Volume 2, Issue 4
OncoLink would like to recognize the contribution of the National Colorectal Cancer Research Alliance (NCCRA) whose initiative with Pharmacia Oncology and Pfizer has made this publication possible.
In March of 2000, Katie Couric, NBC Today Show co-anchor and co-founder of the National Colorectal Cancer Research Alliance, underwent her first colonoscopy. Ms. Couric's colonoscopy was unusual in that it was televised on the Today Show, for millions of viewers to watch. Katie, whose husband, Jay Monahan, died of the disease at age 42, hoped to show viewers that the test was not a big deal and that it had the ability to save many lives through early detection.
A study conducted by the University of Michigan found that Katie had succeeded. The study included colonoscopies performed by 400 gastroenterologists nationwide from July 1998 (89 weeks before Ms. Couric's test) to December 2000 (40 weeks after her test). The researchers saw an increase of 19% in the number of screening tests performed during that period.
Katie says she's "thrilled people paid attention and took action." Her challenge is to keep the positive effects going. This past March Ms. Couric underwent a "virtual colonoscopy" on the air, a procedure that is still considered experimental. Once again, her efforts have prompted people to discuss this "unspeakable" disease with family, friends, and healthcare providers, and become more aware of the disease and the available screening tests.
Prevention Tips: There are simple steps anyone can take to greatly reduce their risk of this preventable, yet deadly, cancer.
Risk Factors: Both men and women are at equal risk for colorectal cancer. The older you are, the higher your risk; nevertheless, 13,000 cases per year will still be diagnosed in people under 50.
African Americans have higher colorectal cancer rates than men and women of other racial and ethnic groups.
Unhealthy habits like smoking or being overweight increase your risk for colorectal cancer. An important risk factor is having a family history or personal history of the following:
By: James Metz, MD
It is estimated that more than 131,000 Americans will develop colon or rectal cancer in 1998. It is the second most common cause of death from cancer in the United States. Colorectal cancer can be treated effectively when it is discovered at an early stage of disease.
There are a number of risk factors associated with the development of colorectal cancer. Hereditary colon polyps, cancer family syndromes, and a history of colorectal cancer in a first-degree relative all place the individual at a higher risk. A personal history of adenomas and colon polyps, previous colorectal cancer, or inflammatory bowel disease also puts the individual at higher risk. However, less than 1/3 of patients diagnosed with colorectal cancer have high-risk features. There is an increased risk of developing colorectal cancer with increasing age. For this reason, it is recommended all individuals over the age of 50 participate in colorectal cancer screening.
There are a number of screening tests utilized for colorectal cancer:
Digital Rectal Examination: The physician inserts a gloved finger into the rectum and feels for any abnormalities. If no blood is visible on the gloved finger, fecal occult blood testing is performed (see below). To date, there has not been significant evidence that the rectal examination has had any effect on mortality when used alone as a screening test.
Fecal Occult Blood Testing: Special cards are utilized to test for occult blood (blood not seen by the naked eye). Patients can place a small sample of feces on the card at home or the physician can place a sample on the card after a digital rectal examination. A special chemical is used by the lab to determine if blood is present. It should be noted many things could cause a positive occult blood test. If you have a positive test, further studies are warranted. Fecal occult blood testing on an annual or biannual basis for individual 45-80 years of age has been shown to decrease mortality from colorectal cancer.
Sigmoidoscopy: A sigmoidoscope is a thin tube with a light at the end, which is placed into the rectum. It can evaluate the distal colon and the rectum (about 1/3 of the colon) for polyps, tumors, and other abnormalities. Regular screening in individuals over 50 years of age may decrease mortality from colorectal cancer. There has been significant controversy over the optimal screening interval.
Colonoscopy: The colonoscope is much longer than a sigmoidoscope so that the entire colon can be evaluated. Patients are usually sedated for a colonoscopy procedure. A colonoscopy may be recommended for patients who are at high risk for colorectal cancer, have abnormalities on a sigmoidoscopy, or have unexplained fecal occult blood.
Barium Enema: A barium enema is a radiologic study of the colon and rectum. Barium is contrast material that is given by enema prior to taking X-rays. This allows the colon and rectum to be visualized and abnormalities can be evaluated. The patient is placed on a table that moves so the contrast can be followed through the bowel.
The American Cancer Society recommends three courses of action beginning at the age of 50, from which the patient and physician can choose for screening. These include:
Dear OncoLink "Ask The Experts,"
What role does diet play in the prevention of colon cancer?
Katrina Claghorn, MS, RD, Registered Dietitian at the University of Pennsylvania Cancer Center, responds:
There has been a great deal of research on the impact of nutrition on colon cancer. Despite all the studies there is still no definitive anti-colon cancer diet. Below is a list of nutritional factors that have been found to have the greatest potential for reducing colon cancer risk.