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This One is Not Debatable-Colon Cancer Screening Can Save Lives
Physicians, Researchers, and Patients Must Work Together
Cancer screening can save lives. While mammography for breast cancer detection has been in the
limelight most recently, colon cancer screening deserves equal, if not more, publicity. Although
mammography rates continue to rise, less than one-third of Americans age 50 or older (the age
recommended for colon cancer screening) have undergone any form of colon cancer screening. It is
not surprising, then, that this particular malignancy still ranks as the third leading cause of
cancer death among American men and women. This is tragic, because it is one of the most preventable
types of cancer.
While effective modes of screening have been available for years, a unified effort to elevate the
general awareness of colon cancer screening has only recently gained momentum. About three years
ago, through the efforts of the colon cancer patient advocacy community, Congress designated March
as 'Colon Cancer Awareness' month. Celebrities and public figures joined the effort, helping to
lessen some of the stigma associated with screening. Insurance companies began to provide coverage
for these life-saving tests.
Alas, gastroenterologists are still waiting for the test takers.
Colon cancer screening rates have yet to reach the level of testing for women's cancers, such as
breast and cervical cancer. And they need to. Despite some recent controversy about the usefulness
of mammography, research shows that it has indeed refined the detection, treatment, and prevention
of breast cancer. In fact, more than 75% of women over age 50 have had breast cancer screening
through the use of mammography. And among this group, deaths are down approximately 20% to 30%,
which translates to roughly 10,000 lives saved each year. Even more impressive is the effect of
annual Pap smears on cervical cancer rates-high utilization of them has led to a mortality reduction
of more than 80%. Women clearly are getting high marks for these tests.
In contrast, both men and women receive failing grades for colon cancer testing. Screening options,
which include the fecal occult blood test, flexible sigmoidoscopy, and colonoscopy, can potentially
reduce colon cancer-related deaths by approximately 80%. The reason is simple--such testing leads
to earlier detection of colon cancer, when surgery and treatment generally can be more effective.
More than 30,000 lives could be saved annually in the US. Nevertheless, more than two-third of
people over age 50 fail to get screened.
Here's how screening can make a difference. In the vast majority of cases, a colonoscopy at the
recommended interval (age 50 and once every 10 years thereafter) leads to the detection and removal
of benign precursor lesions, known as polyps, which can progress to cancer over several years.
Approximately 50% of men and 30% of women will develop these precancerous polyps by their 50th
birthday. Thus, effective and widespread use of colon cancer screening and removal of polyps can
actually prevent the majority of colon cancers, as well as dramatically reduce the need for major
abdominal surgery and significantly reduce the number of lives lost to advanced disease.
The medical community recognizes that the public is squeamish about certain screening methods, which
may make some primary care physicians hesitant to discuss these options with their patients. But,
they're learning to bring up the subject. Researchers continue to investigate and refine screening
methods. There is great hope that in five years it will be possible to examine a stool sample for
genetic alterations that suggest early stage colon cancer. In addition, many health care
institutions, together with the National Cancer Institute, are investing considerable research
efforts to determine if certain medications may play a role in preventing precancerous lesions from
recurring in individuals at high risk for colon cancer. In effect, our concept of cancer is
changing--from viewing it as a dreaded killer to a chronic, but manageable, condition.
Both patients and primary care doctors now must come forth and do their parts. Colon cancer
screenings must continue to be part of the national discourse on cancer prevention-not just in
March, but each and every day. If patients don't speak with their physicians about appropriate
tests and treatment, we may very well be fighting a losing battle. Don't get left behind!
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