March is Colorectal Cancer Awareness Month. Colorectal cancer is the second leading cause of cancer-related death in the U. S. and the third most common cancer.
The evidence is strong that, in adults ages 50-75, routine screening for colorectal cancer reduces mortality. And the good news is that most colon cancer can be prevented and done effectively with minimal risk. We don’t want just to catch colon cancer early – but rather before the cancer even develops.
We know that, on average, 25 percent of all adults older than age 60 have colon polyps (growths like warts in the colon lining), and some of these will develop into cancer, usually within 10 years, if not removed.
A few fast-growing colon cancers do not develop from polyps and still pose real diagnostic dilemmas for us all. But since most cancers do come from polyps, what can one do to protect against developing these polyps or cancer?
Lots has been written about things like avoiding red meat, increasing fruits, vegetables, fish, garlic, fiber and certain vitamins in our diets, but no studies have conclusively confirmed any of these. There are probably good health reasons for making some of these dietary choices, but we can’t yet prove a clear relationship of any to colon cancer or polyp prevention.
Some recent reports suggest that regular aspirin use helps prevent colon polyps, and that is being studied further. The only thing proven thus far to reduce the risk of colon cancer is colon cancer screening. It’s important to note that screening means being checked when you are not having any symptoms.
So, who should be screened? Current guidelines from all the major gastrointestinal professional societies recommend all adults at average risk should start screening at age 50. Higher-risk people (family history of colon polyps or cancer, ulcerative or Crohn’s colitis in mother, father or sibling) are recommended to start at age 45.
Most authorities recommend continuing until age 80, though if someone has some other illness that might increase risk, guidelines are to stop at age 75.
Several tests are available for colorectal cancer screening:
Colonoscopy – Examines the entire colon and detects most small polyps and almost all large polyps and cancers – requires colon cleansing and sedation. Patients have no discomfort and return to work the following day.
Sigmoidoscopy – Examines approximately 20 percent of the length of the colon – can be done without sedation, and, obviously, a significant portion of the colon is never seen.
Virtual colonoscopy – A “CT” scan of the bowel after thorough cleansing of the colon but no sedation. Air is pumped into the bowel – if polyps are found, formal colonoscopy is necessary.
Stool blood tests – There are new immunochemical tests for fecal blood that are more specific and do not confuse by detecting upper gastrointestinal bleeding. Further, some foods that cause a positive test with older methods do not affect these newer tests. Your primary care provider can arrange for this test.
There is reason for some optimism regarding cancer screening. Research is continuing to produce even more advanced noninvasive screening tests. There is even a test “in the pipeline” (not yet ready for clinical use) called “Cancer SEEK,” a blood test that can detect eight common cancers.
At some point in the future we may find colonoscopy reserved only for removing lesions diagnosed by such sophisticated stool and blood tests. But for now, current screening tests should be used.
Who is the best person to help you make decisions about screening – your own personal health care provider. All our excellent Chaffee County providers are quite knowledgeable about colon cancer risk and screening guidelines, and they know you better than anyone else. So everyone should avail himself/herself of these very informed professionals in our community for advice about this very important issue.
Remember, most colon cancer is preventable, but it requires action on your part.
Drs. V. Michael Barkett and Karen A. Johnson are board-certified surgeons with a collective experience of more than 30,000 endoscopic procedures. They perform all their procedures at Heart of the Rockies Regional Medical Center and can be reached through the Specialty Clinic at the medical center, 530-2481.