Fever colonoscopies during pandemic has led to cancer increase, Utah doctors say

A polyp was discovered during a colonoscopy at St. Marks Hospital in this March 22, 2011 photo. Doctors from Intermountain Healthcare on Wednesday encouraged people to schedule a colonoscopy, particularly since the pandemic has led to a big drop in screenings. (Laura Seitz, Deseret News)

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SALT LAKE CITY – Colonoscopies have a bad reputation, partly because of the preparation patients need to do before the procedure. But two Utah doctors emphasized Wednesday how they play an important role in preventing later-stage cancer and can save lives.

Dr. Nathan Merriman, an Intermountain Healthcare gastroenterologist, said he has seen a lot of hesitance from patients needing colonoscopy screenings, especially over the last two years. He has seen a 50% drop in screening colonoscopies during the COVID-19 pandemic.

March is Colorectal Cancer Awareness Month, and Merriman is encouraging people to take time now to schedule screenings or diagnostic colonoscopies and talk to family members about the issue.

In the United States, colorectal cancer is the second-leading cause of death from cancer, and the third-leading cause for both men and women separately. It’s expected to cause over 50,000 deaths in the country this year.

Since the onset of COVID-19, there has been a 15% increase in stage 3 colon cancer, which is advanced enough that it will almost always be treated with chemotherapy, according to Dr. Mark Lewis, an oncologist. One of the causes for this could be delayed colonoscopies due to the pandemic.

Lewis said colon cancer is largely preventable, and with early intervention people will never need to go see an oncologist like him.

“I never want to give chemo. I mean, no oncologist, frankly, wants to give chemo. We’re actually actively trying to give less of it,” he said.

Lewis said that it has never been more important to catch cancer earlier and minimize the risk for chemotherapy than during the pandemic because chemotherapy can weaken the immune system and make it more likely for someone to contract COVID-19 along with other illnesses.

Screenings for colon cancer have fallen behind other cancer screenings, he said, although they are very effective. A colonoscopy does not just find polyps, small tissue bumps that can become cancerous, but they can also be removed during the procedure.

Merriman said it is important to talk to family members about patterns of illness and disease in the family, specifying if there is a history of cancer or polyps. Smoking is also a risk factor for colon cancer.

“We can do so much more to help each other, especially at the family level, to understand what we’re at risk for,” he said.

It is currently recommended that anyone who is 45 gets screened for colorectal cancer, which was lowered from age 50 in the last few years. Those with a family history of colon cancer should begin screenings 10 years before the age that their relative was diagnosed. People who have bowel diseases or polyps, or a family history of either, should also be screened before the age of 45, Merriman said.

He encouraged people to ask a doctor if they are wondering if they should get a colonoscopy. He said the preparation process for a colonoscopy is “tolerable, not terrible,” and has become a lot better over the last 10 years, and is continuing to improve.

Signs that someone has colon cancer can include changes in the shape of stool, abdominal pain that could cause weight loss and bloody stools.

Lewis and Merriman both said they have seen multiple patients who have encountered rectal bleeding for multiple months but waited to talk to a doctor. They said if this is persistent, a patient should get a colonoscopy and be checked for colon cancer.

“We will not know if there are symptoms going on unless (patients) feel comfortable speaking up, and we empower them to speak up … then we can learn from our patients and help them to get the care they need,” Merriman said.

He said he chose to go into gastroenterology because of an unrelated loss in his life that was preventable, and he hopes to help prevent tragedies for others.

“We have this amazing ability to help prevent suffering by identifying polyps in the colon, removing them and preventing the whole cascade of cancer that is hard, so hard, on patients and their families,” Merriman said.

Lewis said he came to Utah because it is the youngest state and there is a particular problem with early-onset colorectal cancer in the state.

People need to be more comfortable talking about colonoscopies and cancer, he said, adding that he sees a lot of people with guilt or who put pressure on themselves after a diagnosis. Although there are prevention steps, like colonoscopies, colon cancer is not always preventable. Lewis said some polyps can take 10 years to become cancerous, while others become cancerous very quickly.

Although they recommend screening at age 45, Lewis said that depending on how the screening goes some patients may not need another screening for years, while others may require follow-ups much sooner.

“Each patient’s treatment is then tailored to them so it is not one size fits all. Once you get into the screening process it looks a little bit different for everybody,” Lewis said.

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