Apr 25, 2014 — Colorectal cancer will kill 50,000 Americans this year. It is the second leading cause of cancer deaths in America - and it is absolutely preventable. Huntsman Cancer Institute’s Dr. N. Jewel Samadder talks about the different options for colorectal cancer prevention, including lifestyle changes. He also discusses the risk factors and signs of colorectal cancer.

Interview

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Host: It's a cancer that I certainly didn't really realize was the second leading cause of cancer deaths in men and women, and you might not have either. It is absolutely preventable. It's called colorectal cancer, and we're here with Dr. N. Jewel Samadder from Huntsman Cancer Institute. Let's talk about this cancer. Do a lot of people realize that it's as deadly as it is?

Dr. Samadder: People don't realize how deadly this cancer is and, more importantly, how preventable it is. Approximately 140,000 Americans will develop colorectal cancer this year, and 50,000 of them will perish from this cancer. It is very preventable because we have a number of technologies including colonoscopy, which is probably the leading option in the United States to prevent colorectal cancer by removing the precursor, polyps, that go onto form these in the colon or by detecting a colon cancer very early when the chance of cure is greatest.

Host: It must really frustrate you when you hear somebody passed away from a colon cancer death. How preventable is it, really?

Dr. Samadder: We know that colonoscopy should be able to hopefully prevent at least 90% of cases of colorectal cancer. A number of studies have shown that getting a colonoscopy reduces your risk of developing colorectal cancer by more than 70% after a single examination.

Host: Wow. That's pretty effective, isn't it?

Dr. Samadder: Yes.

Host: Very effective. What are some other things that somebody can do to help prevent colorectal cancer?

Dr. Samadder: There are a number of other options if people are not interested in receiving a colonoscopy. This includes stool-based testing with fecal-occult blood carts or FIT testing. These are both stool-based testing where small amounts of stool is placed on an indicator cart that can detect microscopic blood, and we know that colorectal cancers will often leak microscopic blood into stool. Another option is a barium enema, which is a radiographic technique, to look and examine the colon. Or a flexible sigmoidoscopy, which is a shorter colonoscope that goes in only halfway through the colon and can be combined with stool carts or a barium enema. Being aware of risk factors for colorectal cancer is also important. This includes smoking, alcohol consumption, a diet high in red meat and low in fiber, a sedentary lifestyle, a personal history of certain diseases like inflammatory bowel disease as well as a family or personal history of colon and rectal cancers.

Host: Why would somebody choose to get these other screening procedures done as opposed to a colonoscopy?

Dr. Samadder: The current guidelines advocate that all of those options, stool-based testing with fecal-occult blood carts, FIT testing, using advanced imaging such as a barium enema or colonoscopy are acceptable options that give patients the maximal amount of choice. However, colonoscopy is still the preferred option from the American College of Gastroenterology since it's been shown to have the strongest evidence for preventing colon cancer. One of the reasons colonoscopy is the preferred option is the other methods including the stool-based testing has to be repeated every single year, whereas a colonoscopy is generally repeated every five to ten years based on the risk factors of family history and where the polyps are found.

Host: It sounds like prevention is absolutely possible. I mean, you'd be silly not to get screening after 50.

Dr. Samadder: Prevention is definitely possible. People do not need to develop colorectal cancer, or if it does develop, we can capture it at a very early stage when it's highly curable.

Host: Plus also screenings are very important, too, because there aren't really any symptoms, are there, generally?

Dr. Samadder: That's a great point. The symptoms associated with colorectal cancer often only occur with late disease, and at that time, the chance of cure is much lower compared to early disease when there are very few symptoms. The symptoms one often talks about with colorectal cancer includes a change in bowel habits such as developing diarrhea, constipation, abdominal bloating, or gassiness. Maybe abdominal tenderness and blood in the stool. But as you can tell, many of these symptoms are non-specific. Many people, including pregnant women, will experience these symptoms throughout their lifetime.

Host: Yeah. So, after 50, how often should I be getting my colonoscopy?

Dr. Samadder: Well, the general recommendations are that you should start with a colonoscopy at age 50 in men and women and plan to repeat every ten years. If polyps are found in that colonoscopy, you should have a repeat within three to five years. If you're in the higher risk groups such as people who have a family history of colon cancer, often we will advocate for colon cancer screenings to start at age 40, or 10 years before the earliest family member with colon cancer and repeat every 5 years instead of the normal every 10 year repeat.

Host: And there are some lifestyle factors that are also included, things that I could actually change to help prevent even these polyps from developing?

Dr. Samadder: Exactly. There are a number of risk factors that people should be aware of that can increase the risk or propensity for developing colorectal cancer. Obviously, just older age. That's not one any of us can prevent.

Host: Unfortunately.

Dr. Samadder: Having a family or personal history of colon or rectal cancer is very important. Again, you can't modify it, but it's important to be aware of it. It's important to let your physician know so that the timing of colonoscopy can be arranged. A personal history of inflammatory bowel disease could increase your risk of colon cancer. Again, it's important for you to be aware of it and to let your physician be aware of that fact. Finally, some things that you could modify, a diet that's low in fiber and high in red meat are associated with colorectal cancer. That's something we could modify in our diet. Having a sedentary lifestyle: again, that's a major risk factor for colorectal cancers and a number of other diseases including cardiovascular disease. Finally, smoking is a risk factor for colon cancer as well as a number of other cancers and cardiovascular disease, and it's very important to consider smoking. If you are smoking, it's important to approach your physician about options for cessation. Most of these risk factors are associated with a two- or three-fold elevated risk for colon cancer.

Host: So when you say two- or three-fold, two or three times?

Dr. Samadder: Yes. Two or three times.

Host: Wow. Is that significant?

Dr. Samadder: Yes. Because the general population risk is 5 to 6%. If you increase that two or three times, your risk of developing colorectal cancer would be between 12 and 15% over your entire lifestyle.

Host: I had read something that if you get colon cancer, a lot of people tend to think you need to get a colectomy. Is that true?

Dr. Samadder: No. That is not true. Oftentimes, if the cancer is caught at a very early stage and it is confined to a small polyp, it could be removed purely through the colonoscope, and no surgery is required. If it's an early stage cancer that has progressed from the polyp itself, still, surgery can be limited to a resection, or removing only a small portion of the colon and reconnecting the colon with no need for an ostomy bag.

Host: Do you think that that's a general perception?

Dr. Samadder: That may be a general perception, but, really, the vast majority of patients will not require a colectomy.

Host: Yeah. And another good reason to get those colonoscopies.

Dr. Samadder: Exactly. Another good reason to get a colonoscopy is we can either prevent colon cancer altogether or capture it at a very early stage where a very limited surgery or removal through the colonoscope might be possible.

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