Over 50? Schedule Your Colon Cancer Screening

From the WebMD Archives

March 8, 2001 -- This year, an estimated 56,700 Americans will die from colon cancer, a preventable disease. Though early detection is key to prevention and successful treatment, the proportion of the U.S. population screened for the disease remains amazingly low, according to a government report released Thursday.

The number of Americans over age 50 that were screened from 1997-1999 edged up a mere 3% from about 41% to 44%, the report shows.

These numbers are especially disappointing considering that at least one-third of these cancers would be prevented if people over age 50 were screened regularly.

Public health officials say that healthcare professionals and the public have failed to embrace national guidelines issued in the mid-1990s recommending that people aged 50 and older have regular colon cancer screenings.

"Efforts to address barriers and to promote the use of colorectal cancer screening should be intensified," write the authors of the report published in Thursday's Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention.

The second leading cause of cancer-related death in the U.S., colon cancer occurs in an estimated two out of every 1,000 people. That means 135,400 new cases will be diagnosed in 2001, according to CDC estimates.

Screening is key because early detection saves lives. The screening tests can detect the disease in people with no symptoms who may have an early form of the disease. If caught early, cancer specialists say it greatly improves the chances of a successful treatment.

For example, if the cancer is confined to the wall of the intestine, explains Anil Rustgi, MD, chief of gastroenterology at the University of Pennsylvania in Philadelphia, the survival rate is much better. Rustgi says that the 5-year survival rate for patients whose cancer is confined to the intestine is about 90%, compared with about 10% for those patients whose disease has spread, or metastasized, to other organs.

"If you do find cancer [with screening], it's great to get it at the early stages" before it has metastasized, Rustgi tells WebMD.

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Rustgi says that the screening tests are useful for preventing colon cancer because the tests can identify suspicious polyps, or small growths, in the colon that could be precancerous, he explains.

Several screening tests are available, ranging from a simple home test that can be performed on an annual basis to a more invasive test that experts advise people aged 50 and older have every 10 years.

The home test is a fecal occult blood test, also known as an FOBT. The test detects occult, or hidden, blood in the feces. A positive result does not always mean that cancer is present, but blood in the feces can suggest cancer. Blood vessels on the surface of cancerous growths are often fragile, and in the intestine, can be damaged by the passage of feces.

Another highly recommended test is a sigmoidoscopy. Doctors use a sigmoidoscopy to look at the inside of the rectum for polyps projecting from the intestine. The procedure involves inserting a flexible, 2-foot long tube into the rectum and up to the colon. The tube allows doctors to see about half of the colon using an attached video camera. Experts advise people aged 50 and older to have one every five years.

Experts say that people at risk should have the entire colon examined using a colonoscopy every 10 years. A colonoscopy involves inserting a flexible, 4-foot long tube into the colon, allowing the doctor to see the entire colon and increasing the chances of spotting a cancerous growth.

In the CDC's two-year study, more than 63,000 people were asked if they ever had an FOBT, a flexible sigmoidoscopy, or a colonoscopy.

In 1999, about 40% of the respondents reported having an FOBT, compared with less than 20% in 1997. Another 43% reported having a sigmoidoscopy within the previous five years compared with about 30% in 1997.

Efforts are now under way to further increase awareness about colon cancer and screening. Earlier this month, the CDC and the Health Care Financing Administration, which oversees the Medicare program, launched a nationwide campaign to raise public awareness. Congress also designated March as "National Colorectal Awareness Month."

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On the state level, Massachusetts, New York, North Carolina, and other states also have begun to raise public awareness by distributing surveys and offering free screening services to the uninsured.

Since 1999, the screening rates also have dramatically increased thanks in part to the public awareness campaigns of private organizations, such as the National Colorectal Cancer Research Alliance, says Rustgi, who serves a member of the Alliance's medical advisory board.

More about these efforts and the disease can be learned by visiting the CDC colon cancer web site at www.cdc.gov/cancer/screenforlife and the National Colorectal Cancer Research Alliance at www.ccalliance.org.

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