisome.
A colposcopy is an exam done in a similar way to a Pap test. The colposcopy allows the Gynecologist to see your cervix in more detail using a speculum and magnifying glass. A liquid is then applied to your cervix to help highlight any abnormal areas. A small sample may be taken (a biopsy) from your cervix for a closer look under a microscope in a lab. The biopsy can help determine if treatment is needed or not.
After the colposcopy, you may need a follow-up Pap test, or another colposcopy to check to make sure that the cells return to normal. Or you may possibly need treatment. There are many simple methods to successfully remove the abnormal cells.
Is an “irregular” pap result an indication of cervical cancer?
A Pap test is a simple test that takes some cells from the surface of the cervix. These cells are then sent to a pathologist who looks at them under a microscope and determines if the cells look normal or not. There are many benign (non-cancerous) reasons for an abnormal Pap so, no reason to panic. However, it is imperative that you listen to the advice and recommendations of your healthcare provider regarding the most appropriate follow up.
In some cases, the abnormal changes may be due to an infection from a strain of the human papillomavirus (HPV). This virus is extremely common in both men and women and is passed from person to person through intercourse or even close genital skin to skin contact. In the vast majority of cases, our bodies fight this viral infection and the cells eventually return to normal. However, in some situations, the body is unable to clear the virus and if left untreated could, over the course of years develop into cervical cancer. Most abnormal Paps do not lead to cancer but, some can stressing the importance of appropriate and timely follow-up of abnormal results. Most women who have developed cervical cancer were never screened or didn’t get appropriate follow up of abnormal screens!
Follow-up of abnormal Pap test results is important because it can help prevent cervical cancer. Abnormal cells often change back to normal cells naturally. However, in some women, the abnormal cells do not change back to normal and can develop into cancer. It is important to do follow-up tests of these abnormal cells, and if necessary, treat them to prevent cervical cancer from developing.
Q: Since this is a new drug … I am worried about giving my daughter the HPV Vaccine … we don’t know what the long term effects could be … can you provide any information about that.
A: The vaccine has been available around the world for a number of years now and there continues to be long term follow up of those who have received the vaccine. No serious contraindications to vaccination have arisen. There is always a potential risk of an adverse effect from any vaccine, including HPV. However, the vaccine has been scrutinized a great deal and it has the recommendation of The Society of Obstetricians and Gynaecologists of Canada, the National Advisory Committee on Immunization and the Canadian Pediatric Society and Health Canada approval. It is rare to get so many endorsements. Canada is generally quite conservative when it comes to adopting new vaccines so we (Canada) are, if anything, late adopters which means if there are any serious adverse trends, they’ve usually surfaced in other countries before Canada has approved it.
We are finding more and more cancers associated with HPV so the protection of the vaccine is proving to be of greater and greater benefit. We have very few vaccines that prevent cancers… this is one of them.
What if I have had two test that have negative results. What are the chances of this being serious?
Answer from Dr. Rachael Halligan:
It is difficult to answer this question without knowing the specifics of the case and I would strongly encourage you to talk directly to your doctor or nurse about your specific abnormal result.
I would suggest that you may have meant two “positive results” rather than two negative. If you did mean two negative results, meaning that you have had two normal pap smears in past 6 yrs, then excellent news. But continued screening with Pap smears (tests) every three years remains important despite a history of normal results. A woman can become infected with the HPV virus at any time. Changes that this virus causes can eventually lead to cancer of the cervix. This process can take up to 10 years to develop hence, screening every three years helps to identify if these changes are occurring and allows intervention/treatment before the changes become an obvious cancer.
On the other hand, if this question was to read “two positive results” then I would say…
Having performed MANY Pap smears in my career as a family doctor, I always like to tell patients that a Pap smear is a test that removes a few cells from the surface of your cervix. These cells are then put into a solution and are sent to a pathologist. A pathologist is a doctor that looks at cells and tissues to determine if certain diseases are present. The pathologist determines if the cells look normal or if they look abnormal. There is a broad spectrum of abnormal and the degree of abnormal determines the kind of follow up.
If cells appear somewhat abnormal, your doctor/nurse will receive a report that states there is evidence of Atypical Cells of Undetermined Significance (ASCUS) or Low Grade Squamous Intraepithelial Lesion (LSIL). This suggests that the cervical cells appear somewhat abnormal and may have been affected by the human papillomavirus (HPV) virus which we now know causes the vast majority of cervical cancers. There is a test available which can determine if you have been infected with the HPV virus, but its currently not covered by OHIP. You could ask your doctor to determine if this would be an appropriate test for you to help answer your question. If no HPV is present, then the changes to the cervix are less worrisome as the causative virus is not present. This test costs approximately $90.00. If you cannot afford this test, not to worry, the suggestion will then be to have a repeat Pap smear in 6 months time. If the Pap is normal at that time, and normal again in another 6 months, then you can relax and return to routine screening every three years. In this case, perhaps the virus was present and caused some changes which your body has now naturally healed from, just like a cold! On the other hand, if the abnormalities persist, this suggests persistence of the HPV virus which then requires more information from a test called a colposcopy. The vast majority of LSIL/ASCUS changes revert back to normal within 6-12 months especially in young women.
A colposcopy is a test performed by a gynecologist. It will feel to you very similar to a Pap smear – uncomfortable but not painful. During this test the gynecologist will put a solution on your cervix which identifies specific areas of the cervix that might have some changes present. The doctor will then obtain samples (biopsies) from these areas of the cervix and once again send this to the pathologist. Now the pathologist has a lot more tissue to look at to determine if and how abnormal the cervical cells are.
If your original Pap smear report says that there is evidence of a High Grade Intraepithelial Lesion (HSIL), this suggests that these cells have moved a little further along the spectrum of abnormal and therefore, a referral for a colposcopy is indicated rather then a repeat Pap smear. The more abnormal the cells, the more likely it is that this represents persistence of an HPV infection that has failed to clear and if left without intervention (over many years), may become a cancer.
To reassure you, MOST abnormal Pap smears do not become cervical cancer…BUT some do! Appropriate follow up is extremely important! In fact, most women who do develop cervical cancer have never been screened with a Pap smear or didn’t receive appropriate/timely follow up of their abnormal Pap smears. Don’t let that be you!
If I have had the HPV Vaccine, do I still need to have Pap tests?
You are at risk as long as you are sexually active. Cervical cancer is related to the HPV virus and your exposure to it. I would suggest that after you turn 21 years old, you go for regular Pap tests every three years even though you have been vaccinated. The vaccines we have today are effective for 70% of cervical cancers.
If I am sexually active, and I am at risk of getting the HPV virus, how are men being screened for this virus?
Unfortunately, men are not being screened for HPV infections unless they are symptomatic. The vaccine and regular Pap tests are the best way for women to protect themselves from cervical cancer once they are sexually active. I would go as far as to recommend the vaccine for males as well.
How long can you have cervical cancer and not know it?
Many women are exposed to the HPV virus and 90% of them will clear it on their own without any intervention or treatment. Most of these women will have absolutely no symptoms. It generally takes approximately 10 years for the HPV virus to develop into a cancer. Thus, with routine screening, most of these will be detected.
If your partner wears a condom is that good enough protection from the HPV virus?
Condom use is great way to reduce the risk but it is not 100% effective. Condoms have the ability to break, are not always applied properly, and are not always applied during the entire act of sexual intercourse. Saying that, I still highly recommend the use of condoms, as they reduce the spread of many common sexually transmitted infections, including Gonorrhea and Chlamydia. The best way to prevent the spread of the virus is to get the HPV vaccine.
My question is about breast cancer and screening. I have been told I have fibrosis / cyst in my breast. Originally when I got my first ultrasound on my left breast the Dr. came in and assumed I was in my 70’s? I was actually in my twenties. I have since had two babies and get an ultrasound once a year. I am concerned for two reasons: One, I noticed a few more lumps in my breast starting to get very painful and sore under my arm pit, and i have never been told to get a biopsy. Should I ? Would this be a “marker” for breast cancer? I keep getting the sense because I am in my mid 30’s that my Dr. doesn’t take my concerns seriously and I don’t want to find out that I have issues because I wasn’t being proactive. Thank you – this is a great service.
Thank you for your question! First of all, I tell all women that all breasts have lumps. This is why we encourage all women to be breast aware. What being breast aware means is knowing what lumps and bumps are normal for you and knowing what is NOT normal for you. It is absolutely appropriate, regardless of your age, to get any NOT usual lumps or bumps examined and evaluated by your health care provider. In pre-menopausal women, the breasts change in response to the hormones responsible for your periods. So in someone such as yourself, being aware of the changes throughout your menstrual cycle is extremely important. In the normal menstrual cycle just after you ovulate (halfway between your periods), a hormone called progesterone is quite high in your system. This hormone is responsible for that breast tenderness some women get before their period and the pain you probably remember from early on in your pregnancies! This may be the time when you feel those extra, tender lumps and bumps. If those lumps and bumps persist then an Ultrasound would be the appropriate initial investigation. Breast cysts or fibrocystic breasts are very common and do not put you at increased risk of developing breast cancer.
An Ultrasound is read by a Radiologist. This is a doctor who specializes in looking at and interpreting the findings of Ultrasounds, mammograms and other diagnostic imaging methods. The Radiologist looks at the images and determines if the areas of concern look fluid filled and therefore look like cysts or determine if they look like something other then a cyst. If the radiologist has any reason to suspect something other then a benign (non-cancerous) process, then he/she will suggest appropriate follow-up advice to your primary care provider. That follow-up may include a mammogram and or an ultrasound guided biopsy.
My advice to you would be to continue doing what you are doing, being breast aware and getting any unusual, persistent breasts lumps checked by your healthcare provider. Ask your healthcare provider to share and interpret the findings of the Ultrasound report to put your mind at ease.
Who is able to VRCA Gene testing? This will tell me if I or close family will get breast cancer?
It is important to remember that most causes of breast cancer are found in women without a gene mutation or even a family history. The bigger risk factors are being a women and getting older.
A mutation of the BRCA gene puts a person at increased risk for breast and ovarian cancer. If you have a family history of multiple women with breast or ovarian* cancer (especially if there is breast cancer before age 50, *ovarian cancer includes fallopian tube and primary peritoneal cancers), someone with cancer in both breasts, a specific type of ovarian cancer called “invasive serous”, breast and ovarian cancer in the same person, male breast cancer, breast cancer before age 35, or breast/ovarian cancer in Jewish families, you should speak to your family doctor about a referral for genetic counseling. A genetic counselor will review your family history, determine if you qualify for BRCA genetic testing, discuss the pros and cons of genetic testing, and give you some guidance about screening and prevention options.
I understand that there is a center in Toronto that will give one day diagnosis for breast cancer. Is this correct and do you need a referral or is this something you pay for?
Thanks for your question. I think you may be referring to a breast assessment centre. There are several within the province and what they offer is a complete work up of any concerning breast changes. Typically at a breast assessment centre you would have the appropriate tests done and see a radiologist and/or surgeon all on the same day. Tests may include mammography, ultrasound and if required a biopsy. It is not always possible to get a diagnosis in a day. For example, if a biopsy is done, the results may take a week or two to come back from pathology. All breast assessment centres do require a doctor’s referral. Services are covered by OHIP.
In the Waterloo-Wellington area there is a breast assessment centre located at Grand River Hospital’s Freeport Site in Kitchener.