PRESCRIPTIONS
Regular colon-cancer screening can be a lifesaver
By Landis Lum
"You know, doc, there's a million things I'd rather be doing than be screened for colon cancer. Like doing the dishes, for example."
My patients are given to saying this kind of thing about colon-cancer screening. It's a topic that nobody ever likes to talk or even think about. But it is a critically important health issue.
Surveys show that many people are not screened because they're too embarrassed. They would rather lose months off their life than face these tests.
But those who already have had the tests say they are willing to have them again if they will save one additional day of their lives.
Cancers of the large intestine kill more people than breast cancer or prostate cancer do.
More than 9 of 10 people with colorectal cancers that have not yet spread survive for five years after diagnosis. The problem is, only 37 percent of these cancers are being found at this early stage. The remaining 63 percent are not being discovered until the cancer has metastasized.
Even more reason to get screened early: This cancer can be prevented if polyps (small lumps of tissue on the inside of the colon) can be found and removed.
Because 75 percent of new cases occur in people with no family history or other known risk factors, you should get screened regularly once you hit age 50, even if you feel perfectly fine, even if you've had no pain, bowel problems, or blood in your bowel movements.
And if your parents or siblings had colon cancer younger than age 60, or you're a black male, or you have other conditions increasing your risk, you may need to start earlier.
So, what screenings are available?
• In sigmoidoscopy, a flexible fiberoptic tube is inserted into the anus for about 5 to 15 minutes while you are lying on your side. It allows a health professional to see the lower 2 feet of the colon, but cannot detect polyps or cancers in the first part of the large intestine (also known as the right-colon). It may be mildly uncomfortable, but is generally not painful. Seventy percent of patients report that sigmoidoscopy was far less unpleasant than they had expected. It reduces the risk of fatal cancers in the rectum and lower colon by 60 percent to 80 percent.
• A colonoscopy also uses a flexible tube, but it is snaked through the entire colon, upper and lower, for 15 to 60 minutes. A sedative that produces a "twilight" sleep is usually used and often makes the procedure more comfortable than sigmoidoscopy, but you'll need to have someone drive you home afterwards.
Colonoscopy reduces the risk of cancer throughout the entire colon by 76 percent to 90 percent. It is more accurate and entails less X-ray exposure than a barium enema X-ray of the colon. Bowel perforation is a rare complication, occurring in 10 per 10,000 procedures (compared with 1.4 per 10,000 procedures for sigmoidoscopy).
• The hemoccult test looks for invisible blood in your movements. It detects only 30 percent to 50 percent of cancers, but it is the only screening shown in randomized clinical trials to reduce death rates.
You smear some feces on two small areas of special cards at home for three consecutive bowel movements, and then send or mail these back to the clinic for analysis. If for any reason you cannot (or will not) do this, but still desire screening for colon cancer, let your physician know you want something else, such as sigmoidoscopy or colonoscopy.
If you're taking the hemoccult stool tests, avoid aspirin and aspirinlike drugs, such as ibuprofen (Motrin, Advil) and Naprosyn (Aleve), for seven days before and during the testing. But Tylenol or certain other pain pills are fine; just check with your doctor first. Taking one adult aspirin a day is also fine, but if you're being prescribed more than this for health reasons, ask your doctor before reducing the dose. Also avoid more than 250 milligrams of vitamin C a day (oranges have 60 milligrams), and don't eat red meats for three days before testing.
Taking all of this into account, what is the best colon-cancer screening strategy?
I would get a hemoccult test every one to two years and combine this with a flexible sigmoidoscopy every five years (although some groups feel that every 10 years is sufficient). Another option is to just do a colonoscopy alone every 10 years. The important point is to do something rather than nothing. It's certainly more important than doing the dishes.
Dr. Landis Lum is a family practice physician with Kaiser Permanente, and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine.
Write: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column provides opinions and information, and is not intended to provide medical advice; you should consult your doctor.
