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March is Colon Cancer Awareness Month Early Detection Can Mean A Cure When Katie Couric broadcast her own colonoscopy live on the Today Show back in March of 2000, she made Americans aware that early detection of colon cancer can mean a cure. After the broadcast, an initial wave of excitement followed and many people received their first colonoscopy. Without ongoing celebrity endorsement, patient interest in colonoscopy has waned somewhat. Only a third of the people who should be screened for colon cancer get simple tests that can identify colon cancer in its curable stages. Third Leading Cause of Cancer in the U.S. Colon cancer strikes more than 120,000 Americans every year and accounts for 55,000 deaths. It is the third leading cancer in both men (after lung and prostate cancer) and women (after lung and breast cancer). Most colon cancers develop over time from precancerous bumps in the colon known as polyps. Colon cancer often grows slowly and produces no symptoms in its early stages. When most colon cancers cause obvious symptoms such as pain or bleeding, the disease is often too advanced to be cured. When colon cancer remains confined to the colon, cure rates of over 90% are common. This is why it is so important to screen for colon cancer BEFORE you develop symptoms. Screening for Colon Cancer Saves Lives Screening is the process of looking for cancer or a precursor of cancer – such as a precancerous polyp - in a healthy person who is at risk for the disease but has no symptoms of that disease. The primary goal is to find early, curable cases of colon cancer that if left alone would develop into incurable cases. A secondary goal is to identify people with precancerous polyps who are at higher risk for developing colon cancer than people without polyps. Such persons can then be followed more closely. We know that screening for colon cancer saves lives and yet, only one third of the persons at risk ever get tested. Some shy away out of embarrassment or out of fear of being diagnosed with cancer. Others are unaware that they should be screened. Even some healthcare providers do not routinely test eligible patients. When Should You Be Screened for Colon Cancer? Colon cancer is uncommon in those under 50. Most experts agree that in the average person screening for colon cancer should begin at age 50. A high fat diet, lack of fiber, lack of exercise, and tobacco use may all increase your risk of developing colon cancer. A family history of cancer may also increase your risk of developing colon cancer. People at high risk include those with precancerous polyps, ulcerative colitis, a first-degree relative* with colon cancer, and a personal history of breast, ovarian, or uterine cancer. If you have symptoms such as pain, cramping, change in bowel habit or rectal bleeding you should not delay a workup. If you are in a high risk category, you may need to have a colonoscopy before age 50 and should check with your health care practitioner. * Parent, brother, or sister. Individuals with a first-degree relative with colon cancer should be screened with a colonoscopy either at age 50, or 10 years before the age at which that relative developed cancer, whichever comes first. Screening Options Digital Rectal Exam – A healthcare worker palpates the inside of the rectum with a gloved and lubricated finger. This allows the identification of lesions in the rectum and allows for the testing of traces of blood that may signify the presence of a tumor or polyps elsewhere in the colon. Fecal Occult Blood Testing (FOBT) – This test consists of a number of cards on which a small amount of stool is placed. A chemical solution is then added to the cards allowing the detection of trace amounts of blood. These traces of blood may come from a variety of sources including the stomach, hemorrhoids and even your diet. A positive test mandates further workup as 5-10% of people with such a result will be diagnosed with cancer. Barium Enema – This is an x-ray that allows visualization of the colon. The colon is coated with a layer of a barium solution and filled with air. Xrays are then taken and polyps or tumors can be identified. A newer version of this test involves the use of CT scanning and is often referred to as a virtual colonoscopy. When a lesion is identified a colonoscopy is indicated. Because of this, most physicians would recommend a colonoscopy as the first screening test rather than a barium enema. Barium enemas are now reserved for patients who cannot tolerate a colonoscopy. Colonoscopy – Colonoscopy is the tool of choice when screening for colon cancer. The procedure is performed by placing a colonoscope, a flexible tube fitted with light and a camera into the rectum. The colonoscope is then advanced through the colon by a trained practitioner. The entire colon is inspected. Suspicious lesions can be biopsied or even removed in their entirety. Colonoscopy has the potential to identify 100% of the cancerous lesions that may be present in the colon. Unlike some of the other screening tests, colonoscopy requires some sedation and must be performed in a specially equipped center. The procedure carries a small risk of complications, including bleeding and perforation. When performed by trained practitioners, colonoscopy is a very safe procedure. My Current Recommendations Actual screening recommendations vary, so be sure to check with your health care practitioner. The following are my recommendations. 1) If you are in a high-risk category, i.e. have a history of precancerous polyps, ulcerative colitis, a first-degree relative with colon cancer, familial polyposis, or a personal history of breast, ovarian, or uterine cancer, colonoscopy is the test of choice for you. 2) For individuals not in the high-risk category, annual fecal occult blood test for all patients age 50 and over, and, 3) Initial screening colonoscopy at age 50, then once every 5 to 10 years if normal; repeat in 3 years if precancerous polyps are identified. 4) My most important recommendation is to be aware and get screened. Do not ignore abdominal pain, weight loss, or rectal bleeding. This month’s article was authored by Dr. Pieter Pil. Dr. Pil is a general surgeon and endoscopist at Martha's Vineyard Hospital. Each year more than 350 colonoscopies are performed at Martha's Vineyard Hospital. We hope you will take the time to look at these useful resources. Resources Here are several links to websites with more information regarding colon screening: 1) Centers for Disease Control Website: www.cdc.gov/screenforlife (404) 639-3534 / (800) 311-3435 2) American Cancer Society Website has an excellent chart describing the different types of screening options to help you decide which test is best for you. http://www.cancer.org/docroot/CRI/content/CRI_2_4_3x_Can_C olon_and_rectum_cancer_be_found_early.asp 1-800-ACS-2345 3) American Academy of Family Practitioners Website has an article which lists screening recommendations for various types of cancers and why recommendations often vary : http://www.aafp.org/afp/20010315/1101.pdf 4) American College of Gastroenterologists website contains excellent patient information resources and links to more information about colon cancer: http://www.acg.gi.org/patients/patientinfo/coloncancer.asp (301) 263-9000 Please feel free to send any comments to [email protected]