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| PREVENTATIVE MEDICINE |
March is Colon and Rectal Cancer Awareness Month
Colon and Rectal Cancer Awareness Colon and rectal cancer kills more Americans than any other malignancy, except lung cancer. Each year, over 140,000 new cases are diagnosed, and over 55,000 people die from the disease. The cumulative lifetime risk for colorectal cancer in the U.S., a high-incidence country, is now over 6%. Colorectal cancer thus causes great pain and suffering, substantial loss of life, at the cost of billions of health care dollars. It is a tragedy that the disease causes this much loss, when actually it is one of the most curable or even preventable forms of cancer if detected at an early stage.
All primary clinicians are strongly urged to screen their patients for colorectal cancer. Clinical experience and the results of a number of recent scientific studies indicate that widespread adoption of the recommendations in these guidelines would markedly reduce the great morbidity and mortality from colorectal cancer in the U.S.
Contrary to a pervasive misconception that colorectal cancer affects mainly men, it actually is the only major cancer that attacks both sexes almost equally. Women, therefore, have to be as concerned about screening for colorectal cancer as they are about screening for breast and cervical cancer.
Risk factors
Routine screening is recommended for nearly 70 million Americans. Most people are at high risk for colorectal cancer simply because they are over age 50, the time in life when the incidence of colon cancer significantly increases. About 20% of people have additional risk factors for colorectal cancer:
- A first degree relative (parent sibling or child) who has polyps or cancer
- A personal history of colorectal cancer or polyps
- A personal history of ulcerative colitis
- Although racial groups appear to have nearly the same incidence of the disease, mortality is noticeably higher in African-Americans.
Screening Recommendations
The American Cancer Society recommends regular screening tests for all adults over age 50. Screening may be recommended earlier and more often for patients who have additional risk factors.
- Patients with a family history should have more frequent screenings, beginning at an earlier age than their relative was when he or she was diagnosed.
- Patients with a history of ulcerative colitis are at increased risk of developing colon and rectal cancer, and therefore should have more frequent screening than the general public
- Patients with a personal history of the colorectal cancer or polyps require more intensive special observation with periodic colonoscopy.
Screening Methods
Over the past 20 years, screening and diagnostic methods have been developed and tested that can reliably detect the disease before symptoms develop in most cases. It is now possible to prevent most colorectal cancer by finding and removing the precursor of most of these cancers – the neoplastic adenomatous polyp.
- Fecal occult blood test: This test checks for blood in the stool that cannot be seen. Hidden blood may be a sign of colon polyps or cancer. A small stool sample is collected and tested in a laboratory.
- Digital Rectal Exam (DRE): This simple test can help detect rectal cancers. The doctor inserts a lubricated gloved finger into the rectum and feels for changes in the rectal lining. A DRE takes less than a minute.
- Barium Enema: This test lets your doctor view the entire colon and rectum using x-rays. A soft tube is placed into the rectum. The tube is used to fill the colon with liquid barium. This liquid makes the colon show up clearly on the x-rays. A small amount of air may be pumped into the colon to make the walls easier to view.
- Flexible Sigmoidoscopy: This test looks only at the rectum and sigmoid colon. During the test, a flexible, lighted tube (called a sigmoidoscope) is inserted into the rectum. Images of the rectum and sigmoid colon are shown on a video screen.
- Colonoscopy: This test allows your doctor to look at the interior lining of your large intestine (rectum and colon) trhough a thin, flexible viewing instrument called a colonoscope. A colonoscopy helps detect ulcers, polyps, tumors, and areas of inflammation or bleeding. During a colonoscopy, tissue samples can be collected and abnormal growths can be removed.
The two tests that have been most intensively investigated for screening are the fecal occult blood test (FOBT) and flexible sigmoidoscopy. The current screening guidelines recommend that all average risk people over age 50 be offered annual FOBT screening plus flexible sigmoidoscopy about every five years. A positive screening test is an indication for colonoscopy. By combining screening with annual FOBTs and periodic flexible sigmoidoscopy, many of the limitations of doing either test alone are addressed. Flexible sigmoidoscopy accurately detects cancers and polyps in the left colon, but fails to diagnose right-sided cancers.
The FOBT is less accurate for detecting cancers lower in the intestine, but is highly sensitive for cancers located above the reach of sigmoidoscopy. By itself, FOBT only finds about 24% of cancer. The combination of FOBT and flexible sigmoidoscopy detects about 76% of colon tumors. Other options for screening that are supported by indirect evidence only include colonoscopy every 10 years or barium enema x-ray examinations every five years.
Eat right, including fruits and vegetables, along with plenty of water in your diet. Regular exercise and over-the-counter fiber may also be of value. It is important that you and your family members be screened for colorectal problems. Have your siblings and children talk to their doctors about colorectal cancer screening.
If you are in need of a screening, please do not hesitate. Call your physician and schedule a screening appointment today.
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March is Colon and Rectal Cancer Awareness Month
