Advanced cancer cases up sharply after colonoscopies drop by half, Utah doctors say

Patients who have fallen behind on their screenings during the pandemic could end up dying needlessly, Intermountain doctors say.

(Intermountain Healthcare via zoom) Dr. Nathan Merriman, a gastroenterologist for Intermountain Healthcare, urges patients to get their screening colonoscopies. Colonoscopies at Intermountain were down about 50% during the pandemic, and advanced-stage cancer cases are now up about 15%, doctors said.

Doctors at Intermountain Healthcare are pleading for Utahns to schedule their screening colonoscopies after noticing a 15% rise in colon cancer cases at stage 3 or higher.

The rise appears linked to a 50% drop in screening colonoscopies during the coronavirus pandemic among Intermountain patients, said Dr. Nathan Merriman, a gastroenterologist for Intermountain.

“There’s been a lot of postponement of routine medical care, especially screening colonoscopy care,” Merriman said.

If colonoscopies are delayed, masses are allowed to grow or become cancerous. The results can intersect catastrophically with the pandemic — and not just because the patient may end up with cancer, said Dr. Mark Lewis, an oncologist.

“In the early days of the pandemic I [asked], ‘How are we going to reconcile this? How can I, in good conscience, take care of my patients if the chemotherapy is going to weaken their immune system in the midst of a global pandemic?’ In some ways, it’s never been more important to catch these cancers early and minimize the number of cases that require chemo,” Lewis said. “And yet, we think because screening has been less common, I’m actually seeing people at later and later stages.

“This is happening at exactly the wrong time,” he said.

Utah is unique in that it has “a particular problem here with early-onset colorectal cancer,” Lewis said. “For years now, we’ve been seeing this happen earlier and earlier and sometimes before the ages when we were initially screening for it.”

The high incidence of early-onset cancer may be linked to patterns in childhood antibiotic exposure, which British researchers have identified as a possible factor when cancer develops in younger adults.

Patients are now recommended to begin colonoscopies at age 45 — or 40 if they have risk factors like a family history of cancer.

“It’s really important to talk to family members about patterns of illness and disease and medical problems to understand what we’re at risk for and really to do a multigenerational approach to this,” Merriman said.

That means finding out about family patterns of colon cancer, colon polyps (small masses that grow in the colon and are generally uncovered in screening colonoscopies), as well as other types of cancer. Patients with a personal or family history of inflammatory bowel diseases, such as Chrohn’s or ulcerative colitis, also should consult with their doctor about possible screenings, Merriman advised.

Anyone who has had a colonoscopy where polyps were found should tell their families immediately so they know they may be at elevated risk, Lewis said — even if your family is uncomfortable talking about poop and its exit path.

“No one wants to be discussing things like rectal bleeding,” said Lewis, whose own father died from colon cancer when Lewis was a teenager. “To us, though, this is what we do. And it’s partly because this has been so stigmatized and so difficult and uncomfortable for folks to talk about that we think rates of screening here have lagged behind other cancers.”

Patients also should be forthcoming about any irregularities in their bowel movements, such as blood in stool or even stool that’s unusually smaller in diameter.

“Another thing we’ve seen is ... the symptoms have been going on for longer,” Merriman said. “There have been several patients’ stories where they’ve had four, six, nine months of rectal bleeding before getting a colonoscopy, and that’s just too long to wait.”

Lewis noted that many of his cancer cases begin after ymptoms like rectal bleeding are dismissed as hemorrhoids.

“I have seen too many cases of bleeding that were just written off as, ‘Oh, this is nothing.’”