Greetings Southwest Health District!

Did you know that March is Colorectal Cancer Awareness Month? As this month comes to a close I’d be remiss if I did not seize this opportunity to encourage each of you to take preventive measures to maintain your colonic health.

Colon cancer is the third leading cause of cancer and the second leading cause of cancer deaths in the United States. It affects both of the sexes, most commonly those over 50. Additionally, individuals with inflammatory bowel disease; a personal history of polyps or colon, breast, ovarian, and uterine cancer; and those with a close family member (mother, father, brother, sister, or child) with colon cancer are at an increased risk of colon cancer.

 Colon cancer affects the large intestines and rectum and usually begins as a precancerous asymptomatic polyp. Polyps are abnormal growths that can gradually change over time and become cancerous- this process can take up to ten years.  Because of this lengthy window of opportunity to remove polyps before the progression to invasive cancer, screening definitely saves lives. When colorectal cancer is detected early the five year survival rate is 90%. Unfortunately less than 40 % of colon cancers are detected early, because screening rates are low.

 The symptoms of colon cancer are blood in or on the stool, stomach pains, a narrowing of the caliber of stool, and unexplained weight loss. Any of these symptoms should be reported to a physician and warrants further diagnostic work-up.

There are two ways to lower risk of colon cancer- prevention and screening.

Preventive actions include:

• Eating five or more servings of fruits and vegetables daily
• Consuming a diet low in fat and high in whole grains
• Drinking alcohol only in moderation
• Avoiding tobacco
• Getting folate into your diet by either eating green leafy vegetables or taking a folic acid supplement
• Taking a baby aspirin a day if there is no medical contraindication
• Taking advantage of your  wellness breaks and exercise at least four days per week

Sound vaguely familiar- many of these are the same recommendations for wellness you’ve heard about in our Hooked on Health campaign.

Individuals 50 or older or 40 with risk factors should be screened regularly for colon cancer.

Screening should include at least one of the following:

• Fecal occult blood test (FOBT) is done at home with three stool sample cards. Stool samples are collected on three different occasions after a special diet. The cards are returned to your health provider to test for occult (hidden) blood in the stool.  A U. S. clinical trial reported a 33% reduction in colorectal cancer deaths and a 20% reduction in colon cancer incidence among people offered an annual FOBT. This is a significant reduction despite the fact that many polyps and/or cancers may not bleed initially, which is an unavoidable limitation of the FOBT. The FOBT is recommended annually.

• Flexible sigmoidoscopy is done by a physician. The physician inserts a thin flexible lighted tube into the rectum and moves it up to visualize the lower third of the colon to check for polyps and/or cancer. Since cancers and polyps in the upper colon will be missed with this screening modality, it is best to screen every five years via sigmoidoscopy in addition to an annual FOBT.

• Colonoscopy is similar to sigmoidoscopy, however the scope is longer and the entire colon can be visualized. In my opinion, colonoscopy is the best colon cancer screening tool that we have at this time because most cancers and polyps are seen and many polyps can be removed during the procedure as well. A normal colonoscopy should be repeated every ten years.

• Double contrast barium enema is given in the radiology area of the hospital. An enema is given with a liquid dye and X-rays are taken to view the dye’s outline of the colon. The limitations of barium enema are small polyps and cancers may not be readily detectable and polyps can not be removed during the procedure as with the sigmoidoscopy or colonoscopy.

Adequate preventive measures coupled with an increase in screening have reduced the burden of colon cancer in this country, but there is still room for improvement.

So, if you are due for colorectal cancer screening because of your age or other risk factors don’t put it off any longer. Take charge of your health and call your healthcare provider to set up your appointment for the colorectal cancer screening test of your choice.  Claim your Hooked on Health points for being screened!  Let’s also try to make a serious effort to practice as many of the preventive measures as possible to preserve our colonic health. After all, an ounce of prevention is worth a pound of cure.

Jacqueline H. Grant, MD, MPH, MPA

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