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Patient Story: Regular Checkups Can Help Prevent Cancer

For one woman, a simple routine checkup made all the difference in preventing an otherwise-undetected cancer from spreading.

Thanks to a routine physical checkup and the resulting colonoscopy, Sarah Richau is cancer-free after a cancerous tumor was successfully removed in surgery. Both the physical and the colonoscopy allowed for early detection, helping to identify and remove the tumor before it could develop or spread.

In September, Sarah Richau, 76, of Hazen, went to have her annual physical with her primary care provider, Physician's Assistant Keri Baumberger with Coal Country Community Health Center. Richau went to her appointment with no signs of anything amiss, having had a colonoscopy when she was 70 which came back with negative results for any warnings of colorectal cancer.

Hindsight is 20/20, and Richau is now able to see small signs that indicated a more serious problem might have been brewing. “It was just anemia, that was the only thing that was concerning,” Richau said. “I did notice when I walked to mail, which I've always done, I would sit down on the bench and rest. Before, that never bothered me.”

The tiredness did not trigger any red flags at the time, and Richau showed no other symptoms (such as stool bleeding) that would have prompted immediate further testing. But Baumberger noticed some concerning signs during the physical checkup, which prompted another screening for Richau. “I did some labs and those results were somewhat concerning,” Baumberger said. “But because of that, Sarah did the colonoscopy.” She added that Richau's hemoglobin count was low, which indicated their might be internal bleeding somewhere. As a result, Baumberger gave Richau a referral for another colonoscopy.

Technically, if you have your colonoscopy done and the results come back all-clear, you then wait 10 more years until you take your next colonoscopy. As it had only been six year, Richau was planning on waiting another four years before having a second screening. However, due to the results of her physical exam, Richau got another colonoscopy on Sept. 27, which showed a cancerous tumor had indeed begun developing. 

Dr. Michael L. Schmit, staff surgeon with Sakakawea Medical Center, said that was routine, and there are even guidelines stipulating when you should wait between screenings and for how long. “It is completely OK to pass 10 years between screenings [if the results are negative],” Dr. Schmit said to Richau. “You happened to fall into that category. Nobody did anything wrong, you were doing what you were supposed to do, and it happened.” Dr. Schmit said the tumor was not a very big mass. He said the biggest things to check were the lymph node count and distance metastasis (a recurrence in another area like the liver), with Richau testing negative on both of these.

Following Richau's colonoscopy and the discovery of the cancerous tumor, a surgery was successfully completed on Oct. 17 by Dr. Schmit, with the tumor removed. Richau was in the hospital for three days before being turned over to an oncologist. “We caught yours early enough, so once we took [the tumor] out, she was basically free of the disease,” Dr. Schmit said.

Richau praised Dr. Schmit's surgical skill, saying the surgery itself was pretty painless and easy. Richau will have 6 month and then yearly checkups, which if they go well will extend to every two and then every three years. Because she did have a cancerous tumor, the checkups will be held every third year on at that point, even if tests continue to come back negative.

In Richau's case, if it had not been for simply going to have her regular annual checkup, the cancer that had started developing might not have been detected for another four years when she had planned to have her next colonoscopy, unless more severe and obvious symptoms started developing. In either case, the cancer might well have progressed to a more serious stage by the time it was detected. 

Baumberger said doing annual checkups like this can be a more preventative way of making sure things are OK and any problems are detected early, rather than waiting until you feel like there is a problem before coming in. “The longer you wait to do these annuals, and then you do find an issue like this, then you're likely looking at bigger treatments and also higher costs,” she said. “A reason to do this is because it is proactive rather than reactive.” Dr. Schmit agreed, saying you might feel pretty good, but once the word “cancer” is written down on paper, it changes your life. This is why it is important to have those regular physicals to check you over and make sure no small issues that are detected might grow larger, and also why it is important to have colonoscopies to screen for colon cancer periodically, with The United States Preventive Services Task Force having recently lowered the colorectal cancer screening age so that it is now recommended to have your first colonoscopy at age 45.

“Screening is important,” Richau said. “I never thought they were, but they are important.” Dr. Schmit talked about recent “alternatives” to traditional screenings, such as Cologuard, a stool test developed by Exact Sciences Corporation. He said this should not be seen as an alternative to colonoscopies, as there is a higher risk of “false-negatives” in such screenings, while any positive reading will lead you to then get a colonoscopy as the next step in any case. 

Dr. Schmit said that people delay getting their colonoscopies because of having to go through the “prep” before the screening, but that undergoing that is small compared to having to deal with a cancer diagnosis and the possible chemo, radiation and other treatments associated with that. “The not-eating didn't bother me with the prep,” Richau said. “It was the sitting on the stool that I didn't like. But it wasn't that bad. It's something that has to be done.”

If you are turning 45, or over 45 and have not had a colonoscopy, this is a good time to consider getting the screening done, as March is Colorectal Cancer Awareness Month. Kara Pulver, Director of Marketing at Sakakawea Medical Center and Coal Country Community Health Center, said the clinic is offering free FIT cards, which she said can lead to discussing options for screenings with your physician.

(Story and photo courtesy of Daniel Arens, Hazen Star)