By By Dr. Joel T. Callahan/Special to The Star
March 26, 2001
This month is Colon Cancer Awareness Month, and there has been a fair amount of media exposure about the high incidence of colon cancer in the United States.
Awareness has been increased by such celebrities as Katie Couric. If we can make the general public aware of colon cancer and, therefore, increase incidence of screening for colon cancer, we should markedly decrease the death rate from this horrible disease.
Colon cancer affects about 140,000 people a year in the United States, and about 60,000 people a year will die from colon cancer and its complications. It is one of the leading causes of cancer death in this country. Over a lifetime, about 5 percent of women and about 6 percent of men will develop this disease.
There is a greater risk of developing colon cancer if there is a family history of colon cancer or colon polyps. This is especially true if this has occurred in more than one family member or if the cancer occurred before the age of 50.
The vast majority of colon cancers arise from small wart-like tumors called colon polyps. Over a period of years, a colon polyp will grow and may develop into colon cancer. A small polyp, about the size of a wart, is rarely malignant. However, a polyp that has reached the size of a pecan or larger has a much higher incidence of malignancy.
With advancing age, especially after the age of 50, there is an increasing incidence of developing colon polyps or colon cancer.
Some of the common signs of colon cancer are: a change in bowel habits, such as alternating diarrhea and constipation, a sensation of incomplete emptying of the bowels, seeing or chemically detecting blood in the stool and a change in shape of the bowel movements.
Various abdominal discomforts, such as abdominal pain, cramping, weight loss, nausea, vomiting and fatigue can also be symptoms of colon cancer. Pallor anemia often suggests colon cancer in the right colon.
In the year 2001, the best way to decrease the death rate from colon cancer is to increase screening tests in high risk patients. Patients with a previous history of having had colon cancer or colon polyps, a family history of colon cancer or colon polyps or a history of ulcerative colitis all have an increased risk of developing colon cancer. People age 50 and older have an increased risk of developing colon cancer.
Several screening tests are available to try to detect colon cancer or colon polyps. In this area, the most commonly employed test would be a digital examination of the rectum, chemical analysis of stool for detection of blood, a limited procedure called fibrosigmoidoscopy, or a colonoscopy.
The colonoscopy is the "gold standard test" with the highest accuracy rate. It affords an examination of the entire colon with the capability to remove polyps or biopsy suspicious areas. The theory is that if a physician finds a polyp and removes it, that potential cancer has been prevented from developing.
Of course, if a person has had one polyp, they may develop other polyps over a period of years. The cure rate for colon caner is extremely good if the cancer can be detected at an early stage. However, in late stages, the cure rate if significantly reduced.
One may ask, "What can I do to prevent developing colon cancer?"
In general, it is thought that smoking, a diet high in fat, a sedentary lifestyle, obesity and heavy alcohol consumption all can play a role in increased incidence of colon cancer.
At first, we would say that all of these things should be avoided. A person should try to have a high fiber diet, avoid obesity, not smoke, not abuse alcohol excessively and get regular exercise. There is strong data to suggest that taking low dose aspirin on a regular basis after the age of 50 helps to reduce the incidence of colon polyps.
None of these things will prevent an individual from getting colon cancer, but adopting this lifestyle will help reduce a person's likelihood of developing this disease. Again, family history is very, very important.
If we can get the general public to practice good health habits and have periodic screening tests for colon cancer, then the death rate from colon cancer should be significantly reduced. We recommend screening colonoscopies for people who are in a high risk category or people having any suspicious colon symptoms.
This summer, Medicare will begin to allow screening colonoscopies to be done on people 65 years of age and older. High risk patients are already allowed by Medicare to have regular colonoscopies.
At the present time, the best way to decrease the death rate from colon cancer is by having screening colonoscopies with removal of all polyps or early detection of small colon cancers.
What the future holds, who knows? The development of genetic and DNA testing holds a lot of promise.
Joel T. Callahan, M.D. is a gastroenterologist who has been practicing in Meridian since 1969. He is a partner at Internal Medicine Clinic and East Mississippi Endoscopic Center, and an assistant professor of clinical medicine at University of Mississippi Medical School.