Prevention is the Best Medicine

By Dr. Ravikant Varanasi

March is National Colorectal Cancer Awareness Month

If you had about a 5 percent chance of developing a potentially fatal disease, wouldn't you want to do something about it?

Colorectal cancer (cancer of the colon or rectum) is the second leading cause of cancer-related death in the United States, with over 50,000 people losing their lives annually. Though screening could prevent approximately 60 percent of these deaths, about one out of every three Americans is not up to date with colon cancer screening.

The situation is even worse for South Asians, whose rate of colon cancer screening is far lower than that of white Americans and other ethnic minorities. Research suggests this may be for several reasons. Among many South Asians, cancer is considered a death sentence, and often a topic to be avoided. Colon cancer screening is considered low priority and often women think of colon cancer as a problem primarily affecting men. Issues of shame and modesty may play a role. Many South Asians also assume that consumption of a vegetarian diet prevents colon cancer. While some studies have shown a decreased risk, the risk is not eliminated. In fact, a 2019 UK study showed a higher risk of colon cancer in vegetarians compared to meat eaters. Clearly, more research in this area is needed.

According to the CDC, colorectal cancer is the third leading cause of cancer death among Asian Americans. While colon cancer is not extremely common in native South Asians, the rate appears to be higher in South Asian immigrants. This may be due to a variety of factors, including adoption of a Western diet, increased intake of sugar and fatty foods, decreased consumption of fruits and vegetables, and rising rates of obesity.

For the last 21 years, March has been designated as National Colorectal Cancer Awareness Month, which means there is no better time to discuss the importance of colon cancer screening.

The good news is that colon cancer can be prevented. Most colon cancers begin as polyps, small growths on the inside surface of the colon. Polyps come in different shapes and sizes, and they have different microscopic characteristics. Certain polyps, such as adenomas and serrated polyps have the potential to turn into cancer over several years.

The growth of polyps and transformation into cancer is often silent, as they seldom cause any symptoms. So even though a person may feel well and apparently be in good health, a colon polyp could be growing and surreptitiously transforming into a life-threatening malignancy.

Fortunately, getting screened can significantly reduce your risk of getting colon cancer. Because it usually takes several years for a polyp to turn into cancer, colonoscopy with polypectomy (polyp removal) can very effectively prevent malignancy. Additionally, timely diagnosis of colon cancer is essential, as treatment of early-stage colon cancer offers a greater than 90 percent chance of survival five years after the diagnosis.

No one will argue that getting a colonoscopy is enjoyable or exciting, and the doctor's office is everyone's least favorite place to visit. But after the twenty-minute exam is over, most people marvel about how easy the procedure was and how they should have never worried about it in the first place.

The day before the procedure, a clear liquid diet is consumed, culminating with drinking a laxative the evening before and morning of the examination. While this is usually the most disagreeable part of the process, it is also the most important. The cleaner your bowel preparation is, the better your colon examination will be. There are several different bowel preparations available and you can discuss the options with your doctor. Do not allow fear or dread of the cleansing process increase your risk of dying from a preventable disease. Since the procedure is done while you are sedated, the exam itself is painless and basically feels like a short nap.

In addition to the cleanliness of your colon, another critically important factor that determines the quality of your colon examination is your doctor. All doctors who perform colonoscopy should be aware of their ADR, or adenoma detection rate. This doctor's “report card" is the rate at which one or more precancerous polyps are found during a screening colonoscopy in patients 50 years and older. Current standards suggest a minimum ADR of 30 percent for male patients and 20 percent for female patients, but you can expect higher rates from your doctor. Don't be afraid to ask your doctor what his or her ADR is. Wouldn't you want your house inspected by someone who is likely to find a preventable problem, so you don't have to make costly repairs later? Your colon health should be no different. Studies have shown that for every 1 percent increase in a physician's ADR, the patient's risk of colon cancer decreases by 3 percent over the next year. If you are going through the process of getting a screening colonoscopy, it is vital that the exam be done well.

The American Cancer Society recommends that all individuals age 45 and older get screened for colon cancer. You might need a screening exam at a younger age if you have a family history of colon polyps or cancer, a personal history of inflammatory bowel disease, or other medical conditions. Your personal medical and family history will determine when and which type of colon cancer screening test is best for you. Screening tests for colorectal cancer are covered by your insurance.

There are many resourceful websites where you can get additional information, including the American Cancer Society ( Cancer.org) and the American Society for Gastrointestinal Endoscopy colorectal cancer awareness website (Screen4coloncancer.org).

If you have not done so already, talk to your doctor about getting screened for colorectal cancer. It is an easy, safe, and proven way of reducing your chance of dying from a very common and preventable disease. Having a colonoscopy will give you peace of mind. And it may just save your life.

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Dr. Ravikant Varanasi is a Fellow of the American Gastroenterological Association and practices in his Pittsboro, Sandford, and Pinehurst offices. Contact: 919-292-6110 for an appointment or visit Pinehurstmedical.com.