Colon Cancer: An ounce of prevention is worth a pound of cure!

In 2009 almost 150,000 cases of colon cancer occurred with nearly 50,000 deaths.  Colon cancer is the second leading cause of cancer mortality in the United States and is an equal gender offender – both genders are affected to the same degree.  Over the past 20 years these numbers have not improved dramatically despite advances in both surgical and medical therapy.  For years medical testing had relied on symptoms in hopes that the prompt evaluation based on timely reporting of these symptoms by patients to their physicians would lead to early detection of cancer and favorably impact survival – it is clear that this approach has not been successful.

In 2009 almost 150,000 cases of colon cancer occurred with nearly 50,000 deaths.  Colon cancer is the second leading cause of cancer mortality in the United States and is an equal gender offender – both genders are affected to the same degree.

Advances in the understanding of the cause of colon cancer – that colon cancer develops from a benign lesion called a polyp (adenoma-carcinoma hypothesis) – has provided a new strategy:  the prevention of colon cancer.  The National Polyp study in 1991 demonstrated that by detecting and removing polyps, colon cancer can be prevented from developing  Subsequent studies have suggested that up to 90% of colon cancer can be prevented by the widespread application of screening beginning at age 50.  In the fifth decade and each decade thereafter the incidence of colon cancer increases.  To achieve the potential of preventing up to 90% of colon cancer in the population requires the participation of the entire population.  In the past widespread participation has been inhibited by embarrassment and a notion that a family history of colon cancer is required to be at risk for colon cancer.  This is incorrect.  In the absence of a family there is a 6% chance (1 chance in 20) of developing colon cancer in one’s lifetime.  The presence of a first degree family member (brother, sister, mother, or father) increases lifetime risk to 10%.

What are the current screening recommendations for colon cancer?  There are multiple recommendations and it is important to discuss with your primary care physician which approach is most appropriate.  The most effective method for an average risk person who has no personal history of colon cancer nor family history is a complete colonoscopy at age 50 repeated every 10 years if no polyps are found  If polyps are removed and are demonstrated to be precancerous (adenomatous) the colonoscopy should be repeated at a 3 to 5 year interval.  There has been recent criticism of colonoscopy questioning its potential to prevent up to 90% of colon cancer.  These criticisms have highlighted two key points:  1) preparation for a colonoscopy is critical and 2) the physician who performs the examination should be an expert – preferably a board certified gastroenterologist.