Screen to Survive
Forget the old adage: When it comes to colorectal health, what you don't know can hurt you.
By Stacey Stapleton

It’s not a popular topic of conversation at cocktail parties or around the dinner table, but perhaps it should be: The threat of colon cancer, especially to people over age 50, is a very real concern indeed. In fact, reports gastroenterologist Amber Khan, MD, colon cancer is the second leading cause of cancer deaths in the United States. The disease crosses all racial and ethnic lines, and 90 percent of colon cancer is found in people over the age of 50. And although a 2006 study in the New England Journal of Medicine found that men tend to develop the disease at a younger age, women are far from exempt; both genders are afflicted with colon cancer in equal numbers.

A Simple Screening Can Save Your Life
Colorectal cancer is a sneaky disease. It’s often called “the silent killer,” since it can be symptomless until it has progressed beyond the treatable stage. Television personality and news anchor Katie Couric became the “face” of prevention screening nearly a decade ago—even undergoing a colonoscopy live on the Today show—after her otherwise healthy and active husband, Jay Monahan, died from the disease at age 42. All physicians agree that the best way to safeguard your health—and perhaps your life—is to get screened for the disease. The Centers for Disease Control and Prevention estimates that approximately 60 percent of colorectal cancer deaths can be prevented if all men and women aged 50 or older were screened routinely. In fact, if you are diagnosed with colorectal cancer in its early stage, the five-year survival rate is over 90 percent. So forget the old adage: When it comes to colorectal health, what you don’t know can hurt you.

The American Cancer Society suggests that men and women with no family history of colorectal cancer get screened starting at age 50. Colon and rectal surgeon Debra Tarantino, MD, advises having a colonoscopy at age 50 and, if it’s clear, repeating the procedure every five years. “Colonoscopy is the best way to screen for colon cancer since, unlike other less-invasive screening methods, it is able to locate pre-cancerous polyps,” says Tarantino. “Your doctor can then remove them on the spot while you are still sedated and have them biopsied.” If large or multiple pre-cancerous polyps are found, your doctor may ask that you get screened again in two to three years.

People with a strong family history of colon cancer are encouraged to get screened at an even younger age. Tarantino advises her patients that they are of greater-than-average risk if they have one first-degree relative (such as a parent or sibling) who developed colon cancer before age 60, or two first-degree relatives who developed colon cancer at any age. In these cases, general guidelines suggest that you subtract ten years from the age your relative was first diagnosed and start screening then if possible. If your mother, for example, developed colon cancer at age 55, you would want to begin regular screenings at age 45.

In addition to family history, certain health and lifestyle factors may increase your risk of developing colon cancer. These include having conditions like ulcerative colitis or Crohn’s disease or a history of colorectal polyps, obesity, smoking, and physical inactivity. One perhaps surprising risk factor is a personal history of breast cancer. “I tell women who have been diagnosed with breast cancer to get a colonoscopy as well, just to be sure,” says Tarantino. She further advises that African-American men and women be particularly vigilant with their colorectal health, as they tend to develop colon cancer at a higher rate.

Of course, if you have any symptoms such as abdominal pain, rectal bleeding, or changes in bowel habits, you should consult your doctor immediately.

What is Colonoscopy?
A colonoscopy involves a doctor using a lighted scope to view the inside of your entire colon. The test takes 15 to 20 minutes and is performed under sedation. Preparing for the screening is easy and involves following a clear, liquid diet and using prescription laxatives to empty your bowels one day prior to the test. Although colonoscopy is painless, it (and its preparation) can be one of the more anxiety- provoking procedures. Khan reminds nervous patients to remember the purpose of colonoscopy. “If you focus on the bigger picture, which is saving yourself from one of the most prevalent cancers of the modern day, you will
do just fine,” she says.

Currently, there is an ongoing debate over how heavily patients should be sedated during colonoscopy. Tarantino, like many other gastro-intestinal specialists, prefers her patients be heavily sedated in what is known as “twilight sleep” and under the care of an anesthesiologist, but some insurance companies are reluctant to add this expense to an already costly procedure. “Under heavy sedation patients feel nothing and remember nothing and the physician can concentrate on the procedure rather than being distracted with monitoring a lightly sedated patient,” Tarantino explains. Patients under lighter levels of sedation are not at increased risk for complications but have reported mild cramping during the procedure. This can be minimized by taking several slow, deep breaths.

Recent Research and Developments
Even as you read this, research is being conducted on new ways to prevent, screen for, and treat colon cancer. In fact, the death rate from colon cancer has been dropping, and many physicians, like gastroenterologist John Franzese, MD, credit this good news to better screenings, early detection, and advances in treatment. “The screening initiative is catching polyps and finding tumors earlier,” he explains, “and so the death rate from colon cancer is dropping.” On the prevention front, Franzese mentions that researchers are studying the use of aspirin therapy for limiting polyp formation, as well as the ability to use minimally invasive genetic testing to evaluate a patient’s risk for developing colon cancer.

Studies have also led to new dietary recommendations for reducing cancer risk. “We’re finding that what we eat matters,” says Franzese. “Recent research has uncovered that a high-fiber diet, coupled with limiting your fat intake and your intake of cured and smoked meats, may help minimize the risk of developing colon cancer.” In a promising study from Harvard Medical School, it was discovered that women with higher levels of vitamin B6, whether from food or from supplements, might be less likely to develop colon cancer.

If some of what you’ve read here leaves you frightened about your risk for developing colon cancer, that’s not necessarily a bad thing. Fear can be a powerful motivator that forces us to make such positive lifestyle changes as quitting smoking, altering our diets—or picking up the phone to schedule a colonoscopy if you haven’t already done so. In spite of the fear that colon cancer inspires, it is largely a preventable disease. Having regular colonoscopies is your best line of defense—and the possibly one of the best ways to save your life.