Thursday, 20 November 2008
updated 1 minute ago
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YOUR DIRECTORY /

How to lower your risk for colon cancer

by Harvard Medical International on Thursday, 27 December 2007

There are no guarantees, of course, but most of us can lower our chances of getting colon cancer in several ways: don't eat too much red meat, don't get heavy, exercise, and for heaven's sake, don't smoke. Starting at about age 50, regular screening - colonoscopy is increasingly favoured - improves the chances of avoiding colon cancer and also of surviving even if you do get it. Screening works because colon cancer is usually a slow-growing disease that starts with adenomatous polyps, small, protuberant growths inside the colon that may contain precancerous cells. Screening tests are designed to find these polyps so doctors can remove them before they become cancerous.

Starting at about age 50, regular screening improves the chances of avoiding colon cancer.

Reasons we procrastinate

But the fact of the matter is that most of us tend to put off screening tests, perhaps especially so the ones for colon cancer. The faecal occult blood test involves gathering stool samples. Sigmoidoscopy and colonoscopy require cleaned-out colons. The preparation, which involves a heavy-duty laxative and then a lot of time in the bathroom, can be something of an ordeal. Many people say the preparation for the procedure is more unpleasant than the procedure itself.

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So-called virtual colonoscopy might be more appealing. This test lets the doctor view the colon from the outside with a CT scanner instead of from the inside with an endoscope, so it's less invasive and can't cause an accidental perforation of the colon, a one-in-a-thousand occurrence with regular colonoscopy. But for now, it still requires a cleaned-out colon, and it remains virtual only if polyps aren't found. If they are, you will need a regular colonoscopy to have them removed. Besides, virtual colonoscopy is still considered experimental and may not be covered by insurance.

As for the other admonitions - cutting back on red meat may not be so difficult. But the gap between word and deed looms especially large when it comes to weight control and exercise.

So we do need easier, more reliable ways of preventing colon cancer, which is the third most common cancer in the United States (about 154,000 new cases a year) and the second most lethal (52,000 deaths annually).

Aspirin is too risky

The daily, low-dose (81- to 325-milligram) aspirin is one possibility. Many people already take aspirin to reduce their risk of having a second heart attack or stroke - or of having their first one if they fall into a high-risk group (a not-very-exclusive club that includes many men over 40 and postmenopausal women). Aspirin also seems to have anticancer properties. In lab and animal experiments, it has prevented the rapid cell division that's associated with cancer. And epidemiologic studies show that people who take aspirin are about half as likely to get colon cancer as those who don't, although the protective effect seems to emerge only after 10 years or more of regular intake.

When aspirin has been put to the test in randomised trials, the outcomes have been mixed - and confusing. One trial that enrolled people who had previously had a polyp found that taking a 325-mg aspirin daily lowered the risk of getting a polyp again. But another trial that compared different daily dosages (81 mg vs. 325 mg) found the smaller amount modestly protective but not the larger one.

In 2007, the U.S. Preventive Services Task Force recommended against taking aspirin - or any other non-steroidal anti-inflammatory drug (Aleve, Motrin, others) - for colon cancer prevention if your colon cancer risk is average. The well-known risks of these drugs (intestinal bleeding, kidney problems, and "bleeding" strokes) outweigh the possible colon cancer protection, the experts decided. Their recommendation didn't address people in a higher risk category, such as those who have had polyps discovered during a screening test.

It’s usually not inherited
As with many of the most common cancers, some colon cancer is clearly caused by inherited genetic mutations that are passed down from generation to generation. But that's a relatively rare event. Fewer than 5% of cases are caused by the two main genetic disorders that have been identified so far, familial adenomatous polyposis and hereditary non-polyposis colorectal cancer.

Another 25% of patients fall into a grey area. The disease runs in their families, so there seems to be some inherited genetic component, but the pattern of who is affected and who isn't suggests other causative factors as well.

About 70% of colon cancer cannot be explained by family history or an obvious inherited factor. Doctors sometimes refer to these as "sporadic" cases although they are the most common. In most instances, therefore, colon cancer has more to do with what we eat, how much we exercise, how much we weigh, and a number of other factors.

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