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Release: March 21, 2000

UI Cancer Center, Center for Digestive Diseases promote colorectal cancer awareness

IOWA CITY, Iowa -- The University of Iowa Cancer Center and the UI Center for Digestive Diseases are taking part in the first National Colorectal Cancer Awareness Month sponsored by the Colon Cancer Alliance (CCA) by stressing the importance of colorectal screening.

An estimated 130,000 men and women will be diagnosed with colorectal cancer in the United States this year, and 56,000 are likely to die from the disease, according to American Cancer Society statistics. Five to 6 percent of the total population -- one in 21 people -- will experience colorectal cancer in their lifetime, according to Robert Summers, M.D., UI professor of internal medicine and medical director of the Diagnostic and Therapeutic Unit in the UI Center for Digestive Diseases.

Despite its prevalence, public awareness about colorectal cancer remains low. One reason is the lack of discussion about issues of the colon and colorectal health, Summers said. Patients and doctors too regularly fail to exchange information about colorectal cancer. Testing for colorectal cancer has not become as accepted as breast cancer or prostate cancer screening, and typically it is only when a prominent figure becomes diagnosed with colon cancer that the media and the public take notice. Katie Couric, Ronald Reagan and Daryl Strawberry are all celebrities who have become "faces" of colorectal cancer.

"A misconception is that this is a man's disease, not a woman's disease, when in fact, the incidence is equal in men and women," Summers said. "For some reason, women are not screened as frequently as men are. That's a problem. We've been a part of several trials to look at preventing colon cancer, and we've found that men get screened almost twice as often than women do."

Given the low profile and lack of coverage about colorectal cancer, the UI Cancer Center and CCA are working toward giving the public a better understanding of what the disease is and how to prevent it.

Colorectal cancer begins silently with no particular symptoms, and it originates as a polyp. A polyp is a growth of abnormal cells that is pre-cancerous. If these cells remain in the colon they can develop into cancer, a process that may take up to 10 years, Summers said.

Screening for colorectal cancer involves the detection of polyps through several techniques. It is recommended that individuals of average risk begin screening at age 50 or earlier. Every five years a person should have a flexible sigmoidoscopy, a barium enema or a colonoscopy. For people over age 50, an occult blood test of the stool should be done.

"These recommendations are undergoing some flux or change, but the standard test has been flexible sigmoidoscopy. This test would be very helpful and probably decrease the number of colon cancer deaths by 50 to 70 percent if people were screened every five years, which is the current recommendation," Summers said.

The drawback to using flexible sigmoidoscopy as the primary screening method is that doctors can see only a third to half of the colon, limiting the search for colonic polyps to only the left side.

The procedure that gives gastroenterologists a look at the entire colon is colonoscopy, in which doctors use a scope to examine the inside walls of the colon and seek out abnormalities. Given that this test is more costly, doctors suggest that a colonoscopy should be done once every 10 years, for people at an average risk. Individuals who have first-degree relatives who have been diagnosed with colorectal polyps or cancer should be screened at age 40 or earlier, Summers said.

Genetic and environmental factors are known to influence the development of colorectal cancer. The environmental causes are related to dietary consumption of red meat and fat, or smoking. A diet rich in calcium and folic acid (a B vitamin), as well as regular aspirin use, has been shown to help reduce the occurrence of colorectal cancer. In about 10 to 15 percent of patients with colorectal cancer, however, heredity causes the disease.

Treatment for colorectal cancer is most effective when the cancer is detected early and if the cancer has not penetrated beyond the wall of the colon. Surgical resection is the primary option for patients. A segment of the bowel is taken out and the regional lymph nodes are removed. Chemotherapy is available for more advanced cases of colorectal cancer. The cancer is not very responsive to any radiation therapy when it is far advanced, Summers said.

"More important than early detection of cancer is finding a polyp before it becomes cancer, and that's the screening," Summers said. "It's been conclusively shown that if you remove polyps, you do a good job of preventing colon cancer. There is a definite need for an increase in public awareness about the high frequency of the disease in the United States, and in emphasizing the importance of screening."

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