< Back to Menu

BOWEL CANCER PREVENTION

Bowel cancer is a huge problem in the United States, second only to lung cancer. Almost 150,000 Americans will develop bowel cancer each year with about 57,000 deaths.

The overwhelming majority of all bowel cancers are detected after age 50, and many of those who get bowel cancer before then have diseases or a hereditary factor that predispose them to bowel cancer and may already be under special care.

Regular colon (bowel) examination will markedly reduce the risk of invasive bowel cancer. The colon examination is not done primarily to detect early cancers. It may indeed pick up early cancers, but the main purpose is to find and remove polyps, benign growths in the intestines that can become cancerous.

Most bowel cancer can be prevented by proper screening using one of two schedules:

a. Examination of the entire lower bowel, about 60 inches (colonoscopy), with a flexible instrument every ten years to detect and remove benign growths (polyps) that can become cancerous. If polyps are found, colonoscopies should be done every three to five years. The American College of Gastroenterology recommends colonoscopy every ten years for those of average risk. They also have recommendations for those they define as at moderately increased risk and for those felt to be at high risk. The recommendation for those with moderately increased risk does not differ substantially from the general recommendation of Healthful Life. The high risk group is defined as those having two or more first degree family relatives (mother, father, brother, sister) with bowel cancer or one first degree family relative with bowel cancer diagnosed under age 60. For those at high risk, they recommend colonscopy every three to five years.

Or

b. A more limited lower bowel examination every five years (sigmoidoscopy) with a flexible instrument that can visualize about 25 inches to detect and remove polyps

If a polyp is found in the lower bowel, a full colonoscopy must be done because, if a polyp is found in the lower bowel, there is a significant possibility of polyps in the upper part of the bowel.

These screenings should start at age 45 (our recommendation) or at age 50 (the recommendation of most screening groups). We start earlier because a substantial number of cases of bowel, cancer occur in men and women under age 50.

If polyps are found, regular followup studies are necessary because there is a reasonable likelihood new polyps will develop.

If the screening is done with sigmoidoscopy, annual studies of stool for blood (hemoccult test) should also be done. If bleeding is detected and then confirmed, a full colonoscopy is mandatory.

Full colonoscopy is the best screening procedure, but it also carries a small risk of serious bleeding or intestinal perforation. Besides, if everyone opted for full colonoscopy, we would not have nearly enough trained colonoscopists (gastroenterologists); and colonoscopy is considerably more expensive than sigmoidoscopy of the lower bowel.

So, full colonoscopy is the better test, but it is somewhat more dangerous and it is more expensive.

The bottom line is that invasive bowel cancer is largely preventable by removing the major risk factor, polyps that can become cancerous.