Dr. Kevin Most: Colon cancer
March is colon cancer awareness month, so we thought we would take a few minutes and discuss new colon cancer screening, treatment and most importantly some studies that should make us more aware of this illness and what we can do to prevent and identify it.
Each year in the United States we identify close to 150,000 new cases of colon cancer. Of those cases close to 7,000 are diagnosed here in Illinois, 3,200 in Indiana, 4,500 in Michigan and 2,500 in Wisconsin so close to 10 percent of colon cancer cases arise from the WGN listening area. It remains the 3rd most common cause of cancer. We have had some advancement in identification and treatment but we still only have a five year survival rate of 65% and this is mainly due to screening compliance.
Currently the screening recommendations from the American Cancer Society for colon cancer start at the age of 45. You may remember last year when we discussed the recommended change from age 50 to 45. Eddie Olczyk had been diagnosed with advanced stage colon cancer in August of 2017 at the age of 50. We followed him thru his battle with this disease and were very happy when almost a year ago he shared with us that he was disease free and had beaten cancer. Eddie continues to be a huge advocate for colon cancer screening and treatment and the medical professionals in Chicago appreciate him sharing his story and his push to get everyone screened.
Both Steve and I have had colon cancer impact a loved one. Many of you may remember the “Wine Diva” who would join Steve on the show to discuss the newest news on wine, she lost her fight with colon cancer at the age of 50. Personally, my cousin Kathleen fought a tough battle with colon cancer and passed away at the age of 50. I was fortunate to have interacted on a personal level with all three of them and know that each of them were in great health and took great care of their health. Remember that colon cancer will have little or no symptoms at the onset, again elevating the need for screening This trend of younger individuals being diagnosed with advanced colon cancer along with other environmental factors (diet) pushed the ACS to lower the screening age for individuals at average risk to start at 45.
Fortunately we have spread the importance of colon cancer screening across the country and very few individuals can say they don’t know that they should be screened. That being said we still have millions of individuals who do not have the routine screening performed even when they know it can save their life. For many the thought of a colonoscopy or the price of a colonoscopy has allowed them to postpone it in their mind, which in many cases has allowed the cancer to advance beyond a point where it can be treated easily. The advances in screening as well as the insurance coverage should eliminate the hurdles that many have placed in front of themselves. The ACA plans cover screening colonoscopy. We also now have an accurate screening test that is done with a stool collection called Cologuard, you may have seen TV commercials on this product. Despite removing all of the hurdles we continue to see lower than expected screening rates. Let’s go over our simple screening options
1.) A simple test that is often done in a doctor’s office looks for any blood in the stool, this may be a sign of cancer- done once a year
2.) Stool DNA test where abnormal DNA is detected- done once every 1-3 years
3.) Sigmoidoscopy- similar to a colonoscopy but does not cover as much area as a colonoscopy- should be done every 5 years with a stool test done every year
4.) Colonoscopy – done every 10 years if normal
5.) CT Colonoscopy- CT scan that looks for cancer- still being perfected but recommended every 5 years
The benefit of the colonoscopy is that it can be used not only as a screening test but can also be used to treat early colon cancer at the same time. Although the Cologuard is much easier for patients to complete, those who test positive will need to have a colonoscopy to identify where the cancer is and in some cases remove it as well. One would hope that with the options for colon screening we can increase our screening rate. This increase will allow for early identification and treatment and thus extend the lives of those with this disease. It is interesting to look and see how this is being handled around the world, in some countries they are using the stool test as the screening and colonoscopy is only being used for those individuals who has a positive stool test. Time will tell how this strategy works on screening rates as well as long term outcomes.
One might ask, why this is one of the most common forms of cancer in some areas of the world and is almost nonexistent in other areas of the world. One may think that poor screening capabilities would lead to some countries having high occurrence rates and death rates. What we have found is that diet and the environment have a much bigger impact than the screening capabilities. As we look at rates in Africa where fiber is a key component of the diet and the lack of processed and fatty foods is minimal we see rates that are dramatically lower than seen here in the US. Many argue it is not only the diet but also many other environmental impacts that we see in developed countries. Let’s put this in perspective, in the very populated country of Nigeria there have only been a handful of cases each year in the entire country.
Why? Let’s look at the risk factors for colon cancer
2.) High Fat diets
3.) Lack of Vit D
4.) Low fiber diets
5.) Alcohol use
6.) Tobacco use
7.) Lack of activity
8.) You have a family member with colon cancer
9.) You have inflammatory bowel disease
Now you can see why we have higher rates here in the US versus large areas in Africa.
What can you do to reduce your risk of colon cancer?
1.) Diet changes- we know that individuals with lower animal fat and more fiber in their diet will lower their risk
2.) Aspirin use actually appears to prevent colon cancer as well, a recent study concludes that low dose aspirin may reduce the risk of colon cancer by 40%
3.) Decreasing or eliminating tobacco
4.) Decrease your use of alcohol
5.) Increase your activity
6.) Minimize your total body weight
7.) Know your risk factors and act on them, if you have a family member with colon cancer your screening should start at the age of 40, or 10 years before the family member was diagnosed.
As we have talked about the increase in cases of colon cancer in those under the age of 50, we are starting to see more research as to why this is occurring. A study came out earlier this month that has shown a connection between prolonged time spent sitting while watching TV has increased the risk of colon cancer in younger Americans. This study looked at 90,000 individuals, under the age of 50, and it was noted that individuals who spent more than 1 hour sitting watching TV had a 12% higher chance of colon cancer when compared to those who watched less than an hour. What is even more concerning is the 70% increased chance of colon cancer for those who watch more than 2 hours of TV a day. This is the first study to track the link between sedentary behavior patterns with the risk of colon cancer for those under the age of 50.
This study did not look at BMI or exercise and is being looked at the sedentary action as a distinct risk factor for colon cancer for those under the age of 50. This study will now be coupled with other studies that have shown that sedentary action for long periods of time impact us in many ways, elevated blood pressure, elevated blood sugar, excess body fat and cholesterol. It appears that a sedentary life style has a larger impact on our health than anyone could expect.
Another study that came out last month from the Salk Institute showed that high fat diets have a large impact in the growth of colon cancer. They feel that this is the reason for the findings of the increase in younger cases of colon cancer. This is based on the much higher fat diet that these individuals have been exposed to. The concern that the very common high fat diet that we see in the United States will continue to drive that we will have higher cases of colon cancer in younger patients. The need to start screening at the age of 45 will have an impact.