Screen for Life

February 9, 10:42 PMHealth ExaminerAngela Spears

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People aged 50 years or older should be screened

Colon cancer — which includes cancers of both the colon and the rectum — is the second-leading cause of cancer death in the United States. Regular testing for and removal of colon polyps — small, protruding clumps of cells on the inside wall of the colon — can prevent colon cancer. According to the Centers for Disease Control and Prevention (CDC) in 2004, more than 53,000 people in the United States died of colorectal cancer (26,881 men and 26,699 women). Katie Couric has been a part of the CDC's multi-year Screen for Life: National Colorectal Cancer Action Campaign.

Colon cancer is one of the most preventable – but least prevented – of all cancers. More than 90% of colon cancers occur in the 50 and older age group. A colonoscopy can detect more than 95% of early colon cancer and it is the only test that can also prevent cancer. This is because a doctor can remove polyps – small growths that may develop into cancer if left alone – before they turn into cancer.

Colon cancer generally grows slowly. It can develop anywhere along the wall of the large intestine, which includes the colon and the rectum. Colon cancer usually begins as an area of abnormal cells (lesion). Most of these abnormal lesions begin as tiny polyps — raised clumps of noncancerous (benign) cells growing on the inner lining of the large intestine. Another type of precancerous lesion (nonpolypoid lesion) forms as a flat or recessed area on the wall of the colon. Nonpolypoid lesions are less common than polyps.

Not all polyps become cancerous, but nearly all colon cancers start out as polyps.The two most common types of polyps are:

• Hyperplastic polyps. Often less than 5 millimeters (mm) in size, these polyps — whose cells look and act differently from normal cells — rarely become malignant
• Adenomatous polyps. Adenomas — whose cells look and act differently from both normal and hyperplastic cells — are more likely to become cancerous as they grow

The 2008 guidelines developed by the American Cancer Society, the American College of Radiology and the U.S. Multi-Society Task Force on Colorectal Cancer recommend several screening options. Each option has benefits and drawbacks. Together with your doctor, you can discuss which is best for you:

•  Fecal occult blood test (FOBT) annually
• Stool DNA testing, though it isn't clear how often this test should be repeated
• Flexible sigmoidoscopy every five years
• Double-contrast barium enema every five years
• Colonoscopy every 10 years
• Virtual colonoscopy (CT colonography) every five years

How to lower your risk:

• Don’t smoke
• Maintain a healthy weight
• Exercise regularly. Get at least 30 minutes of moderate physical activity (such as a brisk walk) at least 5 days a week
• Eat a healthy diet

Get checked. If you're 50 or older and have no other risk factors, you're considered at average risk. But in some people at high risk of colon cancer — such as those with a strong family history of the disease — the cancerous change may occur more quickly.