Equal Opportunity Threat
The third leading cancer in the US now strikes more women than men. Find out
how awareness and lifestyle choices can keep this low profile predator at bay.
Darlene Kipling felt like she’d been sideswiped by a city bus when her doctor announced that she had colon cancer. What made the diagnosis even more alarming is that Kipling, a registered nurse, tends to cancer patients for a living. “I really didn’t expect it to be colon cancer,” she says. “My symptoms were so minor. Probably if I had not been an oncology nurse, I would not have realized I had a problem until much later.”
The minor symptom that prompted Kipling, then 52, to see her physician would easily have been overlooked by most of us: a tiny speck of burgundy in her stool. She spotted it once, then again three weeks later. At the urging of her physician, Kipling underwent a colonoscopy (the most comprehensive test for colon cancer), where he discovered and removed three polyps, growths that project from the lining of the intestine or rectum.
Polyps, which grow on a stalk and may appear like a mushroom or a cherry on a stem, can turn into cancer with time. A biopsy of Kipling’s polyps determined that two of the mushroom-like growths were, indeed, cancerous.
Kipling was fortunate: The disease was early-stage. Colon cancer caught early can often be cured simply by removing the offending growths, but her doctor opted for a bowel resection, surgery that entails removing portions of the diseased bowel and reattaching the remainder to create a functioning colon. The surgery is significant and not without risks, including infection, abscess, fistula, obstruction and lifetime use of a colostomy bag. Fortunately, she came through it without a hitch.
Had Kipling not been a self-described “stool watcher,” she never would have detected what turned out to be a life-saving symptom. If she’d missed the sign, or waited, the symptoms would have progressed and could have included severe abdominal pain, constipation, bleeding and black stools. Early-stage colorectal cancer—which includes cancers of the colon, rectum, appendix and anus—is highly treatable, with a five-year survival rate of 90%, yet only 39% of all cases are diagnosed at this highly curable stage, mostly due to low rates of screening.
“The bottom line for me is that I had the earliest possible form of colon cancer,” says an indebted Kipling, who presently works for Cancer Treatment Centers of America at Southwestern Regional Medical Center in Tulsa, Oklahoma. “The lesson is that people need to check their stool.”
A Warning for Women
Once considered a man’s disease, colon cancer now afflicts more women than men. Colon cancer is the third leading cancer and the second leading cause of cancer death among both sexes in the US, but significantly more women than men are now diagnosed with the malady. The American Cancer Society estimates that 57,460 women will learn that they have colon cancer in 2006, compared to 49,220 new cases among men. Yet the disease continues to be perceived as more prevalent among men.
“It might be a bias in the medical community that we don’t think of women as having colon cancer as much as men,” says Eliot Edwards, ND, who treats patients at Complementary Medicine and Healing Arts in Vestal, New York and Oneonta, New York. “In general, over the years there’s been an inclination in medical research towards looking at men more than women in all areas.”
Colorectal cancers develop slowly over years and most begin as polyps, common in nearly half of all adults. Not all polyps are cancerous, but those known as adenomas, which constitute nearly three-fourths of all polyps, have the potential to turn malignant. Although the causes of polyps are not completely understood, these protruding lumps, which may look the same as normal colon tissue or ulcerate and bleed, are widespread in women and men who live in industrialized countries, suggesting that dietary and environmental factors—such as cigarette smoking, obesity and a low-fiber diet high in red meat and fat—are vital to their development. Over time, polyps are more likely to develop into cancer, with more than 90% of cases diagnosed in individuals older than 50.
Just like the plumbing in your house, avoiding a backup in your internal plumbing is crucial to maintaining a healthy colon and preventing the growth of polyps, explains Edwards. “If a person is constipated, metabolic waste is sitting in the colon for an extended period of time. By correcting constipation, it helps to decrease the tendency to develop polyps.”
In Edward’s experience, constipation is far more frequent among women, which may offer insight into rising rates of colon cancer among the fairer sex. The doctor urges his patients to adopt a constipation-fighting diet low in meat and dairy and high in fiber: “Fiber helps to increase buteric acid, a byproduct of good intestinal flora, which is shown to decrease the incidence of cancer.”
Although the landmark Nurses’ Health Study did not show a strong direct correlation between fiber intake and incidence of colon cancer, the Harvard School of Public Health, which sponsored the study, still recommends a minimum amount of 20 to 35 grams of dietary fiber per day in the form of fruits, whole grains, salads, vegetables and legumes.
Exercise is another approach to keeping bowels healthy and flowing freely. Numerous studies—including the American Cancer Society’s Cancer Prevention Study II and the Nurses’ Health Study—found benefits of up to a 30% to 40% reduction of colon cancer risk through carefully measured physical activity. “Exercise has definitely been shown to help in the prevention of colon cancer, as well as decrease constipation,” says Edwards.
Eat Well, Live Well
Simply by carrying excess body weight, your chances of developing colon cancer are greatly increased. “Obesity is an independent risk factor for colon cancer,” says Pankaj Vashi, MD, gastroenterologist and chief of surgery at Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Illinois. “If everything else is equal, your chance of getting colon cancer is significantly higher if you are obese.” The logical way to reduce the risk of developing colon cancer, suggests Vashi, is to initiate a program that incorporates weight loss, dietary changes and exercise.
“In my opinion, the most important thing is diet,” says Vashi, who notes that in India, his native country, colorectal cancers are very rare. “That’s because 90% of the Indian population, even today, is vegetarian.” In some families, genetic factors can predispose members to colon cancer, a syndrome known as familial adenomatous polyposis (FAP), but the majority of colorectal cancers are clearly attributed to lifestyle.
Vashi suggests initiating lifestyle changes before polyps ever have a chance to develop. “The same instructions hold true for heart disease and colon cancer,” he says. “A low-fat, high-fiber diet, weight reduction, and obviously avoiding chemical toxins in your body like smoking and alcohol.”
It also makes good sense to add a variety of vitamin and mineral supplements to your daily routine. “These are definitely plus points that have been shown to reduce the incidence of colon cancer,” says Vashi. Helpful ones include selenium and zinc; calcium may decrease the risk of large colon polyps, reports the Journal of the National Cancer Institute. Studies have also shown the benefits of antioxidants like vitamins C and E, and beta carotene. “We are more on the go, producing more free radicals [which damage cells and can cause cancer], and we need something to reduce this.” By stabilizing free radicals, antioxidants may prevent damage that they might otherwise cause.
Since colorectal cancer usually causes no symptoms in its early stages, by the time an individual experiences pain or bleeding the disease is often advanced. Given that 75% of colorectal cancers have no risk factors other than age, both the National Cancer Institute and the American Cancer Society recommend that screening for colon cancer should be part of routine care for all adults starting at age 50.
While there are several methods to screen for polyps, including a stool blood test, barium enema x-ray and sigmoidoscopy, they can be limited in their ability to diagnose colorectal cancers. At the same time, checking your stool or looking for other signs is inadequate, as symptoms come and go, or there may be none at all.
Colonoscopy is the most effective examination because it offers direct visualization of the entire colon and allows the doctor to remove polyps for laboratory analysis. Characteristics, number and size of polyps are easily analyzed under a microscope throughout the procedure. The colonoscopy itself is relatively simple; after being given a sedative and pain reliever, the patient lies on his or her side. A flexible colonoscope is gently inserted and advanced. The most difficult part of the exam, say many, is the preparation, which involves fasting and cleansing the bowel. “Ninety-nine percent of my patients would come back and ask me, ‘Are you sure you gave me this procedure?’” says Vashi.
While no one is expected to look forward to a colonoscopy, fear and embarrassment prevent many from pursuing the potentially life-saving exam. Many individuals who should get screened don’t, despite the fact that as many as 60% of deaths from the disease could be prevented if everyone over age 50 were checked once every decade. The Centers for Disease Control and Prevention (CDC) reports that only 42.5% of US adults aged 50 or older underwent a colonoscopy or sigmoidoscopy within the previous 10 years. Among African-Americans and Hispanics, screening rates run as low as 28%.
Darlene Kipling, for one, is grateful that she had a colonoscopy. Now cancer-free for 12 years, Kipling has made important dietary changes, including forgoing some favorite foods and cutting back on salt and sugar. “I stopped eating red meat. I had been a very big meat eater and there is a link between red meat eating and colon cancer,” says Kipling. “I was a chronic soda pop drinker, and I immediately stopped and began drinking bottled water.”
Colorectal cancer may not be polite dinnertime conversation, but maybe it should be. More and more patients have been asking doctors for colonoscopy exams, perhaps accounting for an average decline in deaths from colorectal cancers by 1.8% per year since 1990. Still, nearly 60% of all Americans have never had an exam. “Get yourself screened,” urges Vashi. “If that message is spread, then we have done our job.”