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HEALTH OFFICIALS URGE SCREENING FOR COLON CANCER - GOOD SUGGESTION, SOME MISINFORMATION (May 2002) On March 13, 2002, the Department of Health and Human Services urged all Americans over age 50 to be screened for bowel cancer. Bowel cancer is diagnosed in about 150,000 Americans each year and there are more than 50,000 deaths annually. Perhaps, one-half the deaths can be prevented by detection and removal of benign growths in the bowel called polyps before they become cancerous. In some cases, the polyps have already turned to cancer, but the cancerous polyp can still be removed before it becomes invasive. The newspaper report included a considerable number of inaccuracies. 1. It says those over age 50 should have an examination of the lower bowel with a flexible instrument (flexible sigmoidoscopy) every two years. The proper interval is every five years (and Healthful Life starts at age 45). 2. The release says that, in addition, a full colonoscopy (a more extensive examination of the entire bowel (colon) with a flexible tube) should be done every ten years starting at age 50. In fact, colonoscopy every ten years is an alternative to flexible sigmoidoscopy every five years. If you do colonoscopy every ten years, a very complete examination, there is no reason to also do flexible sigmoidoscopy. Colonoscopy examines more of the bowel and detects at least one-third more polyps, but it carries a small, but real, increased risk of complications, including significant bleeding or perforation. It is also more expensive and should only be carried out by a well-trained specialist. 3. The recommendation is made for annual stool examinations for blood starting at age 50 (Healthful Life starts at age 45). That recommendation applies to those having flexible sigmoidoscopy every five years. Most experts do not urge annual stool tests for blood for those getting colonoscopies every ten years. 4. Risk factors for bowel cancer are listed. Included among the risk factors: smoking; alcohol; a high fat - high cholesterol diet; and obesity. But, (a) The evidence on high fat - high cholesterol diet is poor. (b) The evidence for alcohol as a risk factor is not very impressive. It could be true, but, even if it is, the amount of daily intake required to increase risk is not clear. (c) The evidence on smoking is weak. (d) The evidence on obesity is unsettled, and there are a lot of inconsistencies in the various reports. 5. Fruits and vegetables are said to be protective. That may be true, particularly for vegetables, but it is controversial. Still, there are plenty of reasons to include good amounts of fruits and vegetables in your diet. Left out of the report is that the evidence is quite good that regular moderate intensity exercise reduces risk of colon cancer (CLICK HERE for a list of moderately vigorous and vigorous physical activities). Also, left out is the possible protective effect of folic acid (everybody should have a daily intake of at least 400 micrograms of folic acid, obtained through high folate foods (CLICK HERE for list), folic acid-fortified foods, especially cereals, or a folic acid supplement. Indeed, it is perfectly reasonable to aim for a total of 800 micrograms a day through diet and supplement. The report may have a fair number of inaccuracies, but the bottom line is absolutely correct. Everybody starting at age 45 (or 50) should undergo screening for the prevention of and early detection of bowel cancer, either with: - flexible sigmoidoscopy every five years, plus annual stool testing for bleeding or - full colonoscopy every ten years, done by a specialist (some doctors will wish to do annual stool tests for blood for those undergoing colonoscopy every ten years; others will not. Either approach is reasonable). |
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