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March 2019 I was talking with Karen Oslund, the executive director of the Cancer Resource Centers of Mendocino County and MCHC Health Centers board member, and she told me some disturbing news: Mendocino County is trending in the wrong direction when it comes to colon cancer. Karen is working with doctors from UC San Francisco on a grant project, and during a recent visit, they mentioned an epidemiological study that showed more people in our county are being diagnosed with advanced-stage colon cancer. When Karen spoke with local oncologists—Dr. Rochat on the coast and Dr. Wang in Ukiah—both doctors said they almost never treat patients with early stage colon cancer. The only explanation for this is that people are not getting screened. As a medical community, we know how to identify and treat colon cancer, but we can’t help patients if we don’t know they have a problem. I understand people don’t want to go to the doctor unless they absolutely have to, and I can appreciate why people avoid getting a colonoscopy, but I promise, a colonoscopy is way easier than the treatment required for advanced-stage colon cancer. Also, colonoscopies are not the only colorectal screening tool available. By the time you hit 50 years old, you should have at least one of the following screenings. FIT (STOOL SAMPLE TEST)   The fecal immunochemical test (FIT) screens for blood in your stool, which can be an early sign of cancer. FIT can detect even microscopic amounts human blood from the lower intestines. FIT results are unaffected by a patient’s medicines or food, whereas the alternative test, the guaiac fecal occult blood test (gFOBT), cannot differentiate between human blood and animal blood, so if you had a rare steak, you could get a false positive. Patients who choose this type of colorectal screening must get one every year starting at age 50, unless the test comes back positive, in which case a colonoscopy is required. COLOGUARD Cologuard is another non-invasive screening. It involves capturing an entire stool sample, start to finish, for DNA testing to identify genetic markers that put the patient at heightened risk for colon cancer. The test is done at home and mailed in for results that are typically available about two weeks later. With negative results, the Cologuard screening should be repeated every three years. COLONOSCOPY The gold standard for colorectal screening is the colonoscopy. If a FIT or Cologuard screening comes back positive, the patient will be required to get a colonoscopy, which involves emptying the bowels the night before and then being sedated while a doctor uses a flexible scope through the rectum to identify any polyps or lesions. If small polyps are found, they are removed and sent to the lab to determine whether they are benign hyperplastic polyps, pre-cancerous tissue, or cancer. The prep is typically the most unpleasant part. It involves drinking a powerful laxative to induce diarrhea for several hours before the procedure. Because patients are sedated during the procedure, it is not painful. A clean colonoscopy (no polyps or lesions) typically allows patients to go ten years without the need for additional colorectal screening. COLON CANCER If a cancerous tumor is found, depending on the tumor’s size, a surgeon can often remove it without need for further treatment. However, if the cancer has spread (metastasized), then chemotherapy may also be required. When colon cancer is found in its earliest stages, most patients have an excellent prognosis. For me, it was worth getting a colonoscopy for two reasons. First, I want the most reliable test, and second, I love the idea of not having to get screened again for ten years. Everyone’s different, but if you are 50 years old and haven’t had a colorectal screening, make an appointment with your medical provider today. Please don’t wait. Cancer only gets larger and more difficult to treat.   Dr. Jerry Douglas is the chief medical officer at MCHC Health Centers, a local, non-profit, federally qualified health center offering medical, dental and behavioral health care to people in Lake and Mendocino Counties.