by Stewart B.Segal, MD
PREVENTION – COLON CANCER
As many of you know, I have a family history of colon cancer. Colon cancer is cancer of the large intestine (colon), the lower part of your digestive system. Rectal cancer is cancer of the last several inches of the colon. Together, they’re often referred to as colorectal cancers. There were 102,900 new cases of colon cancer diagnosed in the U.S. in 2010 and 39,670 cases of rectal cancer. In 2010, 51,370 Americans died from colorectal cancer. An individual with an average risk profile for colon cancer has a six percent risk of developing colon cancer during his lifetime. While six percent doe not sound high, if you had a six percent chance of winning the Mega Millions lottery, you would be purchasing tickets right now.
According to Mayo Clinic’s website, risk factors for colon cancer include:
- Older age. About 90 percent of people diagnosed with colon cancer are older than 50. Colon cancer can occur in younger people, but it occurs much less frequently.
- African-American race. African-Americans have a greater risk of colon cancer than do people of other races.
- A personal history of colorectal cancer or polyps. If you’ve already had colon cancer or adenomatous polyps, you have a greater risk of colon cancer in the future.
- Inflammatory intestinal conditions. Long-standing inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can increase your risk of colon cancer.
- Inherited syndromes that increase colon cancer risk. Genetic syndromes passed through generations of your family can increase your risk of colon cancer. These syndromes include familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer, which is also known as Lynch syndrome.
- Family history of colon cancer and colon polyps. You’re more likely to develop colon cancer if you have a parent, sibling or child with the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater. In some cases, this connection may not be hereditary or genetic. Instead, cancers within the same family may result from shared exposure to an environmental carcinogen or from diet or lifestyle factors.
- Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meats.
- A sedentary lifestyle. If you’re inactive, you’re more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer.
- Diabetes. People with diabetes and insulin resistance may have an increased risk of colon cancer.
- Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.
- Smoking. People who smoke cigarettes may have an increased risk of colon cancer.
- Alcohol. Heavy use of alcohol may increase your risk of colon cancer.
- Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colon cancer.
Screening for colon cancer should include digital rectal exam, fecal occult blood testing, a complete blood count, colonoscopy and virtual colonoscopy. The goal of screening is to prevent colon cancer by identifying its precursors and removing them or to lessen the impact of colon cancer through early diagnosis and treatment.
Digital rectal exams with fecal occult blood testing (chemical test for hidden blood) and blood counts should begin at the age of 40 and occur yearly. In the past, I recommended a flexisigmoidoscopy (short scope done in office) at the age of 50. Fifty percent of colon cancers occur in the upper bowel, out of the reach of the flexisigmoidocope. Due to its “short comings”, I now recommend a full colonoscopy for all patients 50 years old or older. Naturally, if you have seen any blood in your stool or on your toilet paper, you should report this finding to your doctor.
Virtual colonoscopy is a fairly new diagnostic tool. While it is likely to be as good as a full colonoscopy for diagnosis of polyps and cancer, it does not allow for treatment. During a colonoscopy, the gastroenterologist can biopsy or remove any abnormal tissue leading to a diagnosis and/or cure.
Depending on your family and personal history and findings at the time of your colonoscopy, repeat exams will be done every 1 – 10 years.
Please see your doctor and discuss the details of cancer screening with him. The life you save may be your own.