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Published on March 19, 2018

A day of inconvenience to prevent colon cancerA day of inconvenience to prevent colon cancer

March is National Colorectal Cancer Awareness Month. Have you and those you care about over the age of 50 undergone the appropriate screening?

Colon cancer is another disease that has been recognized for many millennia. Evidence going back 4,000 years exists showing the disease was treated with herbs in ancient China. The Greeks used olive oil as a preventive cleansing agent and, in India, mustard was used to treat the symptoms of colon cancer.

With the dawn of the 20th century came greater understanding of the disease. In 1896, the association with polyps was first described. Hereditary relationships were described in 1913 and in 1925, separate researchers described relationships between inflammatory bowel disease and ulcerative colitis and colorectal cancers. Genetic testing for some hereditary causes became available during the 1990s.

Recent data shows that from 1975 through the mid-1980s, the incidence of colorectal cancer increased, but since then incidence has been declining. Despite that, it was expected that in 2017 more than 135,000 new cases of colorectal cancer would be diagnosed. As of January 2016, there were almost 1.5 million Americans living who had a history of colorectal cancer – some of these cases had been “cured,” while others were undergoing treatment.

The split between men and women is almost equal. During an average lifetime, the risk of a male being diagnosed with this cancer is 4.6 percent; a female 4.2 percent. As with many cancers in which heredity plays a role, lifestyle also has significant influence. Obesity, consumption of alcohol, processed meats and red meat, as well as smoking, are all known to significantly increase risk. As with many diseases, physical activity has a protective effect.

The period since 2000 has ushered in an acceleration in the rate of decline of the incidence of colorectal cancer, which is felt to be primarily the result of the increase in screening procedures and the removal of polyps prior to them becoming cancerous (so why are you putting off being screened?).

There are several commonly recommended screening tests available, and you should discuss with your primary care physician which is the best choice for you. You should be aware that a family history of colon cancer or polyps may result in the recommendation for earlier or more frequent screening.

Colonoscopy allows the physician to examine the rectum and the entire colon. It allows biopsies and removal of polyps to occur immediately. By the way, you sleep through it!

Sigmoidoscopy allows for direct examination also, but only of the rectum and colon on the left side of your body, leaving another half of the large bowel unseen. For this reason many consider it a less palatable screening option.

CT colonoscopy is a radiologic imaging study requiring the same prep as colonoscopy without the ability to biopsy abnormalities.

Since I have raised the prep, let’s talk a minute about that now. Many people complain that the prep is awful and may procrastinate as a result of that. I can tell you from personal experience (I just successfully passed my third colonoscopy) that although the clear liquid diet the day before wasn’t fun and the prep that cleared my colon beginning at 6 p.m. the day before gave me more bathroom reading time than I would prefer, they are not a reason to avoid screening. A day of inconvenience trumps a diagnosis of cancer in my book, does it not in yours?

To be complete, there are further screening strategies that may be chosen: guaiac-based fecal occult blood test (gFOBT) which is stool testing for blood (sometimes combined with sigmoidoscopy), fecal immunochemical test (FIT), which uses antibodies to detect blood in the stool, and FIT-DNA testing which combines the FIT with a test that detects altered DNA. I will freely share that in my book colonoscopy done on a schedule based upon your risks and the findings of prior exams is the only choice I have made for myself.

For those of you still avoiding screening, what are the symptoms of colorectal cancer?

  • Weakness, excessive fatigue and sometimes shortness of breath
  • Rectal bleeding
  • Blood in stool or toilet water after having a bowel movement
  • Dark or black stools
  • A change in bowel habits or stool diameter
  • Lower abdominal cramping and discomfort
  • Urge for a bowel movement without stool resulting
  • Constipation or diarrhea lasting more than a few days
  • Diminished appetite
  • Unintended weight loss

While we have come a long way in our ability to treat cancer and, as mentioned earlier, there are now a remarkable number of Americans who are survivors of this diagnosis, who wants to see whether or not you might be a survivor? In 2018, being over 50 and not having colorectal cancer screening is like getting behind the wheel of your car and not putting on your seatbelt. Why would you do that?