Colon Cancer: A Preventable Cancer
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DR. DAVID FLEISCHER, Georgetown University Medical Center: Good morning. Nice to see you.
SUSAN DENTZER: Several years ago, Renate Heymann had a growth removed from her lower intestine. Ever since, Heymann, who is 69, has been on the alert for signs of cancer.
DR. DAVID FLEISCHER: I know you know we’re doing this because you had had polyps in the past.
SUSAN DENTZER: That concern is what brought Heymann to Georgetown University hospital in Washington recently for a routine test known as a colonoscopy. It’s an up-close and very personal look inside her large intestine, or colon, with the aid of a high-tech instrument called a colonoscope.
RENATE HEYMANN: I feel good to come and have it checked. If it’s benign, fine, and if it’s cancerous, not so fine. But then they can take care of it early rather than have it, well, go bad. That’s why I’m here.
DR. DAVID FLEISCHER: Everything’s going fine.
SUSAN DENTZER: Heymann’s physician, gastroenterologist, David Fleischer, inserted the colonoscope into Heymann’s rectum, at the very end of her colon. He then pushed it along the roughly five-foot length of the rest of her colon. All the while, the tiny lighting system and computer chip in the tip transmitted the images from inside her colon to a television monitor. Fortunately, this time Dr. Fleischer found no growths, known as polyps, in Heymann’s colon.
DR. DAVID FLEISCHER: You doing okay? We’re all done.
SUSAN DENTZER: Since Heymann was sedated with medication before the procedure began, she felt little discomfort during the 15-minute procedure. She says the gritty details of getting a colonoscopy shouldn’t dissuade people from being screened.
RENATE HEYMANN: Why risk dying of colon cancer if it can be detected? I wish most cancers could be detected this way. I would do all the tests if it could be done.
SUSAN DENTZER: Heymann is one of a growing number of Americans for whom an urgent message has already sunk in. Colon cancer is the second most deadly form of cancer after lung cancer, killing some 56,000 Americans each year. That’s more than die of either breast or prostate cancer. But the good news is that colon cancer is also one of the most preventable cancers, and if found early, it’s also highly curable.
DR. DAVID FLEISCHER: It’s really remarkable that the earlier the diagnosis is made, the better the survival is. Colon cancer is divided up into stages, “a” through “d,” and “a” is an earlier stage. But if you can find it at an early stage, more than 95 percent of people are cured.
SUSAN DENTZER: That’s a prime reason why earlier this month, a Senate aging committee hearing kicked off observance of the first annual colorectal cancer awareness month. On hand was NBC newswoman Katie Couric, who made a compelling personal pitch about the importance of colon cancer screening.
KATIE COURIC, NBC News: As many of you know, my husband, Jay Monahan, was diagnosed with colon cancer in 1997. He had no family history of the disease. After an unbelievably courageous battle, he died nine months later, just two weeks after his 42nd birthday. During this terrible nine-month struggle, motivated by fear and desperation, I got a quick and painful education about this devastating disease.
SUSAN DENTZER: Couric said that among the things she learned was how few effective treatments were available for advanced cancer, besides surgery to remove the cancerous portion of the colon, and chemotherapy. She also told lawmakers that discussion of colon cancer and the need for preventive screening is too often shrouded by public queasiness and shame.
KATIE COURIC: A lot of people simply don’t want to talk about it. Colons, rectums, bowels– it’s not exactly the stuff of cocktail party conversation.
SUSAN DENTZER: As a result, only about six out of ten Americans who should get even the most basic screening for cancer do get it. Worse, just one out of seven Medicare beneficiaries are screened, even though the Medicare program will pay the cost of colonoscopies and other screening procedures. But Couric added that over time, the embarrassment could be whittled away, so that screening for colon cancer could become as commonplace as procedures like mammography for detecting breast cancer.
KATIE COURIC: Women didn’t like to say “breast” and men didn’t like to say “breast” in the context of breast cancer for a long, long time, and it has become part of the lexicon, as it should be. The more we discuss it openly and candidly, and the more we say the words “colon” and “rectum” and “colonoscopy”– I know it’s not easy; it took me a while to be able to say it as well– the better off we’ll be. I think that really is the first step.
SUSAN DENTZER: Dr. Bernard Levin, a gastroenterologist, agreed.
DR. BERNARD LEVIN, M.D. Anderson Cancer Center: We have a saying, “don’t let your patients die of embarrassment,” and I think that’s terribly important. Even if we use the tests that are available right now, we could save perhaps 28,000 lives every year.
SUSAN DENTZER: Dr. Fleischer says that the best precautionary measure to take is to be screened with a colonoscopy.
DR. DAVID FLEISCHER: The gold standard in the year 2000 is a colonoscopy. The test allows you to see the entire colon, and more than 95 percent of individuals, because patients are sedated for the procedure, it’s usually something that’s not unpleasant in any way. It also has the advantage that you can take out a polyp if you see it, so it’s like one-stop shopping.
SUSAN DENTZER: That’s important because over a five- to ten-year period, even a polyp that starts out benign can develop into colon cancer. Yet there are other, more easily performed screening tests that, while not as conclusive as colonoscopies, are still useful. The current consensus among experts is that any or all of these tests should begin at age 50, although there is growing discussion about starting them even earlier, at age 40.
DR. DAVID FLEISCHER: In the average risk patient, screening generally begins over the age of 50. Everybody would think that you should have a hemacult test. That’s a… just a card where your stool is sampled to see if it has blood that you don’t see with your eyes. So a hemacult test should be on an annual basis.
This test should then be followed up every two to three years with a more thorough investigation of the colon, such as a sigmoidoscopy, or every five years with a colonoscopy. Unlike a colonscopy, a sigmoidoscopy can be performed without a sedative in a primary care physician’s office, after the patient cleans out his or her colon with the aid of enemas.
DR. DAVID FLEISCHER: A sigmoidoscopy is a tube that’s generally about 60 centimeters that’s inserted through the rectum, and it enables you to look at about a third of the colon, 25 percent to a third of the colon. The plusses are it’s simple and less expensive; the downsides are you only examine part of the colon. Fleischer says another screening procedure is a so-called double contrast barium enema.
DR. DAVID FLEISCHER: It’s an x-ray test. It requires no sedation so it’s different from colonoscopy in that regard. It allows you to see the entire colon on an x-ray picture. National studies have shown it’s not as sensitive as a colonoscopy so you don’t see everything you would see with a colonoscope.
SUSAN DENTZER: And in fact, a study published recently in the New England Journal of Medicine compared the effectiveness of colonoscopies with barium enemas. It looked at a group of patients who had already had polyps removed and it found that the barium enemas were less effective than colonoscopies in detecting new growths.
So until more is known about effective prevention strategies and until better colon cancer treatments are available, far and away the best approach is routine screening. That’s the point driven home by a new advertising campaign sponsored by a colon cancer coalition. This commercial features the actor Dennis Franz from the television show NYPD Blue.
DENNIS FRANZ: A simple test could save your life. How do I know so much? My father didn’t catch it early, and he died. So while this message is for you, it’s also for him.
SUSAN DENTZER: Government officials have told lawmakers they’ll study the possible reasons why more people are not getting screened, and they’ll look to devise still more ways of raising colon cancer awareness among the public.