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Dr. Minkin talks about screeningColon Cancer Awareness
The colon or large intestine is a part of the human anatomy that many people feel uncomfortable discussing. To a gastroenterologist however it is an interesting organ that needs proper care.
March is colon cancer awareness month and it is worth taking a moment to review the current medical thinking about this potentially devastating disease. Colorectal cancer is one of the most common cancers in this country. Many of us know friends or family members who have been affected. Approximately 150,000 new cases are diagnosed each year in the United States. In 2006 more than 55,000 Americans died from colorectal cancer, placing it second behind lung cancer as a cause of cancer death. For the average person the lifetime risk of developing colon cancer is 5-6% with 90% of cases developing after the age of 50.
People may find it helpful to become familiar with risk factors, protective factors and the concept of preventative care. Although men have a moderately higher risk for developing colorectal cancer than women both groups are at risk and there is no difference in the approach to care. Most colon cancers develop in people with no obvious risk factors however there is a sizeable minority who are considered at above average risk. Environmental and genetic factors both play a role. People who have a sibling or parent with colon cancer or large colon polyps may have a specific genetic disorder or a predisposition to develop both colon polyps and cancer. This association is especially noted when the family member develops a problem at a young age. People should review their family history with their physician and discuss the appropriate time to begin colon screening. Other risk factors include obesity, diabetes and cigarette smoking.
Although not fully protective there are several factors which have been associated with a decreased risk of colorectal cancer. As with many other illnesses physical activity may decrease risk. Diets high in fruits and vegetable and low in red meat may confer some protection. Unfortunately, the use of fiber supplements has not been shown to be as helpful as previously thought. Antioxidants such as vitamin A, E and C have also not been shown to be of any significant benefit. On the positive side high calcium intake, including the use of calcium supplements, probably reduces risk and is recommended by the American College of Gastroenterology to prevent the development of colon polyps. Polyps are the precursors of most colon cancers. Finally, several but not all studies have noted a protective effect with the regular use of aspirin or non-steroidal anti-inflammatory drugs such as Ibuprofen.
Despite a healthy life style colon cancer can still strike and modern screening options should not be ignored. The vast majority of colon cancers start with a colon polyp. Polyps are common and are seen with increasing frequency with age. A polyp is a growth in the colon wall that looks like a pimple or lollipop. Cells lining the colon are constantly dying and being replaced. Sometimes there are small changes in a cell’s DNA resulting in excessive tissue growth and subsequent polyp formation. Multiple DNA changes may accumulate and over many years some polyps continue to grow and eventually become cancerous.
The slow process of change from normal colon tissue to polyp to cancer has given modern medicine an opportunity to intervene and alter the natural history of colon cancer.
Based on the association between polyps and cancer the American Cancer Society and the American Gastroenterology Association have strongly recommended that the colon be examined beginning around the age of 50 in average risk individuals. In recent years the gold standard of imaging has been with the use of colonoscopy. Colonoscopy uses a video camera on the end of a flexible scope to directly look at the colon lining. In the future an x-ray/CT image of the colon may be alternative approach. Both exams require a bowel purge which many people find the most difficult aspect of the process. Colonoscopy has the advantage of polyp removal. Polyp removal has been shown to reduce the risk of developing cancer by 60-80%. Although much of the benefit of colonoscopy is based on polyp detection occasionally an early cancer is found. As with many cancers, early detection results in a greater chance of cure.
Central Vermont Medical Center recently completed a new outpatient treatment center. Colon exams can now be done in a modern private facility. If you have reached the mid century mark please consider the benefit of periodic colon screening.
Andrew Minkin, MD is certified by the American Board of Internal Medicine with a subspecialty of Gastroenterology. He currently practices with Dr. Eric Asnis at Green Mountain Gastroenterology located on the Central Vermont Medical Center campus.
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