Colon cancer back pain

Colorectal cancer is a leading cause of cancer death among Americans, but with screening and early detection, colon cancer can be caught and cured.

Jay Monahan had everything to live for. A handsome and successful attorney, he had become the legal analyst for NBC, where his wife, Katie Couric, works as the cohost of the "Today" show. But in 1997, he received the shocking news: He had colon cancer. The disease spread rapidly, and his life was tragically cut short just eight months later. At 42 years of age, he died, leaving behind Katie and two young daughters.

Jay Monahan was just one of some 55,000 Americans who die each year of colon and rectal cancer. Approximately 138,000 new cases will be diagnosed in 1999. The surprising thing is that it doesn't have to be this way. A lot is known about how to prevent colon cancer and how to find it before it gets dangerous. Caught early, this kind of cancer can have a very good long-term outlook. But more often than not, colon cancer isn't found in the early stages.

Misperceptions about colon cancer abound. Many women believe that colon cancer is a "man's disease." The fact is that just as many women get the disease as men. Others think it only runs in families. While it's true that colon cancer is more common in those who have close relatives with the disease, less than 10 percent of cases can be blamed on an inherited gene defect. The bottom line is that any of us can get it.

But there is good news about preventing colon cancer. We now have two weapons that can protect us: primary prevention and screening. Primary prevention refers to the actions we can take to stop the cancer from ever beginning, through diet, exercise, and other lifestyle factors. Screening tests, intended to find the disease at an early stage, play an important role because colon cancers take so many years to develop. Only in the past few years have we begun to realize the power both of these weapons hold.

An Ounce of Prevention

Recently, the Harvard Center for Cancer Prevention issued a report that summarized the impact of diet and lifestyle factors on cancer. Their startling conclusion: 50 percent of all cancer is preventable, and 35 percent of all cancer deaths in the United States can be attributed to poor diets, obesity, and a sedentary lifestyle. Although these statements were made about cancer as a whole, they are especially true about colon cancer.

In a sense, colon cancer is a disease of progress, being much more common in the United States than in the less-developed world. Our foods are a good example. Grains and produce start out with a host of natural cancer-protective substances. In the process of making the foods more "refined," a lot of the good nutrients are removed, such as the bran from wheat. Cancer researchers have spent years studying the effects of various foods on colon cancer. Some foods appear to prevent, while others are more likely to cause, colon cancers (see "What's for Dinner" page 39).

Does drinking alcohol increase the risk of colon cancer? While an occasional cocktail probably doesn't hurt, it does appear that moderate to heavy alcohol intake raises the risk, especially when combined with poor diet. And smoking hurts more than just the lungs--it's believed to contribute to about 25 percent of colon cancer.

Exciting new research suggests that colon cancer risk may be cut by calcium supplements. Calcium, found in dairy products and some vegetables, is a vital nutrient for good health, but most of us consume much less than 1,000 mg per day, the currently recommended daily allowance for adults. Folic acid, found in green, leafy vegetables and many vitamin supplements, appears to be protective against colon cancer; vitamin E shows similiar potential as well. The coming years hold the promise of bringing answers about what impact these supplements will have in cancer prevention. Meanwhile, it makes sense to supplement with a multivitamin (look for one that includes folic acid and vitamin E) and calcium whenever our diets fall short.

Lack of exercise is a clear cause of colon cancer, according to researchers at the Harvard Center for Cancer Prevention. They see public policy changes as a way to promote more physical activity. Most important on their priority list are boosting physical education in schools and making more safe, affordable spaces for everyone to exercise, such as more sidewalks and bikeways.

"Almost any kind of physical activity is good for prevention of cancer," said Dr. Graham Colditz, director of education at the center. "But you have to have a safe neighborhood to go out and walk in."

Modern technology, from automobiles to personal computers, also has paved the way for many of us to be come couch potatoes. "Exercise has been engineered out of our lives," says Dr. Michael Thun, epidemiologist and cancer researcher for the American Cancer Society. "We need to find a way to get exercise back into our daily lives."

Despite the obvious benefits, more than 60 percent of us fail to get the daily exercise of 30 minutes or more that experts recommend as a goal to help prevent cancer. If we did, 10 to 15 percent of all new colon cancers might be prevented. Obesity also raises the risk of colon and other cancers.

Screening: The Other Weapon

A colon cancer doesn't develop overnight. It usually starts as a tiny polyp, a benign growth on the lining of the colon. Over a period of many years, the polyp may slowly enlarge and later transform into a cancer. At times, the growing polyp may give off tiny amounts of blood into the bowel movement. This blood may be hidden to the naked eye, but found by fecal occult blood testing (FOBT). Finding this blood is an important clue that there may be a polyp or cancer growing.

FOBT is usually done in the privacy of your home, with a kit from your physician. A narrow popsicle stick is used to transfer a tiny stool sample onto a collection card, which is then mailed back to the doctor's office. The doctor's laboratory tests the card with a chemical that turns bright blue if blood is present in the sample.

The bad news is that people aren't getting the painless and inexpensive test, which could make a big dent in colon cancer mortality. Dr. John Bond, professor of medicine at the University of Minnesota, estimates that only about 25 percent of people who should be screened actually get the testing, which is now paid for by Medicare and some other insurance companies.

"People are unaware that colon cancer is the second leading cancer killer," said Dr. Bond, who is co-director of the Digestive Health Initiative Colon Cancer Campaign, an organization dedicated to increasing public awareness. "They're unaware of how effective screening is at cutting the death rate from colon cancer." Screening tests may find polyps before they turn into cancer. At other times, screening finds cancers that are already there, but small and easier to cure. According to recent studies, at least 50 percent of colon cancer deaths could be avoided if the current screening guidelines were being followed.

Yearly FOBT is recommended for all men and women beginning at age 50, because the risk of colon cancer increases as we age. People who have a family history of colon cancer or a personal history of polyps, colon cancer, or inflammatory bowel disease need to begin undergoing screening tests at an earlier age. Those who have more than one close relative with colon cancer also should talk to their doctors about whether genetic testing is right for them.

FOBT isn't perfect--it doesn't find every colon cancer. That's why experts now recommend a sigmoidoscopy every three to five years beginning at age 50. In this test, a narrow flexible tube containing optical fibers is put into the rectum and advanced about two feet up into the colon. If polyps or masses are found, a tiny mechanical arm reaches out from the tube to remove them. A digital rectal exam is also recommended at the same time. In some cases, the doctor may instead recommend that the entire colon be examined either with a longer scope (colonoscopy) or with a colon x-ray.

Research News: Will an Aspirin a Day Keep Cancer Away?

Most people have heard that an aspirin a day can cut down on heart attacks and strokes. Now there's evidence that it may reduce the development of colon cancer, too. Large-scale studies are now in progress to find out what role aspirin or other anti-inflammatory drugs should play in colon cancer prevention. The question they hope to answer: Will the benefits outweigh the risk of side effects?

There's also a connection between estrogen replacement therapy and colon cancer. While long-term estrogen use may increase the risk of breast cancer, it actually lowers the occurrence of polyps and colon cancers, according to several studies. Though no one knows why, estrogen users had a 30 percent lower risk of colon cancer than those who haven't taken it.

We Know It, But Can We Do It?