Dedicated to Discovery. Committed to Care.

Making a difference in colorectal cancer
By Richard Saltus

A photograph of Denise Powers

Vigorous exercise is part of Denise Powers' regimen aimed at preventing colorectal cancer.

Baseball star Eric Davis has fought it. Ronald Reagan and U.S. Supreme Court Justice Ruth Bader Ginsberg had it, too. "Today Show" host Katie Couric even underwent a colonoscopy on national television to highlight the disease that claimed her husband's life.

A photograph of Katie Couric

NBC-TV's Katie Couric launched a national campaign in 2000 to increase colon cancer awareness.

Yet despite the experiences of these public figures, the threat of colon and rectal cancer still hasn't hit home for many Americans — and thousands are dying needlessly because people haven't taken advantage of the screening tests that can save lives.

"It's unfortunate, but colorectal cancer doesn't have a high profile," says Sapna Syngal, MD, MPH, of Dana-Farber's Center for Gastrointestinal Oncology (CGO). This is especially troubling as it will be diagnosed in some 135,400 Americans in 2001— approximately 98,200 of them colon cancer cases and 37,200 cases affecting the rectum. ("Colorectal" is the most comprehensive term, but people commonly use "colon cancer" to cover both.)

Whether it's lack of awareness, squeamishness about the subject, or reluctance to have an inconvenient screening procedure, only one-third of those who should be getting tested are doing so. As a result, colon cancer is often diagnosed after it's become hard to treat and almost impossible to cure.

A photograph of Sapna Syngal, MD, MPH

Sapna Syngal, MD, MPH

"This is a disease where you can really make a big difference," emphasizes CGO Director Robert Mayer, MD, a national expert on colorectal cancer. "You find the precancerous polyps, remove them, and reduce the risk dramatically of developing this cancer." And adopting lifestyle changes that may protect against colon cancer has no downside, he adds. "That's something everybody ought to be doing, particularly those with a family history of the disease."

That is precisely why, to celebrate her 50th birthday this year, DFCI patient Denise Powers took on a "minitriathlon," running, biking 20 miles, and swimming across a mile-wide lake. Not only does the Syracuse, N.Y., math teacher enjoy the strenuous exercise, but it's also a way to counter the unusually high risk of colon cancer in her familycaused by an inherited genetic mutation.

Besides keeping active, Powers shuns red meat and takes daily aspirin, calcium, and multivitamins. She also has an annual colonoscopy, in which a slender, flexible tube with a fiberoptic core and a video camera at its tip is used to scan the inner surface of the entire large intestine for polyps (precancerous growths). The test is done under sedation. "I'm doing everything I'm supposed to be doing to prevent the disease," she says. People at average risk need colonoscopies only once every 10 years after age 50. Power's risk is much higher because of her genetic predisposition for the condition known as hereditary nonpolyposis colon cancer syndrome.

Paths of Progress, Fall/Winter 2001

Paths of Progress Archive

Catching it early

Colorectal cancer is highly preventable if precancerous polyps are detected and removed. The cancer itself is very treatable if caught early and limited to a small section of the colon.

Screening recommendations:
For people at average risk, screening should begin at age 50. There are three options:

  • A fecal occult blood test (FOBT) annually and flexible sigmoidoscopy every five years
  • A colonoscopy every 10 years
  • A double-contrast barium enema every five to 10 years

The doctor should perform a digital rectal exam at the time of these tests.

People at above-average risk should begin screening earlier and do it more often, in consultation with their physician. Those at higher risk include people who have had colorectal cancer or polyps, inflammatory bowel disease such as ulcerative colitis, or people whose close relatives have had colorectal cancer.