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Colonoscopy Promoted During Colorectal Cancer Awareness Month

Breaking News - March 2006 - Week 4

(Mar 22, 2006)

Healthcare in  the News

-- March is National Colorectal Cancer Awareness Month, and the American Cancer Society (ACS) wants to remind Americans that the disease is the third third leading cause of cancer deaths - and is largely preventable.

Picture of a female and male physician

Experts say colon cancer is one of the most preventable forms of cancer - if you take the right steps.

But those steps may not be what you think.

For example, a diet rich in fiber was long considered a sure-fire way to help protect against the disease.

But, a recent review of 13 studies in the Journal of the American Medical Association (JAMA) found fiber offered no overall protective effect when all risk factors were taken into account.

So what should you do? That is the answer doctors are looking to share during National Colorectal Cancer Awareness Month. And that answer, in a word, is colonoscopy.

The Importance of Testing

Colorectal malignancies account for 10 percent of all US cancer cases, the ACS notes.About 55,000 Americans will die of the disease this year. That death toll could be cut in half if people followed the ACS's testing recommendations for colorectal cancer.

Testing is critical, because early colorectal cancer often has no symptoms. Testing is especially important for people aged 50 and older because they account for more than 90 percent of colorectal cancer cases.

When detected at an early stage, patients with colorectal tumors have a 90 percent survival rate. Unfortunately, low screening rates mean that just 39 percent of these cancers are diagnosed at an early stage.

"Many people 50 and older do not know they are at risk and that they need to be screened," says Dr. Carolyn D. Runowicz, national volunteer president of the ACS.

"If we can increase awareness and compliance to the level we've achieved with the Pap test and the mammogram, we will have a tremendous opportunity to save thousands of lives through prevention and early detection of colon cancer," she says.

Colonoscopy is the "Gold Standard"

According to Dr. Blair Lewis, a professor of medicine at Mount Sinai School of Medicine in New York City, there is a way to avoid colon cancer that has already proven itself the gold standard - regular colonoscopy screenings after age 50.

"Sometimes we can miss the forest for the trees," says Dr. Lewis, who is also a spokesman for the American Society for Gastrointestinal Endoscopy.

"We talk about fiber, when we really should be talking about everyone being checked for colon polyps. There's no other malignancy that has a benign, removable precursor. It's that simple," Dr. Lewis adds.

Polyps are benign growths on the wall of the colon or rectum. They are common in people over age 50, and are believed to lead to colorectal cancer.

A colonoscopy utilizes a tiny camera inside a slender tube that is inserted through the rectum. The procedure lets doctors look for early signs of cancer inside the entire large intestine, from the rectum all the way through the colon to the lower end of the small intestine.

Even better, if a polyp is found during a colonoscopy, the physician can remove the polyp, eliminating the cancer threat on the spot.

Doctors estimate that about 64 percent more Americans should be getting screened with colonoscopy than are currently being screened.

"The numbers really are quite shocking," Dr. Lewis says. "The big reason that comes back is embarrassment. It's a horrible thing to die of embarrassment. It's just not appropriate. People should get checked."

Fiber's Role, Other Prevention Strategies Uncertain

Some people who want to avoid colon cancer but do not want to endure a colonoscopy often pursue a number of lifestyle strategies, says Dr. David Lieberman, chief of gastroenterology at the Oregon Health and Science University Hospital in Portland.

While these changes in diet and exercise are all good and will benefit the body overall, there is not a lot of evidence directly linking them to colon cancer prevention, he says.

Fiber seemed a winner early on. First reviews of data found a 16 percent lower incidence of colon cancer in the 20 percent of people with the highest fiber intake, according to the JAMA review.

But then researchers began compensating for other risk factors - such as multivitamin use, red meat consumption, milk and alcohol intake - and the perceived benefits of fiber disappeared.

"I think it shows how complicated it is to quantify fiber as a risk factor for colon cancer," Dr. Lieberman says. "Fiber comes in very different forms, and it often comes in forms that include other factors that could impact your risk.

However, Dr. Lieberman still recommends lifestyle changes to fight colon cancer.

He urges his patients to reduce their alcohol intake if they are heavy drinkers, exercise at least several times a week, lower the amount of animal fat in their diet, and take a multivitamin to make sure they are getting the right amounts of calcium, vitamin D, folic acid, and other important vitamins and micronutrients.

Dr. Lieberman also recommends a high-fiber diet, despite the recent JAMA study results.

"There's some compelling evidence that it probably plays some role in combination with other factors in fighting colorectal cancer," he says.

"There are other benefits of fiber rather than just the colon. There's evidence it may be beneficial in managing cardiovascular disease, hypertension, and constipation," adds Dr. Lieberman.

"I recommend pretty much what the [US] Food and Drug Administration's (FDA) guidelines recommend - seven servings a day of fruits and vegetables, and whole grains. Can I prove that's necessarily going to reduce their risk of colon cancer? No. But I think it may reduce the risk overall," Dr. Lieberman says.

Always consult your physician for more information.

For more information on health and wellness, please visit health information modules on this Web site.

More About Colorectal Cancer

Colorectal cancer is cancer found in the colon or rectum. The colon and the rectum are part of the large intestine, which is part of the digestive system.

Because colon cancer and rectal cancers have many features in common, they are sometimes referred to together as colorectal cancer.

Cancerous tumors found in the colon or rectum also may spread to other parts of the body.

Colorectal cancer is the second most common cancer in both men and women. It is estimated by the American Cancer Society that 148,610 of colorectal cancer caseswill be diagnosedin 2006.

However, the number of deaths due to colorectal cancer has decreased, which is attributed to increased screening and polyp removal.

Risk factors for colorectal cancer:

Risk factors may include:

  • age
    Most people who have colorectal cancer are over age 50, however, it can occur at any age.
  • diet
    Colorectal cancer is often associated with a diet high in fat and calories, and low in fiber.
  • polyps
    Benign growths on the wall of the colon or rectum are common in people over age 50, and are believed to lead to colorectal cancer.
  • personal history
    People who have had colorectal cancer, as well as ovarian, uterine, or breast cancers, have a slightly increased risk for colorectal cancer.
  • family history
    People with a strong family history of colorectal cancer or polyps in a first-degree relative (in a parent or sibling before the age of 60 or in two first-degree relatives of any age), have an increased risk for colorectal cancer.
  • ulcerative colitis
    People who have ulcerative colitis, an inflamed lining of the colon, have an increased risk for colorectal cancer.
  • physical inactivity
  • high-fat and/or low-fiber diet
  • alcohol consumption
  • diabetes
  • working night shifts

Symptoms of colorectal cancer:

The following are the most common symptoms of colorectal cancer. However, each individual may experience symptoms differently.

People who have any of the following symptoms should check with their physicians, especially if they are over 50 years old or have a personal or family history of the disease:

  • a change in bowel habits such as diarrhea, constipation, or narrowing of the stool that lasts for more than a few days
  • rectal bleeding or blood in the stool
  • cramping or gnawing stomach pain
  • decreased appetite
  • vomiting
  • weakness and fatigue
  • jaundice - yellowing of the skin and eyes

The symptoms of colorectal cancer may resemble other conditions, such as infections, hemorrhoids, and inflammatory bowel disease.

It is also possible to have colon cancer and not have any symptoms. Always consult your physician for a diagnosis.

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