Colorectal cancer is second only to lung cancer as the leading cause of death in men and women in Rhode Island. We can effectively prevent 90% of the lung cancer deaths with appropriate tobacco control measures (including secondhand smoke). We can substantially reduce the burden of colorectal cancer by regular screening for colorectal cancer and preventive measures, all of which are available to everyone.

Although the incidence of colorectal cancer is only slightly above the national average in Rhode Island, the death rate is 26% higher in Rhode Island than in the national average for this disease. The reasons for this can be attributed to the lifestyle in Rhode Island and the lack of regular colorectal cancer screening. A healthy diet consisting of fruits and vegetables, cereals and other natural grain foods with low fat and red meat, moderate alcohol consumption and regular exercise are associated with a lower incidence of colorectal cancer. Very few Rhode Islanders can say that they adhere to this healthy lifestyle on a regular basis.

Less than 50% of the people in Rhode Island over the age of 50 had ever had any test for colorectal cancer at any time. These tests include FECAL OCCULT BLOOD TEST, a relatively simple procedure where a sample of stool is placed on a small card and then tested by a physician for the presence or absence of blood; SIGMOIDOSCOPY, an office procedure that examines the left half of the colon and all of the rectum; and COLONOSCOPY, which is a procedure that is performed in a special endoscopy suite, usually requires some light anesthesia and examines the entire colon on the right and left side and the rectum. A fourth procedure, double contrast barium enema, is usually reserved for those individuals who for one reason or another cannot tolerate colonoscopy.

Some people are at high risk for colon cancer and need to initiate their screening before the age of 50 and have it performed on a regular basis. These individuals have a history of colorectal cancer in their family: a parent, sibling, grandparent, with known colorectal cancer – these are considered at higher risk. Even higher risk are individuals with a family history of polyposis, where literally thousands of small polyps develop in the colon and rectum. Also at high risk are individuals with a history of longstanding inflammatory bowel disease, and Crohn's Disease. Individuals who fall into this high-risk category should start their screening earlier than age 50. For standard risk individuals (everyone else), screening should start at age 50 and be repeated on a regular basis thereafter.

Screening can reduce the problem of colorectal cancer substantially. If, on examination, a pre-cancerous polyp is found and removed, that lesion never progresses to form a cancer. The “dwell time” of a polyp before it transforms into a cancer may be anywhere from 5 to 10 years. Thus, by regular screening, pre-cancerous lesions can be detected and removed. Colorectal cancer will never occur in that individual. Thus, we can essentially eradicate this disease by regular screening for pre-cancerous lesions.

In Rhode Island, all insurance carriers cover colorectal screening “if medically indicated,” i.e. if your primary care provider or other doctor orders it.

Preventive measures are also available. We know that a healthy diet, regular exercise and alcohol in moderation are associated with reduced colorectal cancer risk. In addition, an aspirin a day (in individuals who can tolerate aspirin without risk of gastrointestinal bleeding) reduces the number of polyps that can be found in an individual. Aspirin works through a special enzyme system called “Cox-2” which is associated with polyp growth. Aspirin inhibits this enzyme system. Newer Cox-2 inhibitors have been developed for people with arthritis: Celebrex and Vioxx. These are currently being tested to determine whether they have the same ability to inhibit polyp formation and growth as aspirin has been shown to have.

A diet rich in calcium or adding calcium supplements have also been found to inhibit polyp growth. The use of a calcium supplement of approximately 500 mg. per day may be useful in this regard. Other food supplements and vitamins have not been rigorously tested. They may be helpful but some may be useless.

Thus, with a healthy diet, exercise, moderate alcohol, and the addition of an aspirin, calcium supplement, plus regular screening, we can make colorectal cancer history.

For more information and answers to specific questions contact the Rhode Island Cancer Council at info@ricancercouncil.org or call us at (401) 728-4800 or toll free 866-879-4100.

IT IS EASIER TO PREVENT CANCER THAN TO TREAT IT.

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