By Dr. Jun R. Ruiz
March is Colorectal Cancer Awareness Month. This is an important campaign as colorectal cancer (CRC) is the third most common cancer among Filipinos. Breast and lung cancers are more prevalent in the Philippines.
The Medical City aims to be at the forefront in the fight against colorectal cancer. This cancer is preventable, treatable, and beatable. CRC screening can save lives, but not that many people are being screened. As an advocate, I believe that we should continue to educate the general public and mobilize the health community into programs to beat colorectal cancer.
Almost all of these cancers start as abnormal growths in the lining of the colon and rectum called polyps. These polyps grow slowly and some may take around 10 years to develop into cancer. Not all polyps progress to cancer. The removal of these polyps reduces the risk of developing cancer.
These polyps and occasionally early cancer do not cause complaints, like rectal bleeding, constipation, and abdominal pain that are experienced by patients in later stages of cancer.
The most common individual-specific factors that increase risk for cancer in the colon and rectum are:
1. Age greater than 50
2. Personal history of colorectal cancer or advanced polyps
3. Family history of cancer in the colon and rectum
Age >50 is the most common risk factor for this cancer, as 90 percent occur after the age of 50. A family history of a first-degree relative with CRC is increased two to three-fold.
There are also lifestyle habits that can be modified that likely contribute to the formation of this cancer:
1. Cigarette smoking
2. Alcohol consumption
4. A diet that has high saturated fat, low fiber, and high red meat consumption
Living a healthy lifestyle by avoiding smoking, not consuming excessive alcohol, regular exercise, and eating the right food can lower your risk for cancer in the colon and rectum.
In several countries, CRC screening is recommended for people starting at the age of 50 years. Screening at an earlier age, usually at 40, is advocated in first-degree relatives of patients with colorectal cancer, and in those with other additional risk factors.
The gold standard for CRC screening is a colonoscopy as it can detect and remove early lesions like polyps. The procedure involves a flexible fiberoptic scope with a camera that is inserted through the rectum and is carefully advanced to visualize the colon under mild anesthesia. However, it is an invasive test and has low risk to cause complications.
Some patients may not want to have an invasive test or may find the cost of a colonoscopy expensive. A stool test called the Fecal Immunochemical Test (FIT) is a good screening alternative. FIT detects only human blood and is specific for bleeding in the colon. The test is repeated every year if the initial test is negative. If the test is positive, a colonoscopy is needed to rule out the presence of cancer.
As a gastroenterologist who advocates CRC screening, I recommend a screening colonoscopy for persons between 50 to 75 years of age who are healthy and with whom the risk for complications is low. If the patient does not want to have a colonoscopy, I suggest they start with FIT. If we want a population-based screening method, FIT is the most appropriate method in the age of Universal Health Care to screen more people. After a discussion with his physician, the patient can choose his preferred screening test. By undergoing either method of CRC screening, we can beat colorectal cancer