Cancer by Gillian Friedman, M.D.
Colorectal Cancer (which includes cancers of the colon, rectum and appendix,
as well as some anal cancers) is the second leading cancer killer in the
United States annually, trailing only lung cancer. It is the third most
diagnosed cancer in the U.S. and Canada (after lung and breast in women,
and lung and prostate in men). The American Cancer Society estimates that
146,940 cases of colorectal cancer (CRC) will be diagnosed in the U.S.
this year, and 56,730 deaths will occur.
Despite its high incidence, colorectal cancer is one of the most detectable
cancers, and if found early enough one of the most treatable. More than
90 percent of those diagnosed while the cancer is still localized survive
more than five years. Currently, however, only 37 percent of colorectal
cancers are detected in this early stage. The Harvard Center for Cancer
Prevention recently reported that regular screening, combined with a healthy
lifestyle, could prevent more than half of all U.S. colon cancer deaths.
Primary prevention through polypectomy, or the removal of polyps, substantially
reduces the risk of developing colorectal cancer.
The most common symptom of colorectal cancer is to have no symptoms at
all. Nonetheless, people should pay attention to possible signs such as
changes in bowel habits; diarrhea or constipation; narrower than normal
stools; unexplained weight loss or anemia; constant tiredness; blood in
the stool; a feeling that the bowel does not empty completely; or abdominal
discomfort such as gas, bloating, fullness, cramps or vomiting. If you
experience any of these symptoms for more than a few days, talk to your
doctor to determine the cause. Understand that at this point you are diagnosing
an active condition and no longer screening. If symptoms persist, insist
on getting a colonoscopy.
Colorectal cancer is a slow-growing cancer that can take up to ten years
to develop, leaving a generous window of opportunity for screening. Screening
for colorectal cancer works in two ways—first, it identifies asymptomatic
cancers early when treatment is most effective, and second, it locates
growths (polyps) inside the colon that can be removed before they become
cancer. Experts differ about which screening tests should be used and
how often adults without known risk factors for colorectal cancer should
be tested. However, all professional guidelines emphasize the importance
of a regular screening program for all adults over age 50 and others at
risk that includes annual fecal occult blood tests (FOBT), periodic partial-
or full-colon exams, or both. Leaders in the field have estimated that
widespread adoption of these screening practices could save as many as
30,000 lives each year. That’s more than 50 percent of the colorectal
cancer deaths expected this year.
Unfortunately, screening rates are low. In a recent survey of Americans
over age 50 conducted by the Centers for Disease Control (CDC), only 40
percent of respondents had ever had an FOBT (the take-home stool-card
test) and only 42 percent had undergone a flexible sigmoidoscopy (a visual
examination of the last part of the colon, where the majority of cancers
occur). By contrast, 85 percent of women had been screened for breast
If screening works, why aren’t more people doing it? Screening rates
are influenced by many factors, not least of which are lack of public
awareness about colorectal cancer and the benefits of regular screening;
inconsistent promotion of screening by medical providers; widespread limitations
on insurance coverage for preventive health practices; negative attitudes
about the screening procedures; and absence of social support for openly
discussing and doing something about the disease down there.
If none of your relatives had CRC, the recommended age to start screening
is 50. If you don’t know if your relatives had CRC, ask. Find out,
and take the answer to your doctor to develop a screening plan that’s
right for you. Knowing your family history and getting the appropriate
screening could save your life. If CRC occurred in one first degree relative
(a parent, sibling or child), or in two or more second degree relatives
(aunts, uncles or grandparents), screening should start at age 40, or
ten years before the age when your relative was diagnosed. If you have
a history of inflammatory bowel conditions like ulcerative colitis or
Crohn’s disease, or have abdominal or intestinal polyps, you may
be at higher risk for CRC and should talk with your doctor about an appropriate
screening strategy. Women have a higher incidence of cancers of the right
side of the colon, which a flexible sigmoidoscopy won’t visualize.
Thus, some authorities recommend that women in particular should have
The Colon Cancer Alliance offers patient support, education, research
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Other articles in the Kevin Richardson issue include— Volunteerism
and Sean Astin, Awards/Galas—New Ability Awards & Western Law
Center, Picture Perfect Kids, Marilyn Bartlett and the ADA, Seeing in
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