Colorectal Cancer Screening - Frequently Asked Questions

March has traditionally been designated Colorectal Cancer Awareness month and for the present year, President George W. Bush has endorsed it. He has encouraged Americans to join in the crucial effort to save lives by taking action against colorectal cancer by talking with healthcare providers about screening, telling friends and family members about the importance of early detection, and providing support for those diagnosed with colorectal cancer. The Center for Disease Control, Centers for Medicare and Medicaid Services and National Cancer Institute are participating together in the Screen for Life: National Colorectal Cancer Action Campaign to educate Americans aged 50 and older, particularly minority groups, about the benefits of colorectal cancer screening. Along with other similar groups, the focus is on screening and follow-up care for people who traditionally lack access to quality health care.

What is Colorectal Cancer and why is it being given such importance?
Colorectal cancer is a disease in which cells in the colon or rectum become abnormal and divide without control, forming a tumor. (The colon and rectum are parts of the body’s digestive system that remove nutrients from food and store solid was te until it passes out of the body.) Cancer cells invade and destroy the tissue around them and they can break away and spread to other parts of the body.

Colorectal cancer is the fourth most common type of cancer and the second leading cause of cancer death in the United States. Each year, 135,000 new cases are diagnosed and more than 56,000 people die from colorectal cancer. There is not much difference between men and women. Its incidence varies among different racial and ethnic groups. Immigrants to the United States (from countries where rates of colon and rectal cancer are lower than in the U.S.) have higher rates than do those who remain in their native country. Studies have shown that first and second generation American offspring from these migrant groups develop these cancers at rates that affect the United States white population.

Common signs and symptoms of colorectal cancer include:
- A change in bowel habits or a feeling that the bowel does not empty completely
- Blood (either bright red or very dark) in the stool
- Stools narrower than usual
- General abdominal discomfort
- Weight loss with no known reason
- Constant tiredness
- Vomiting

These symptoms may be caused by colorectal cancer or by other conditions. It is important to check with a doctor. However, THERE MAY NOT BE ANY SYMPTOMS.

What is screening, and why is it important?
Screening means checking for health problems before they cause symptoms. Screening can find some cancers before they spread to other parts of the body.

Colorectal cancer screening is used to detect cancer, polyps that may eventually become cancerous, or other abnormal conditions. If screening detects an abnormality, diagnosis and treatment can occur promptly. Colorectal cancer is generally more treatable when it is found early.

What happens if a colorectal cancer screening test shows an abnormality?
If screening tests find an abnormality, the health care provider will perform a physical exam and evaluate the person's personal and family medical history. Additional diagnostic tests may be ordered such as blood tests, x-rays and sigmoidoscopy or colonoscopy.

If an abnormal area is found during a sigmoidoscopy or colonoscopy, a biopsy is performed to determine if cancer is present.

What methods are used to screen people for colorectal cancer?
Health care providers may suggest one or more of the tests listed below for colorectal cancer screening.

A fecal occult blood test (FOBT) checks for hidden blood in the stool. When performed every 1 to 2 years in people age 50 to 80, it reduces the number of deaths due to colorectal cancer.

A sigmoidoscopy is an examination of the rectum and lower colon using a lighted instrument called a sigmoidoscope. Sigmoidoscopy can find precancerous or cancerous growths in the rectum and lower colon. Regular screening with sigmoidoscopy after age 50 can reduce the number of deaths from colorectal cancer.

A colonoscopy is an examination of the rectum and entire colon using a lighted instrument called a colonoscope. Colonoscopy can find precancerous or cancerous growths throughout the colon, including the upper part of the colon, where they would be missed by sigmoidoscopy.

A double contrast barium enema (DCBE) is a series of x-rays of the entire colon and rectum, which are taken after the patient is given an enema with a barium solution and air is introduced into the colon. The barium and air help to outline the colon and rectum on the x-rays. DCBE is more effective at detecting larger growths than smaller ones.

A digital rectal exam (DRE) is often part of a routine physical examination where the health care provider inserts a lubricated finger into the rectum to examine nearby structures, such as the prostate in men. Unlike the colorectal cancer screening tests described above, DRE allows for examination of only the lowest part of the rectum.

Additional information about these tests is available from the National Cancer Institute's (NCI) Web site at http://cancer.gov/colon.

Do insurance companies pay for colorectal cancer screening?
Insurance coverage varies. People should check with their health insurance provider to determine their colorectal cancer screening benefits. Medicare covers several colorectal cancer screening tests for its beneficiaries. Specific information about Medicare benefits is available on the Medicare Web site at http://www.medicare.gov/health/overview.asp.

The NCI booklet What You Need To Know About™ Cancer of the Colon and Rectum provides more information about the diagnosis and treatment of colorectal cancer. This publication and other cancer resources are available from the NCI Publications Locator at http://cancer.gov/publications, or by calling the Cancer Information Service (CIS) toll-free at 1-800-4-CANCER (1-800-422-6237) (see below).

Resources
Cancer Information Service
Toll-free: 1-800-4-CANCER (1-800-422-6237)
(for deaf and hard of hearing callers): 1-800-332-8615

Dr Irfan Khan Sandozi