Catching Colon Cancer Early

Experts say it can be beaten if detected soon enough

TUESDAY, March 9, 2004 (HealthDayNews) -- Over the years, a multitude of medical studies have focused on how to reduce the risk of colon cancer, which will kill nearly 57,000 Americans this year.

Some have shown a diet rich in fruits, vegetables and fiber might improve your odds against getting the disease.

"But the biggest thing people can do to reduce risk is to be screened. It's critical," says Dr. David A. Johnson, chief of gastroenterology at the Eastern Virginia School of Medicine in Norfolk.

Given that March is National Colorectal Cancer Awareness Month, now could be a good time to look into screening.

Early detection makes the difference in the outcome of colorectal cancer, according to the American Cancer Society. When the cancer is detected in a localized state, the five-year relative survival rate is 90 percent. But only 38 percent of colorectal cancers are discovered that quickly. If more people took screening seriously, experts say, that number would no doubt improve.

Toward that end, stricter guidelines on colorectal cancer screening were issued by the U.S. Multi-Society Task Force on Colorectal Cancer in 2003. The new recommendations suggest that before deciding how a person should be screened, a doctor first needs to classify the person's level of risk, based on family history of the disease.

It's very crucial to know your risk, agrees Dr. Dennis Ahnen, a gastroenterologist and staff physician at the Denver VA Medical Center.

Anyone with a family history or a personal history of colon cancer or polyps, which can precede cancer, is high risk, he says. "If you have a single first-degree relative [such as a father or brother] with colon cancer at a young age, under 50, or more than one first-degree relative with colon cancer at any age, that is a strong family history."

Those people should begin screening at age 40, or 10 years before the age at which the earliest colon cancer in the family occurred, Ahnen says.

Intermediate risk describes someone who has one family member with colon cancer that occurred after age 50, Ahnen says, although some experts say over age 60. For these, screening should start at age 40.

People who have no family or personal history of cancer or polyps and no gastrointestinal diseases such as ulcerative colitis have an average risk, and they should start screening for cancer and polyps beginning at age 50.

Next is to decide, with your doctor, the best options. Among them are colonoscopy, sigmoidoscopy, fecal occult blood testing and double-contrast barium enema.

Colonoscopy involves the insertion of a long, flexible tube with a camera mounted on the end, up through the rectum and into the colon. The pictures taken by the camera are transmitted to a monitor.

A flexible tube is also inserted for sigmoidoscopy, but the viewing area is limited to a smaller part of the intestine -- the sigmoid, or descending colon only. Occult blood testing analyzes stool samples for blood, which can be a symptom of cancer. Double-contrast barium enema is a radiological test in which a liquid is inserted into the rectum to better show the image of the GI tract on an X-ray.

Although the official guidelines offer an array of options, many experts say colonoscopy is the preferred test.

"Push as hard as you can for the best test, which is a colonoscopy," Johnson says. Task force guidelines suggest colonoscopies be repeated every 10 years if they are normal, and sigmoidoscopies should be repeated every five if they are normal. Barium enemas should be repeated every five years if normal and occult blood testing is advised annually.

In the future, "virtual" colonoscopies, which are less invasive than traditional colonoscopies, may become more common, Ahnen says. They use computer-assisted tomography to survey the colon from outside the body.

No matter which test you choose, experts say rectal bleeding, blood in the stool, a change in bowel habits and cramping pain in the lower abdomen are all signs to get medical attention as soon as possible.

More information

For five colorectal cancer prevention tips, see the American College of Gastroenterology. For more information on the revised guidelines, check the American Gastroenterological Association.

SOURCES: Dennis Ahnen, M.D., gastroenterologist, staff physician, Denver VA Medical Center, and professor, medicine, University of Colorado School of Medicine, Denver; David A. Johnson, M.D., professor, medicine, chief, gastroenterology, Eastern Virginia School of Medicine, Norfolk, and secretary, American College of Gastroenterology
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