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    Screening Critical to Detect Colorectal Cancer

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    "I think that the ACS ... guidelines are very logical and should be followed," Gazelle says.

    Those who are at high risk for colorectal cancer and should therefore get screened beginning at age 40 include people with a family history of colorectal cancer and people with inflammatory bowel disease. People should also be screened if they have one of two hereditary disorders that increase the cancer risk: familial adenomatous polyposis or hereditary nonpolyposis colorectal cancer syndrome.

    Colorectal cancer is preventable in part because -- unlike some other cancers -- it is slow to develop. Often, noncancerous polyps, similar to warts, form on the inside of the colon. Over a period of years, a few of these may go on to become cancerous. As a result, doctors screen for the presence of both polyps and actual tumors, Smith says.

    The different screening methods each have some pluses and minuses, Gazelle tells WebMD. Although polyps and cancers can develop in any part of the colon, only two methods examine the entire colon: colonoscopy and the double-contrast barium enema (DCBE), he says. Although interest in colonoscopy has risen since Couric televised her own procedure, Gazelle says that a DCBE is also effective.

    The old-fashioned method, a digital rectal examination, is inadequate, the Harvard researchers write, and sigmoidoscopy, which only covers a portion of the colon, is best in combination with the fecal occult blood test.

    Although screening can prevent colon cancer, many insurers still won't pay for it, Gazelle says. But in 1997, the federal Health Care Financing Administration decided to cover screening for Medicare recipients. Some insurers have followed. A bill now in Congress, sponsored by Sen. Ted Kennedy (D-Mass.), could force other insurers to pay for screening.

    Because the subject of colon cancer is considered distasteful, many doctors and patients don't bring it up, and as a result, too many people are not screened, Smith says.

    "The main thing people need to understand is that this is an important health problem for both men and women," he says. "If your doctor has not mentioned it, you should initiate the discussion."

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