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Austin doctors seeing more serious cancer cases after people put off colonoscopies during pandemic

Eric Ebner was diagnosed in November with colon cancer and had surgery to remove it in January.

Eric Ebner, 58, had been putting getting a colonoscopy on the backburner since he was 50. 

"I'm always really busy," he says.

He runs physics labs at Austin Community College. When the pandemic started, he had more time as classes went virtual, and his job became about filming projects in the lab instead of having students in the lab. 

Still he put it off, even though his mother, his girlfriend and his best friend were all telling him to get it done. 

Finally, in November, after his girlfriend had hers, she told him it was his turn, and he finally went.

Ebner was diagnosed with colon cancer that was the size of a walnut. His cancer was found while it was still Stage 1. In January, he had surgery to remove it and seven inches of colon surrounding the area as well as nearby lymph nodes. The lymph nodes were all clear, and he did not need any other treatments.

He will have yearly colonoscopies for the next two years. If all goes well, he can spread out future colonoscopies. 

Now he tells everyone to have the test. "Put it on their calendar," he says. "It's pretty painless." 

Even the prep work to clear out the colon was not as bad as he had imagined it would be. 

If he had not listened to his girlfriend, "we could be in a whole different paradigm right now," he says. "I feel very lucky."

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Dr. Thiru Lakshman, a colorectal surgeon at St. David's North Austin Medical Center, was Ebner's surgeon.

What he, other doctors at St. David's and around the world are noticing is people putting off colon cancer screenings more than usual during the pandemic. 

"The pandemic has caused its own internal medical pandemic," he says. "People are not getting screened." 

Lakshman says people have been both skipping regular screenings and waiting longer with symptoms before they come in for a colonoscopy.

Symptoms for colon cancer include blood or other changes in stools, difficulty going to the bathroom, unplanned weight loss, abdominal pain or cramps, or fatigue. People who are diagnosed with colon cancer, especially in the early stages like Ebner's, might have no symptoms.

As the pandemic continues and as people get vaccinated, they are starting to come in after months to a year of waiting to be screened.

"We are now seeing the repercussions of that," Lakshman says. 

He's seeing six to seven cancer diagnosis referrals a week instead of the one to two a week he was seeing before the pandemic. Many of these cancers are found in later stages. Colorectal cancers are the third most common cancer in the United States and the third leading cause of cancer deaths. 

Most colon and rectal cancers are slow growing and can wait a month or two to be removed, but not months to a year, which is what has happened during the pandemic. 

A colonoscopy is a valuable tool for finding the cancer and also for finding polyps and removing them before they become cancer. Lakshman estimates that about 20 to 25 percent of colonoscopies reveal a polyp. 

People should receive their first colonoscopy no later than age 50, though some recommendations advise beginning at age 45. If you have a family history of colon cancer, your first colonoscopy should be 10 years before that relative's cancer was diagnosed.

A normal colonoscopy should be repeated every 10 years, or every five years if polyps were found, perhaps sooner depending on what those polyps looked like. Usually by age 80, people can stop having colonoscopies because the risk of death by colon cancer decreases compared with other causes of death in the over-80 age group.

Like Ebner found, the prep work for a colonoscopy has improved. It's doesn't take as long, doesn't require drinking as much liquid and the flavor of the prep drinks are better, Lakshman says. "It's not a like a Champagne cocktail," he says, but it's improved

Lakshman says in addition to getting colonoscopies, people can improve their cancer risk level by choosing low-fat, high-fiber diets including plenty of high-fiber fruits and vegetables, exercising daily and avoiding tobacco, alcohol and obesity.