The Importance of Early Colorectal Cancer Diagnosis and Detection
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cancer or colorectal cancer is the third most common type of cancer
and the second leading cause of cancer death in the United States.
It has been estimated that achieving the population colorectal
cancer screening goals could save 18,800 lives per year.
Regular screening is the best way to detect polyps
in the colon before they turn cancerous. During regular check ups
(and after age 40 years), men and women should have annual rectal
exams. Beginning at age 50 years, one of the following tests should
be performed with the rectal exam:
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Fecal occult blood test (FOBT) and flexible
sigmoidoscopy (if normal, repeat FOBT yearly and the
sigmoidoscopy every 5 years).
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Colonoscopy (if normal, repeat every 10 years).
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Double contrast barium enema or colon x-ray (if
normal, repeat every 5-10 years). If you have a personal history
of inflammatory bowel disease, you should have a colonoscopy
every 1-2 years.
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A new computerized method, Virtual Colonoscopy,
allows doctors to visualize the inside of the colon. This test
is performed by inserting a tube into the rectum and the colon
is inflated with air. A CAT scan or MRI is then performed and a
3-dimensional image of the colon is projected onto a computer
screen and the doctor moves the tip of the tube through the
length of the colon to look for lumps that may be cancerous.
This test usually takes less than 5-minutes and
is non-invasive with less discomfort than the conventional
method of colon exams. Sedation is seldom needed and the patient
can go home immediately after the procedure.
If you have a family history of colon cancer, you
may have inherited a genetic mutation that can lead to polyps and/or
cancers developing at an early age, even in teenage years. Find out
if there is a family history of colon cancer and discuss with your
doctor the proper screening guidelines.
 Benefits
of Early Colorectal Cancer Diagnosis and Detection
There is convincing evidence that screening for
colorectal cancer with fecal occult blood testing, sigmoidoscopy, or
colonoscopy detects early-stage cancer and adenomatous polyps.
Although colonoscopy is considered to be the
standard, it is not perfect. Studies comparing colonoscopy and CT
colonography—show that colonoscopy may miss even polyps larger than
10 mm and colorectal cancer.
The evidence is convincing that there is a reduction
of colorectal cancer mortality in adults age 50 to 75 years by using
the 3 recommended screening tests. Evidence also show that the
benefits of detection and early intervention decline after age 75
years. Follow-up of positive screening test results requires
colonoscopy regardless of the screening test used.
Harms of Cancer Diagnosis and Screening
Procedures
The primary established harms of colorectal cancer
diagnosis and screening are due to the use of invasive procedures
initially or in the evaluation sequence. Harms may result from the
preparation the patient undergoes to have the procedure, the
sedation used during the procedure, and the procedure itself.
Colonoscopy
In the United States, perforation of the colon
occurs in an estimated 3.8 per 10,000 procedures. Serious
complications—defined as deaths attributable to colonoscopy or
adverse events requiring hospital admission, including perforation,
major bleeding, diverticulitis, severe abdominal pain, and
cardiovascular events—are significantly more common, occurring in an
estimated 25 per 10,000 procedures.
Flexible Sigmoidoscopy
Evidence is adequate that serious complications
occur in approximately 3.4 per 10,000 procedures.
Fecal Tests
Evidence is inadequate about the harms of fecal
tests is lacking.
Using CT Colonography for Colorectal Cancer
Diagnosis
The risks for perforation associated with screening
CT colonography in research settings are estimated to be 0 to 6 per
10,000 CT colonography studies. However, these estimates may be
higher than what can be expected in screened populations because the
studies included symptomatic populations.
Radiation exposure resulting from CT colonography is
reported to be 10 mSv per examination. The harms of radiation at
this dose are not certain, but the linear no-threshold model
predicts that 1 additional individual per 1000 would develop cancer
in his or her lifetime at this level of exposure.
The cumulative radiation risk from the use of CT
colonography for colorectal cancer diagnosis should be considered in
the context of the growing cumulative radiation exposure from the
use of other diagnostic and screening tests that involve radiation.
On the other hand, improvements in CT colonography technology and
practice are lowering this radiation dose.
Recommended Reading
Prescription for Herbal Healing: An Easy-to-Use A-Z Reference to
Hundreds of Common Disorders and Their Herbal Remedies, Phyllis A.
Balch, CNC (2002), NY: Penguin Putnam, Inc.
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Page Content Obtained From
Phyllis A. Balch, CNC (2006). Prescription for Nutritional Healing,
Fourth Edition. NY: Penguin Putnam, Inc.
This book offers a practical A-to-Z reference to
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