By Dr. Jun R. Ruiz
THE WORLD celebrates Colorectal Cancer Awareness Month this month of March. This is an awareness campaign to promote colorectal cancer (CRC) screening. CRC is the third most common cancer among Filipinos after breast and lung cancers.
Cancer screening can save lives — this strategy has been shown to reduce CRC risk by as high as 70% — but not that many people are being screened. As an advocate, I believe that now is the time to educate the general public and mobilize the health community to beat CRC.
Almost all of these cancers start as abnormal growths in the lining of the colon and rectum called polyps. These polyps grow slowly and it can take around 10 years for some polyps to develop into cancer — not all polyps progress to cancer. The removal of these polyps reduces the risk of developing cancer. One thing to consider is that polyps and early cancer usually do not cause complaints, like rectal bleeding, constipation, and abdominal pain that are experienced by patients in later stages of cancer. It is this lack of symptoms that is the danger.
RISK FACTORS FOR COLORECTAL CANCER
The factors that increase the risk for cancer in the colon and rectum are:
• age greater than 50;
• personal history of colorectal cancer or advanced polyps;
• family history of CRC; and,
• pre-existing diseases involving long-term inflammation of the colon
Age is the most common risk factor for this cancer, as 90% of these cancers occur after the age of 50. A family history of a first-degree relative with CRC increases the risk two to three-fold. The risk is especially higher when that relatives’ cancer occurred before the age of 60, or when two relatives have CRC.
There are also lifestyle factors that likely contribute to the formation of cancer in the colon and rectum. These are: cigarette smoking, alcohol consumption, obesity, and, a diet high in the consumption of saturated fat and red meat, and low in fiber.
Living a healthy lifestyle by avoiding smoking, not consuming excessive alcohol, exercising regularly, and eating the right food is already a good idea as it lowers your risk for emphysema, cirrhosis of the liver, metabolic syndrome, diabetes, and heart disease. In addition, all these measures can lower your risk for cancer in the colon and rectum.
In several countries, CRC screening is recommended for people starting at the age of 50. Screening at an earlier age, usually at 40, is advocated in first-degree relatives of patients with colorectal cancer, and even earlier in those with other additional risk factors.
The gold standard for CRC screening is a colonoscopy as it can detect early lesions like polyps and these can be removed during the procedure. The process involves inserting a flexible fiberoptic scope with a camera through the rectum and carefully advancing it to visualize the colon, all while the patient is under mild anesthesia. However, it is an invasive test and has the potential to cause complications like bleeding and puncturing the colon.
Some patients may not want to have an invasive test, or may find the cost of a colonoscopy prohibitive. A good screening alternative is a stool test called the Fecal Immunochemical test (FIT). FIT detects only human blood and is specific for bleeding in the colon. Persons who have a positive FIT are 12 to 40 times more likely to have cancer than those with a negative test. The test is repeated every year if the initial test is negative. If the test is positive, a colonoscopy is needed to rule out the presence of cancer.
As a gastroenterologist who advocates CRC screening, I recommend a screening colonoscopy for persons between 50 to 75 years of age who are healthy, unless the risks of the procedure is high in that patient. If the person does not want to start with a colonoscopy, I suggest using the FIT. After a discussion with his gastroenterologist, the patient can choose his preferred screening test.
A shared decision between the patient and his physician is very crucial. By undergoing either method of CRC screening, we would be able to beat colorectal cancer.
Dr. Jun Ruiz is a Diplomate of the American Board of Internal Medicine in Gastroenterology, and a consultant at The Medical City in Pasig, Metro-Manila. He finished his Gastroenterology fellowship at the George Washington University in Washington D.C. and was an Attending at the Kaiser Permanente in California for nine years. He is the first Filipino chapter author of the best-selling medical reference The Merck Manual. He is connected with the Colorectal Unit of The Medical City.