Download March is Colon Cancer Awareness Month

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]