Worth talking about
MARQUETTE – Getting ready for a colonoscopy, what with the day of fasting before the procedure and other uncomfortable prep work, probably isn’t at the top of anyone’s bucket list of Fun Things To Do Before They Die.
Maybe it should be, considering it could be a life-saving procedure.
That topic was among those covered in a March 15 talk, “Colon Cancer: No One Likes to Talk About It, But We Should.” The presentation was given at the Hampton Inn by Dr. Philip Lowry, medical director of the UP Health System Cancer Center.
“Cancer has really become something that people are much more free to talk about in the last 20 years,” Lowry said.
That’s great, he said, because people are more aware of the disease.
“That being said, colon cancer is not necessarily, like, high on that list of easy things to talk about,” Lowry said.
However, it’s an important topic, he said, not only because of the disease itself but because there’s a lot people can do about it.
Colorectal cancers, Lowry pointed out, are overall the second most common cause of cancer death, according to the American Cancer Society. Lung cancer remains the biggest cancer killer.
“The death rates from colon cancer, fortunately, have declined in recent years,” Lowry said. “We aren’t seeing as many per capita deaths with colon cancer as we did five or 10 years ago. I think that’s a testament to the power of the screening procedures and some of the things that we’re doing right now.”
That’s the good news. However, he said one in three adults between the ages of 50 and 75 never have had appropriate screening for colon cancer.
“This doesn’t require any new breakthrough medications,” Lowry said. “It doesn’t require any fancy new surgical techniques.”
What is required, he stressed, is being proactive with prevention and early detection.
In fact, Lowry likened cancer to a weed in that if it’s left to “grow’ for too long, the established roots make it difficult to eradicate.
“Really, the best way to fight cancer is to not let it get started in the first place,” said Lowry, who added that with colon and breast cancer, things can be detected along the way as cells turn from normal to abnormal.
For instance, removing a polyp from a colon early could prevent cancer from taking hold, he said. However, he noted some polyps are benign and are not destined to become cancer.
Lowry, however, stressed one point.
“There’s a big difference between screening and a diagnostic work-up,” Lowry said.
Screening is appropriate for individuals without symptoms. However, signs that require a work-up, he said, include:
– bloody or black tarry bowel movements;
– a persistent change in the character of bowel movements;
– an unusual sense of urgency to move bowels;
– abdominal pain; and
– weight loss, unusual weakness or fatigue.
Having had a colonoscopy even as little as one year previously that turned out fine, he said, doesn’t mean there won’t be problems if symptoms start to occur.
“If there are symptoms or there’s a change in the examination, that’s a whole different story,” Lowry said.
The ideal screening test, he said, is of minimal risk at a reasonable cost. Results, obviously, should be accurate, with a positive test indicating there’s a problem.
“The positive test is letting us know earlier that something’s going on at a time when it makes a difference for us to fix that something,” Lowry said.
The American Cancer Society, he said, has colorectal screening guidelines starting at age 50, and earlier for higher-risk patients. Tests that primarily detect cancer are an annual guaiac-based fecal occult blood testing or fecal immunochemical testing, and a stool DNA test every three years, he said.
Tests that find polyps and cancer are a flexible sigmoidoscopy, double contract barium enema and a CT colonography every five years, and a colonoscopy every 10 years.
The U.S. Preventive Services Task Force, he said, recommends annual high-sensitive fecal occult blood testing for people between the ages of 50 and 75, and for selected patients earlier and/or to age 85. It also recommends an sigmoidoscopy every five years combined with fecal occult blood testing every three years, and a colonoscopy every 10 years.
Lowry said people should speak with their primary care physicians about their particular circumstances to decide on a course of action.
It is important, he said, people should be doing one of the procedures rather than none of them.
A colonoscopy, Lowry said, is the most definitive intervention, involving a flexible tube with light on the end. The device allows a doctor to see inside the colon as well as grab and remove a polyp.
However, the procedure requires some unpleasant prep work.
“I have yet to meet anybody who looks forward to a colonoscopy,” Lowry acknowledged.
Not getting one, though, could have worse ramifications.
“So, to not have to spend that one day getting ready for the colonoscopy may mean that you’re spending months or years with other much more toxic things being done,” Lowry said.
Prevention is even better than early detection, he said, although factors that can’t be changed include age, previous cancer, a personal history of inflammatory bowel disease, type 2 diabetes, a family history of colorectal cancers or pre-cancerous polyps and ethnicity, with higher rates seen in African-American and Ashkenazi Jewish populations.
“But there are things that we can change,” Lowry said.
Being overweight or physically inactive, eating diets high in red meats, smoking and alcohol consumption are lifestyle habits people can change, he said, to reduce the chance of colon cancer.
“Smoking remains the biggest scourge to health in this country,” Lowry said.
Genetic testing also is a possibility.
“We’ve really seen an explosion in the last 20 years of understanding how a cell works,” Lowry said, “and in turn, there’s been an explosion in cracking the genetic code that underlies how those cellular functions occur.”
That means people with family risk syndromes can be identified, and their screening programs can be changed to be done more aggressively and more often.
Marsha Nardi of Ishpeming said the talk was informative and down-to-earth.
“I’ve had breast cancer twice,” Nardi said. “I’m recovering now, and I’m having genetic testing.”
Lowry told the audience, though, that no one is going to live to be 150 years old.
“Cancer to me is part of the normal aging process,” Lowry said.
However, people should be intelligent in their choices regarding quality of life, he noted, with the use of chemotherapy and radiation taken into consideration.
Lowry said: “At the end of the day, we want to live life well.”
Christie Bleck can be reached at 906-228-2500, ext. 250.