Women and Colorectal Cancer

As Nancy Robison belatedly discovered, colon cancer can strike women, too.

So entrenched was her idea that only men tend to get colon cancer, that despite her training as a licensed practical nurse, Robison, 52, of Franklin, Pennsylvania, dismissed the possibility of colorectal cancer when she began experiencing rectal bleeding and other symptoms, which she attributed to hemorrhoids.

Six months later, in mid-1997, surgeons at the Cleveland Clinic removed two large tumors from her colon, or large intestine. "People think that because there's so much money behind breast cancer research and its talked about so much, that's the only cancer women die of," Robison says.

Third leading killer for women

In fact, colon cancer -- also known as colorectal cancer -- is the third leading cancer killer among women (behind lung and breast cancer, respectively) and affects both genders at virtually identical rates. About 142,000 new cases will be diagnosed and about 51,000 people are expected to die of the disease in 2010, according to the American Cancer Society.

For people over 50, screening would prevent at least a third of deaths from colon cancer. Still, screening rates remain stubbornly low. Between 2001 and 2008, the screening rate among US adults over 50 increased from 42.5 percent to 55 percent.

How did the myth about women and colorectal cancer take root? As Robison suggests, media neglect is one likely culprit.

Cancers that strike women exclusively -- ovarian, cervical, or endometrial cancer -- or nearly exclusively, such as breast cancer, have commanded much of the media spotlight over the years, says Dr. Amy Halverson, a colorectal surgeon at Northwestern Memorial Hospital in Chicago.

Yet, somewhat ironically, research shows that women with a history of ovarian or endometrial cancer, especially when it's diagnosed at an early age, are at increased risk of developing colon cancer, too -- perhaps, Halverson notes, because they have a genetic predisposition for malignancies.

It doesn't help that bowel function is an embarrassing topic -- one bordering on taboo for many people. Even if patients suspect something is wrong, they may be too embarrassed to mention it during a visit to the doctor, closing the door on early detection and treatment, says Bernard Levin, MD, chief of the Division of Cancer Prevention at the University of Texas Anderson Cancer Center in Houston.

A personal battle

One person who regrets letting shame get the upper hand is actress Barbara Barrie, a co-star of the former TV sitcom Suddenly Susan whose movie credits include Breaking Away and Judy Berlin. She wrote a book in 1999 titled Don't Die of Embarrassment that chronicles her battle with colorectal cancer. She won the battle with treatment that included a colostomy so she can manually discard wastes collected in an external pouch.

The disease caught up with Barrie in April 1994 after decades of rectal bleeding and denial on her part. Clinicians in those early years theorized at different times that she suffered from hemorrhoids, a fissure, nerves, and stress.

More recently, Barrie ignored a doctor's recommendation that she get a colon exam.

"How stupid was I?" she wrote in her book. "This delay had probably harmed me. So much for a college degree, a thousand years of psychoanalysis, health foods, high fiber, low fat, and 40 years of exercise programs. Dumb." Barrie subsequently learned from a cousin that colon cancer ran in the family, a hush-hush topic among her relatives up until then. She went on to endure two operations and the painful aftermath.

Jeanette Leathers, an interior designer in Alpharetta, Georgia, in her sixties, knew little if anything about colorectal cancer until her surgery for the disease, even though it had claimed the life of a friend's husband. Only after the operation, when she mentioned her personal struggle to others, did numerous people cite relatives or acquaintances who also had battled the disease.

During her chemotherapy, the vivacious Leathers managed to take care of her grandchildren, work part-time, and travel to Washington, D.C. for her sister's 50th wedding anniversary, where she danced and talked until midnight. Her cancer now appears to be in complete remission.

"There are a lot more people who have it than you would think," says Leathers, whose daughter had three precancerous polyps, or growths, removed from her colon at age 29.

On air colonoscopy

Medicine scored a coup against such secretiveness in March 2000 when Katie Couric, then co-anchor of the Today show and contributing anchor on Dateline NBC, underwent a colonoscopy on camera. Couric's husband died of colon cancer at age 42.

The broadcast had such an impact that the number of colonoscopies nationwide jumped nearly 20 percent in the subsequent 40 weeks, according to Dr. Peter Cram at the University of Michigan Health System, lead author of a study that looked at what has since come to be known as the "Couric Effect."

Early detection of colorectal cancer

There are few legitimate reasons these days for people 50 or older and with a family history of colorectal cancer not to undergo routine screening. A range of tests is available, and many insurers pick up the tab for one or more of these tests.

In March 2008, the American Cancer Society joined with other national health groups to issue the first-ever joint consensus guidelines for colorectal cancer screening. The groups recommend all men and women get screened beginning at age 50. In some situations, screening is recommended at an earlier age. These are usually cases in which there is a strong family history of colon cancer or in the cases of patients with certain diseases (inflammatory bowel disease, for example) that increase the risk of colorectal cancer.

The consensus guidelines divide screening tests into two groups - those that can detect polyps and cancer and those that only detect cancer - and note a preference for those that detect polyps, since they can be removed before cancer is present. The screening options include:

Tests that find polyps and cancer (preferred): flexible sigmoidoscopy or double contrast barium enema or CT colonography (virtual colonoscopy) every 5 years; or colonoscopy every 10 years. If an examination reveals polyps, they should be removed.

Tests that mainly find cancer: fecal occult blood test (FOBT) or fecal immunochemical test (FIT) every year; or stool DNA test (frequency undetermined).

Each test has its pros and cons in terms of effectiveness, cost, ease of use, invasiveness, and risk of complications, and individuals should discuss these with their doctors before deciding which test or tests to take. But the bottom line is that all of these tests are believed to be effective in saving lives when done at the recommended time intervals.

Meanwhile, there are other steps you can take to stay healthy:

  • Eat a healthy diet with an emphasis on plant sources. Eat 5 or more servings of fruits and vegetables each day, choose whole grains, and limit meat consumption.
  • Don't smoke.
  • Exercise regularly.
  • Some studies have shown that nonsteroidal anti-inflammatory drugs (such as ibuprofen) may be associated with reduced risk of colorectal cancer. However, because the risks of these drugs may outweigh the benefits, experts do not recommend that people with average risk of developing colorectal cancer take them as a prevention strategy.

The future is encouraging. Researchers continue to develop more patient-friendly screening techniques and health advocates continue chipping away at the embarrassment factor. Says Nancy Robison, "It shouldn't take a [colorectal cancer diagnosis] or the death of a family member to motivate others in the family to undergo screening."

References

Interview with Amy Halverson, MD, colorectal surgeon at Northwestern Memorial Hospital in Chicago.

Interview with Bernard Levin, MD, chief of the Division of Cancer Prevention at the University of Texas M.D. Anderson Cancer Center in Houston

Interview with Peter Cram at the University of Michigan Health System

Interview with Nancy Robison, a colorectal cancer patient from Franklin, Pennsylvania

Interview with Jeanette Leathers, interior designer and colorectal cancer patient from Alpharetta, Georgia

Interview with Barbara Barrie, actress and colorectal cancer patient

Barrie, Barbara. Don't Die of Embarrassment: Life After Colostomy and Other Adventures. Simon & Schuster. 1997.

National Cancer Institute. Prevention of colorectal cancer. July 30, 2010.

American Cancer Society. Cancer facts and figures.

Northwestern Memorial Hospital. Colorectal cancer awareness month is for women and men alike. March 2003.

Centers for Disease Control and Prevention. Colorectal cancer screening. January 2010.

Centers for Disease Control and Prevention. CDC study finds colorectal cancer screening rates remain low. May 2003.

Weinberg DS, et al. Risk for colorectal cancer after gynecologic cancer. Annals of Internal Medicine. August 1999. 131(3):189-93.

Cram P, et al. The impact of a celebrity promotional campaign on the use of colon cancer screenings: the Katie Couric effect. Archives of Internal Medicine. July 2003. 163(13):1601-5.

Centers for Disease Control and Prevention. Colorectal cancer: health professionals facts on screening. January 2010.

American Cancer Society. Can colorectal cancer be found early? January 2004.

American Cancer Society. Can colorectal cancer be prevented? August 2010.

American Cancer Society. Health groups issue updated colorectal cancer screening guidelines. March 5, 2008.

American Cancer Society. Should I be tested for colon and rectum cancer? August 2010.

National Cancer Institute. Colorectal Cancer Prevention (PDQ). Feb 29, 2008. August 2, 2010.

American Cancer Society. What are the key statistics about colorectal cancer? August 9, 2010.

American Medical Association. Colorectal cancer screening rates rising but still low. AMA News. March 1, 2010.

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