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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

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Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Wednesday, February 22, 2006

March is Colon Cancer Awareness Month

(The following is an article being published in our local health and fitness magazine, with the tacit approval of my editor.)

Why should I care?
The risk of colon cancer goes steadily up once you hit fifty. Unless you've figured out how not to age at all as you get older, you better be aware of this disease's potential threat to you health. The disease does not care whether you are male or female, black or white. For it is the third most common type of cancer for both sexes, and altogether causes more deaths than either breast cancer or prostate cancer.

But hasn't everyone heard of Katie Couric, colon cancer, and colonoscopy?
Evidently not in Kentucky, We have the second lowest rate of colon cancer screening in the country. Sadly, Louisville/Jefferson County is bringing up the rear, having one of the highest rates of colon cancer deaths in Kentucky and the nation.

OK, I'm aware. Now what?
"Ask for IT!" as in Information and Testing. Our screening guidelines have changed dramatically over the last ten years, and they are not seared into our medical consciousness the way Pap smears and mammography are. Even conscientious physicians may overlook colorectal cancer screening in all their patients. As in all health-related issues, a knowledgeable patient is her own best advocate.

Give IT to me, then.
Because 90% of cases are diagnosed in patients over 50, we recommend that screening begin at that age. Studies have shown that ANY form of screening is better than no screening at all. The forms of screening include the following:
True colonoscopy.
Barium enema, preferably air-contrast.
Flexible sigmoidoscopy
Fecal occult blood testing
Less common forms include the following:
CT colography ("virtual colonoscopy")
Chromosome analysis of cells shed in the stool.
There are patients who should undergo testing at an earlier age. Patients with family histories of colon polyps or cancer should start their testing at the age of 40, or possibly even earlier. Patients with inflammatory bowel disease are often advised to begin screening earlier, too.

You make your living performing colonoscopy. Which test, by chance, do you recommend?
Colonoscopy, of course. It has major advantages over the other forms of screening. It is more accurate, in most hands, at detecting polyps and cancer than barium enema. It allows us to see the entire colon, instead just the third that is seen with sigmoidoscopy. It is more accurate than stool testing and, at least for now, virtual colonoscopy. It allows us to sedate patients, which is not routinely done for virtual colonoscopy. Most importantly, it allows us to spot and remove precancerous growths called polyps. In these cases we are actually preventing, not just detecting, colon cancer.

Sounds like a big hassle to me. And the clean-out for it doesn't seem inviting, either.
It is a hassle, but most folks only have to go through it only every ten years. It's not like getting yearly prostate checks or Pap smears, thank goodness! Every year we get cleverer with administering the clean-out. There are several different preparations you can take for colonoscopy. Discuss them with your doctor. Who knows, maybe some day we'llhave a prep that people actually enjoy.
The hassle is well worth it. Since 1985, coincident with the growth of colonoscopy, we have seen a 2% drop in colon cancer deaths each year, and nationally deaths from cancer are actually falling! Not all colon cancer deaths are preventable, but we think the vast majority of them are in patients who undergo proper testing.

Colonoscopy is expensive, isn't it?
The up-front costs can be a little daunting, but it is a whole lot cheaper than the costs of treating advanced colon cancer. It is so much cheaper that the Federal government is underwriting colonoscopy screening in Medicare beneficiaries.
In the long run it also saves the health insurance companies money. Recently I received a card from my health insurer reminding me that I was over 50 (thanks for the reminder!) and that I should be thinking about undergoing colonoscopy. This is proactive behavior on the part of the health insurer at its best.
By comparison, it is actually less expensive to save a life from colon cancer than it is to save a life from breast cancer.

You promise you'll sedate me for this?
We got more sedation than you have anxiety. I didn't feel a thing when I had mine, and I was glad I could check off colon cancer from my list of worries!


Blogger dlamming said...

Isn't the decline in US cancer deaths mainly due to a decrease in the number of people smoking?

6:58 AM  
Blogger Judy said...

I'm alive because I had a colonoscopy 6 years ago (and 5 more since, just to make sure). I nag everyone who'll hold still about colonoscopies, including perfect strangers. I'm constantly amazed at the excuses, but I generally win my point with friends when I offer to drive them to their appointment if they can't make other arrangements.

My mom had a flexible sigmoidoscopy every 5 years from the time she turned 50 and a negative occult blood screen every year. It took me a year AFTER my diagnosis to badger her into getting a colonoscopy. Fortunately, her malignancy was at an early stage at diagnosis and she's also cancer free -- and nagging.

9:22 PM  
Blogger JusPasenThru said...

Dlamming-the single most important thing we do in cancer prevention is smoking cessation. The death rates of breast, cervical and colon cancer are falling in areas that have adopted aggressive screening programs for those diseases.

Judy-thanks for your hard work. Nagging can be a VERY good thing to do.

BTW, for the first time I used a "high definition colonoscope" with zoom capablities today. How useful they will be in the long term remains to be seen, but they sure are cool and fun to play around with.

BTW partII, one of my patients today had "hemorrhoidal bleeding" (her diagnosis) for six months before her physician browbeat her into getting a colonoscopy. She had colon cancer. I pray she does well. I wish us middle aged folks wouldn't play doctor with stuff like that.

6:45 PM  

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