Article from BMH
for March 21, 2007
Brattleboro Reformer

Just Do It
by David Albright, M.D.

March is National Colon Cancer Awareness Month, designed to highlight the importance of early detection of colon cancer. Colorectal cancer is the 3rd most common cancer in both men & women, so this information is very important reading.

The mantra for many years in cancer medicine has been early diagnosis, early treatment, early cure. Unfortunately the nature of many types of cancers means that by the time they are diagnosed, often a cure is no longer possible. Colon cancer is the third most common cancer in this country and the second leading cause of cancer death. It accounts for 146,000 new cases of cancer each year, with 56,000 individuals dying as a result of colon/rectal cancer. Each individual has a risk of about 5-6% likelihood of developing colon/rectal cancer in the course of their life time.

Colon/rectal cancer has a well-known natural history. A cancer will almost always start as a tiny benign polyp and over a period of many years naturally grows and changes to become a malignant cancer. It is this long lag period between the start of the precancerous state of the polyp and the actual malignant transformation that allows for the opportunity of true prevention, early diagnosis, and cure.

There are a number of colon cancer risk factors including a family history of colon/rectal cancer or polyps, inflammatory bowel disease such as ulcerative colitis, a diet high in red meat, sedentary lifestyle, obesity, smoking, and/or excessive alcohol. Also, just being born in North America or Northern Europe seems to increase our risk. Factors which are thought to be protective include no family history of colon/rectal cancer, being born in Asia or Africa, a diet high in fruits and vegetables, regular exercise, and a diet rich in folic acid and calcium.

The good news is that cancer of the colon is one that can, in fact, be detected early, treated early and cured. Regular screening tests should start at age 50 unless there is a family history, in which case screening starts at age 40. Presently there are several methods of screening for colon/rectal cancer. The first and oldest is the use of fecal occult blood testing. Three separate samples of stool are collected over a course of several days. Unfortunately, large scale studies have indicated that this test decreases colon cancer mortality by only about 15-33%, even when done properly on a yearly basis as recommended. It does not detect polyps very well and there are also many false positives. The use of aspirin or a nonsteroidal anti-inflammatory drug such as Ibuprofen interferes with the test causing false positives, as does the use of Vitamin C. These things have to be avoided in the days prior to the actual collecting of the specimens. A false positive test on stool testing then requires that further evaluation be pursued, usually in the form of a colonoscopy.

The second method that has been widely used is a flexible sigmoidoscopy. This procedure can be done in the doctor’s office without sedation. It has been shown, if done on a regular basis every five years, to result in a decrease in mortality by 60-70%. Unfortunately, even combining stool tests with sigmoidoscopy leaves a one-in-five chance of undetected pathology. Advantages of flexible sigmoidoscopy are that it generally does not require sedation or taking the day off from work but, again, more than two-thirds of the colon goes unexamined.

The current gold standard for colon/rectal cancer screening and detection, and one of the most widely accepted, is colonoscopy. Studies indicate that it will detect 95% of polyps which can then, at that time, be removed via the colonoscope. Approximately 1% of individuals undergoing colonoscopy will be found to have a cancer. Colonoscopy, if entirely normal with no polyps found, needs to be repeated only once every ten years in average risk individuals.

People are frequently worried about the preparation for the usually painless colonoscopy. A vast majority of people prepare with low-volume laxatives combined with a clear liquid of their choice the day before the procedure. The big advantage of colonoscopy is that at the time of the procedure any polyps found can be removed, thereby preventing cancer from ever developing. Individuals who are found to have polyps will need to undergo more frequent screening depending on the nature of the polyp when examined under the microscope.

Colonoscopy does have some disadvantages, including the need for heavy sedation resulting in the need for somebody to accompany you home since you would not be allowed to drive immediately following it. You may miss an entire day of work as a result. Potential complications of colonoscopy include bleeding, perforation, and over-sedation. However, most physicians feel the benefits of colonoscopic screening far out- weigh the risk. There are special situations such as individuals with family histories positive for colon/rectal cancer in which screening may be started at a younger age and may require more frequent screening exams. These issues would need to be discussed with your own physician. Currently two physicians in Brattleboro do screening colonoscopies: gastroenterologist Dr. Jeffry Potash and Dr. Gregory Gadowski, general surgeon.

While colonoscopy is felt to be the gold standard, the future of screening may involve the ‘virtual colonoscopy’, a radiology test. However, data on accuracy is mixed and if any abnormalities are suspected, a colonoscopy would then be recommended. The most important thing is to undergo appropriate screening whether that be fecal occult blood testing on a yearly basis, flexible sigmoidoscopic exam every five years, or the colonoscopy every ten years once you reach the age of 50. Just be sure to do it at the correct time in your life.

Dr. Albright is an internist on the Brattleboro Memorial Hospital medical staff. The hospital will have materials including pins and a DVD (about colon cancer and the various screenings) available in the front lobby for the remainder of the month. BMH sponsors “For Your Health”.