The truth is that colorectal cancer claims far too many lives—and needlessly so. This disease is the second-leading cause of cancer death in the United States, yet fewer than 50% of eligible individuals are undergoing appropriate screening (1). This is particularly concerning, when we know that colorectal cancer screening—whether it be fecal occult blood test (FOBT), flexible sigmoidoscopy, double-contrast barium enema, or colonoscopy—saves lives.

The scientific evidence showing the lifesaving benefit of these screening tests is overwhelming. For example, randomized controlled studies have shown that use of annual FOBT over time can detect up to 92% of cancers and can reduce colorectal cancer deaths by 33% (2-4). Case-controlled studies have also demonstrated a reduction in colorectal deaths with screening sigmoidoscopy (5-8). In addition, the National Polyp Study showed the potential preventive value of colonoscopy, achieving a 76% to 90% reduction in the development of colorectal cancer with the removal of polyps (9). Indeed, according to the American Cancer Society, it is estimated that “the great majority of these cancers and deaths could be prevented by applying existing knowledge about cancer prevention and by wider use of established screening tests” (10). Based on this wealth of evidence, the US Preventive Service Task Force and professional medical societies issued guidelines recommending colorectal cancer screening in persons who are at average risk and who have no symptoms of disease, beginning at age 50 (11-13). For those with certain risk factors, screening at a younger age may be recommended.

It is true that colorectal cancer screening, as any medication or medical procedure, has both benefits and risks. In the case of colonoscopy, for example, this test is extremely comprehensive and allows for the detection and removal of potentially pre-cancerous polyps throughout the entire rectum and colon. However, there are rare complications, such as perforation, that can occur. While the potentially lifesaving benefits clearly outweigh the risks of colorectal cancer screening, it is always important that physicians provide information on the advantages and disadvantages of screening for each individual patient. This patient-physician discussion includes consideration of overall health, risk factors, screening options, benefits and risks of each option, and individual patient preferences.

Unfortunately, far too few people visit their physicians to have this discussion. This is why efforts to raise public awareness—including those of Katie Couric and other celebrities—are so important. In fact, with regard to colorectal cancer, the study results reported by Larson and colleagues showed that 37% of adults 50 and older who had “seen or heard celebrities like Katie Couric talk about getting a sigmoidoscopy or colonoscopy,” stated that it made them more likely to undergo screening (14). We, like many health professionals, are thrilled with this extremely positive news. It shows that people recognize the value of focusing on wellness and prevention, rather than waiting for symptoms (which often do not develop until the disease is advanced) before seeing their physicians.

Before Ms. Couric’s efforts, people were embarrassed even to bring up the subject of colorectal cancer. Ms. Couric helped make it acceptable for people to talk—and most importantly to talk with their doctors—about this disease. As physicians, we are grateful for this opportunity to discuss colorectal cancer screening with our patients. As individuals who have lost loved ones to cancer, we are grateful for the countless lives saved as a result.

Raymond DuBois, M.D., Ph.D.

Hortense B. Ingram Professor

Associate Director of Cancer Prevention & Control

Department of Medicine

Vanderbilt-Ingram Cancer Center

Vanderbilt University Medical Center

Nashville, Tennessee

Bernard Levin, M.D.

Professor of Medicine

Vice President and Betty B. Marcus Chair in Cancer Prevention

MD Anderson Cancer Center

Houston, Texas

Mark B. Pochapin, M.D.

Director, The Jay Monahan Center for Gastrointestinal Health

Chief, Gastrointestinal Endoscopy

NewYork-Presbyterian Hospital

Associate Professor of Clinical Medicine

Weill Medical College of Cornell University

New York, New York

Anil Rustgi, M.D.

T. Grier Miller Professor of Medicine and Genetics

Chief, Division of Gastroenterology, Director, GI Cancers

Abramson Cancer Center

University of Pennsylvania School of Medicine

Philadelphia, Pennsylvania

Robert J. Mayer, M.D.

Professor of Medicine

Director, Center for Gastrointestinal Oncology

Dana Farber Cancer Institute

Harvard Medical School

Boston, Massachusetts

References

1— Seeff et al. Patterns and predictors of colorectal cancer test use in the adult US population. Cancer 2004;100:2093.

2—Mandel et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993;328:1365-1371.

3—Hardcastle et al. Randomised controlled trial of faecal-occult blood screening for colorectal cancer. Lancet 1996;348:1472-1477.

4—Kronborg et al. Randomised study of screening for colorectal cancer with faecal-occult blood test. Lancet 1996;348:1467-1471.

5—Selby et al. A case control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992;326:653-657.

6—Newcomb et al. Screening sigmoidoscopy and colorectal cancer mortality. J Natl Cancer Inst 1992;84:1572-1575.

7—Muller et al. Protection by endoscopy against death from colorectal cancer: A case-control study among veterans. Arch Intern Med 1995;155:1741-1748.

8—Kavanagh et al. Screening endoscopy and risk of colorectal cancer in United States men. Cancer Causes Control 1998;9:455-462.

9—Winawer et al. Prevention of colorectal cancer by colonoscopic polypectomy. N Engl J Med 1993; 329:1977-1981.

10— American Cancer Society. Colorectal cancer facts and figures: special edition 2005. Atlanta, Ga, 2005.

11—US Preventive Service Task Force. Screening for colorectal cancer: Recommendation and rationale. Ann Intern Med 2002;137(2):129-131.

12—Smith et al. American Cancer Society guidelines for the early detection of cancer, 2005. CA Cancer J Clin 2005; 55: 31-44.

13—Winawer et al. Colorectal cancer screening and surveillance: clinical guidelines and rationale: update based on new evidence. Gastroenterology. 2003;124(2):544-560.

14—Larson et al. Brief communication: Celebrity endorsement of cancer screening. J Natl Cancer Inst 2005;97(9):693-695.

EDITORS' NOTE: The authors are affiliated with the National Colorectal Cancer Research Alliance -- co-founded by Katie Couric, Lilly Tartikoff, and the Entertainment Industry Foundation -- which is dedicated to the eradication of colorectal cancer by promoting the importance of early medical screening and funding research to develop better tests, treatments, and ultimately a cure. Drs. DuBois, Levin, Pochapin and Rustgi conduct research on the disease and/or provide patient care; their work is supported, in part, by the NCCRA’s fundraising efforts. As CEO of the Entertainment Industry Foundation (the entertainment industry’s collective philanthropy), Ms. Paulsen – along with her staff – provides the administrative infrastructure for the NCCRA.

© 2005 HealthNewsDigest.com