Screening Colonoscopy can Prevent Colorectal Cancer

The dictum “An ounce of prevention is worth a pound of cure” resonates with every intelligent, health conscious individual. Yet, when a physician suggests getting a screening colonoscopy performed, as the individual approaches the recommended age of fifty years or more, it is met with a lot of trepidation and excuses. Even after 40 years of practice as a Gastroenterologist, one of the saddest diagnoses I make is of COLON CANCER because, of all the common cancers, only colon cancer is easily preventable. Many individuals are not aware that colon cancer screening – unlike screening for breast cancer, lung cancer, prostate cancer and others- is performed to prevent cancers, not just to diagnose them. There are numerous studies that show that colon cancer screening has reduced the incidence of colon cancers and polyp removal prevents occurrence of colon cancer in the future. The following few paragraphs might help to allay fears and answer some of the common questions.

Basic Facts

Colo-rectal Cancer (CRC) is the third most common type of cancer and second leading cause of cancer related death in the United States. Approximately 142,000 new cases are estimated to be diagnosed in year 2013 and approximately 51,000 persons will die, in spite of the excellent medical care available. The lifetime risk of being diagnosed with CRC is equal in men and women and is estimated to be 5 percent, Most colon cancer lesions arise in the pre existing colonic growth called ‘polyps ‘ These polyps have a long natural history of years before they change to cancer stage. Identification and early removal of these precursor lesions prevents colon cancer. These basic facts have compelled the American Cancer Society, the American College of Gastroenterology and the American Society of Gastrointestinal Endoscopy to issue recommendations for colonoscopy as a procedure of choice to identify and remove these lesions. There are other ways to screen for colon cancer including Fecal Occult Blood Testing (FOBT), Barium Enema with Air Contrast, Flexible Sigmoidoscopy and CT Colonography, however, they all have some limitations and if positive, a colonoscopy needs to be done. CRC screening by colonoscopy has a number of advantages over above mentioned tests. It is highly sensitive, examines the entire colon and above all allows for screening, diagnosis and removal of polyps in a single visit.

Procedure

A colonoscopy is an internal examination of the colon, using an instrument called a colonoscope. It is a small camera chip attached to a flexible tube. The tube is inserted thru the anal opening and advanced slowly under vision to the terminal small bowel after a thorough cleansing of the bowel as per instructions provided by the physician. The examination is performed after administration of a sedative and pain reliever. Any lesions found during examinations are removed by passing a wire loop through the scope to cut the polyp from the wall of colon using an electric current. Biopsies may be taken with tiny biopsy forceps inserted through the scope and photographs may be taken for documentation. The tissue removed is sent for pathological evaluations. A colonoscopy typically takes less than 20-30 minutes and is very safe. Because of the sedation a majority of patient may not feel any discomfort and may have no memory of the test. Actually, most patient say the preparation for the test is more difficult than the test itself.

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Risk Factors

Anyone can get CRC, however, 90% of new cases and 94% of deaths occur in individuals 50 years old or over that age, that is why age 50 has been established in the guidelines. Other risk factors also play an important role. Family history of CRC poses a very significant role because of genetics. Prior history of colonic polyps, family history of colonic polyps and prior history of breast, uterine or ovarian cancer are also very important risk factors. History of inflammatory bowel disease, including ulcerative colitis / Crohn`s disease may necessitate doing colonoscopy at an earlier age and more frequently. High fat, low fiber diet intake, sedentary life style, diabetes mellitus, smoking and obesity are some of the other softer risk factors to keep in mind.

Beside the factors enumerated above, if a person has any of the following symptoms the need for urgent attention and colonoscopy is urged: rectal bleeding, low blood count or anemia, change in the shape or frequency of bowel movements, stomach cramps worsened by meals, bloating sensation and sensation of incomplete bowel evacuation.

Current Recommendations for the Prevention of Colorectal Cancer

1. Get screened regularly.
2. Maintain a healthy weight throughout life.
3. Adopt a physically active lifestyle.
4. Consume a healthy diet with an emphasis on plant sources; specifically:
• Choose foods and beverages in amounts that help
achieve and maintain a healthy weight.
• Eat 5 or more servings of a variety of vegetables and fruits each day.
• Choose whole grains in preference to processed (refined) grains.
• Limit your consumption of processed and red meats.
5. If you drink alcoholic beverages, limit consumption.

Most people have an excellent chance of preventing colon cancer if they eat a balanced diet rich in vegetable and fruit fibers, maintain an active life style & healthy weight and above all incorporate screening colonoscopy protocol. Let us all work to gather to make Colon Cancer a disease of the past.

Respectfully Submitted,

Jagdish K. Gupta MD, FACP, FACG

Clinical Assistant Professor,
SUNY, Downstate Medical Center, Brooklyn NY
Tel. # 718-638-3150