Catching Color Cancer Early

Colon cancer screening can save your life.

If you’re over 50, talk with your doctor about colonoscopy.

When Katie Couric had a colonoscopy, America watched it on TV. Couric had her colonoscopy broadcast because she knew that colon cancer screening and polyp removal save lives.

“Colon cancer death rates are declining thanks to improved awareness and screening,” says Dr. Austin Garza of Associates in Gastroenterology, P.C. When detected early, the prognosis for colon cancer is more favorable. Yet only about half of the people who are at risk due to age or family history are being screened.

It is estimated there will be 147,000 cases of colon cancer in Americans this year. In men, colon cancer cases have the third highest incidence (estimated 72,800), behind prostate (234,000) and lung (93,000). In women, colon cancer cases also are third (76,000), behind breast (213,000) and lung (82,000). Among all cancer deaths, colon cancer is second. (Centers for Disease Control, www.cdc.gov/cancer).

Yet Americans are not being screened adequately. According to CDC data, only about 50 percent of the at-risk population is getting screened, and approximately 42 million average-risk Americans have not undergone a validated screening test.

“We can potentially save many more lives,” Dr. Garza says.

Risk factors

The risk of colon cancer increases with advancing age. Sixty-five is the average age at diagnosis, and the peak occurrence is in the seventh decade of life, Dr. Garza says.

Scientists have found that about 80 percent of colon cancer lacks a genetic or inherited component. Most of those cancers, known as “sporadic” cancers, stem from mutations occurring in a colon cell that give rise to a polyp and ultimately to cancer.

“We believe this sequence takes approximately 10 years,” Dr. Garza says. Since most cancers occur around age 65, average-risk patients should begin screening at age 50. For patients with a history of colon cancer or colon polyps in a first-degree relative (mother, father, brother or sister), screening should start at age 40, or 10 years before the age of diagnosis in the first-degree relative.

Risk factors for colon cancer include inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis) and a personal or family history of colon cancer or polyps. Lifestyle factors such as smoking, high alcohol consumption, obesity, high-fat diet and, to a lesser extent, lack of exercise and low-fiber diet may contribute to development of the disease.

You may have heard that a high-fiber diet can help prevent colon cancer. According to studies, “a high-fiber diet is not protective, but is still endorsed for prevention of diverticulosis (small, protruding sacs of the inner lining of the intestine that are common after age 40), and is generally part of a healthy diet,” Dr. Garza says.

There are cases of colon cancers that are hereditary. Some patients can develop cancer as early as in their teens. Patients with a strong family history should see a gastroenterologist.

“However, it is important to remember that 80 percent of colorectal cancer is sporadic, in individuals without any recognizable risk factors,” Dr. Garza says.

Screening for colon cancer

The U.S. Preventive Services Task Force, the American Cancer Society and the American Gastroenterological Association currently endorse five screening and treatment strategies:

  • An annual fecal occult blood test
  • Flexible sigmoidoscopy, a nonsedated procedure, recommended every five years
  • Combined fecal occult blood test annually and flexible sigmoidoscopy every five years
  • Air contrast barium enema every five years
  • Colonoscopy every 10 years

The latest technological innovation in imaging the GI tract is capsule endoscopy, which can be used to view the approximately 20 feet of the small intestine that cannot be seen by traditional endoscopy, Dr. Garza says. The device can pick up obscure bleeding and may identify small intestinal cancers, which are quite rare. Capsule endoscopy does not replace other imaging methods, however, and is used primarily to investigate gastrointestinal bleeding or suspected Crohn’s Disease.

Prevention

“The best preventive measure is to undergo screening for colon cancer, and the best screening method is colonoscopy,” says Dr. William W. Lunt of Associates in Gastroenterology. That’s because the doctor can see the entire colon and remove any precancerous polyps in one procedure. Colonoscopy also can find early-stage colon cancer so it can be treated early. Based on data from the National Polyp Study (NPS), the risk of death from colon cancer is reduced up to 90 percent by undergoing colonoscopy.

Colonoscopy is widely available and covered by most if not all insurance plans, including Medicare. The procedure involves bowel preparation to clean the colon and IV sedation. It typically lasts about 30 minutes and recovery is rapid.

A diet high in vegetables and low in fat seems to be protective, along with plenty of exercise. Evidence supports use of calcium to prevent polyp formation, particularly in women. Aspirin also may help; lower rates of colon cancer were seen among female nurses who took aspirin daily compared with those who did not. Aspirin’s benefit, however, must be balanced against the potential for bleeding. This is definitely something you should discuss with your doctor.

Hormone replacement therapy (HRT) has been shown to prevent polyps in women, but HRT has potential harmful side effects and thus is not recommended purely for polyp prevention.

“Both the incidence of colon cancer and cancer-related deaths have been declining slowly, about 1-2 percent annually, mainly, I believe, due to increased screening and polyp detection,” Dr. Garza says. “Early detection also helps with survival, as cancer caught at an early stage has a much more favorable survival rate.”

Case studies

C.H., a healthy 52-year-old female who had been feeling perfectly well, went to her primary care physician for a routine physical. Part of the exam included checking her stool for blood. A microscopic amount of blood was detected, and she was referred for a full colonoscopy. During the exam a large colon mass was easily detected in her upper colon. The colon cancer was easily removed with laparoscopic techniques through small incisions. This tumor was an early-stage lesion, and no further treatments were needed. A follow-up colonoscopy one year later was normal.

“Because the patient had a routine physical and an appropriate screening test was performed followed by colonoscopy, the patient was diagnosed at an early stage and was cured of colon cancer,” Dr. Lunt says.

B.M. is a young 44-year-old, very active and healthy male who for the last year was having very mild, vague abdominal pain and bloating. He saw his family physician, who set him up for a colonoscopy. The patient was actually getting better and his symptoms were improving; he almost cancelled the procedure but decided to proceed because it had already been scheduled. At the time of the exam he was having no symptoms. During the procedure, a large colon cancer was detected. He had a resection and follow-up chemotherapy; one year later, his colonoscopy was normal.

“Neither of these patients had a family history of colon cancer,” Dr. Lunt says. Because of appropriate colon cancer screening, both are alive today.

For more information about colonoscopy, visit http://www.agcosprings.com