Colorectal cancer is the second leading cause of cancer deaths in the United States and Rhode Island after lung cancer. There are excellent screening procedures which can either prevent colorectal cancer by discovering a pre-malignant, pre-invasive polyp and removing it or by discovering an early, small, malignant lesion, easily removed and over 90% curable. The tragedy is that over 50% of the people in Rhode Island have never had any test for colorectal cancer.

Actually, there are four tests, which are useful for colorectal screening. The simplest, most easily performed, is called "fecal occult blood test" (FOBT). This test can be done at the time of an annual physical examination, or a physician can give the patient two or three cards to take home with instructions on how to provide a small specimen of feces and return it to the doctor's office for analysis. This procedure can detect any blood in the stool. Its major drawback is that it is not terribly accurate. Even so, annual FOBTs can reduce cancer of colon deaths by 23%.

The second test that is available is "sigmoidoscopy." A physician inserts a flexible fiber optic device through the rectum, and can examine about a third of the distal end of the colon and all of the rectum. Using a combination of FOBT and sigmoidoscopy, performed on a regular basis, can reduce deaths from colorectal cancer by over 50%.

The gold standard test is "colonoscopy." This procedure is performed by a trained endoscopist, usually a gastroenterologist or a surgeon. The entire colon and rectum can be carefully examined and any suspicious areas can be biopsied or small polyps can be removed entirely. This procedure, if negative, needs only to be repeated in 10 years for most people.

The fourth procedure, the "double contrast barium enema," is an x-ray of the entire colon. If abnormalities are detected, colonoscopy is usually required to determine the nature of the lesion.

Who needs to be screened for colorectal cancer? The answer is everyone. About two-thirds of the population is at "standard risk" for this disease. Starting at age 50, FOBT and sigmoidoscopy every three to five years, or colonoscopy once at 50 and if negative, repeated ten years later, is all that is needed. The other third of the population is at "high risk." These are individuals who have colorectal cancer in their families. Their mother, father, grandparents may have had the disease. If one of these family members had colorectal cancer earlier than age 50, then they are at particularly high risk and should start screening procedures ten years earlier than when the cancer appeared in their relative. High-risk individuals require annual FOBT, sigmoidoscopy every two to three years, or preferably, colonoscopy starting at least at age 50 and repeated every two to three years or sooner if needed.

There are other individuals who are also considered high risk. These are people who have been found to have special hereditary diseases linked with colon cancer or have had inflammatory bowel disease or Crohn's Disease. These individuals need special attention to prevent an invasive cancer from becoming established.

Everyone, standard risk and high risk, can benefit from a healthy diet designed to reduce the risk of sporadic colorectal cancer. A diet rich in whole grains and green vegetables, low in fat and red meats, has been associated with lower colorectal cancer incidence. Some studies have reported a beneficial effect of increased calcium to reduce pre-malignant polyp formation in the colon. It is important also to know that a baby aspirin a day will be beneficial. This aspirin works through a mechanism called "Cox-2 inhibitions" and the new drugs, Celebrex and Vioxx, used for arthritis may also have a beneficial effect on reducing colon polyp formation, although this has not yet been clearly established by clinical trials.

We do not have to endure the high mortality rates for colorectal cancer and the impact it has on the quality of life. This is a disease that can be prevented by a healthy diet and diligent screening for colorectal cancer starting at least at age 50 and regular attention to having it repeated. This is a disease that can be eradicated in the 21st century.

For more information and answers to specific questions contact the Rhode Island Cancer Council at Tel@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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