Caring for Your Colon
Kaiyu JI, Gastroenterologist, Hepatologist, Chief of Gastroenterology and Hepatology, Director of Endoscopy
There have been numerous articles published on the importance of colonoscopies in the early detection of colorectal cancer (CRC). Most recently, The Register-Guard newspaper published an article entitled “Colonoscopy is the Best Weapon Against Intestinal Cancer.” Because summer fun will soon commence and everyone will be in a more relaxed mood, I wanted to take this opportunity to discuss the oft-ignored topic of CRC prevention.
Background of CRC
CRC isn’t a new phenomenon. Developed countries have well-established guidelines for CRC screening as well as lists of risk factors. Data related to CRC is also readily available. According to recent studies, 1 out of 17 people over 50 in the United States have CRC. In Asian countries – especially big cities like Beijing and Shanghai – the prevalence of CRC has increased rapidly in the past 10 years. Because CRC varies so wildly between urban and rural areas – occurrence is significantly lower in rural areas – there is no comprehensive data for CRC in China.
However, things seem to have taken a slightly positive turn for CRC patients. Two years ago, data from the United States showed the first ever decrease in CRC prevalence. This decrease, though slight, is significant. And it can be mainly attributed to the increase in colonoscopies and other screening methods.
CRC can affect anyone. Patients with a fair bit of medical knowledge argue that 95% of CRC is diagnosed in patients who are older than 50, so they try to skip over the gastrointestinal portion of their regular check-ups. It’s true that most CRC patients are older, but the remaining 5% should not be overlooked.
I frequently meet with my colleagues from the local cancer hospital. What continues to surprise us is the decreasing onset age for CRC. My colleagues have found that CRC is developing ever earlier in patients, sometimes in patients as young as 35. This is a sobering discovery and unprecedented in China.
In light of these findings, I recommend that everyone meet with their physicians to do a risk evaluation and tailored screenings.
I suggest that everyone meet with their physicians to evaluate their risks for CRC at age 20. There’s no need to do screenings yet. Because each country has different risk factors, I’ve included some general guidelines below based on my professional assessment of international commonalities.
People who are at increased risk for CRC have at least one of the following:
- A personal history of CRC (or had an adenomatous polyp)
- A genetic syndrome predisposition to CRC (e.g., HNPCC, FAP)
- One or more immediate relatives with CRC
- Two or more extended relatives with CRC
Inflammatory bowel disease causing pancolitis or that has been active longer than 8 to 10 years
Types of CRC screenings
If you and your physician have determined that you may be at a high risk for CRC, it would be good to ascertain whether you’ve developed the disease. There are three screening methods I would like to mention:
- Fecal occult blood test. This should be done during your regular annual check-up. Don’t neglect it just because it’s a hassle, and don’t give yourself the excuse that you’re ‘too busy’. This is an easy way to determine whether you need to do further tests.
- Barium enema. This is usually done by a trained radiologist. This involves filling your colon with a barium solution and developing an X-ray image.
- Colonoscopy. This is usually done by an internal medicine physician. This involves examining the inside of your colon with a small camera.
Colonoscopies are by far the best way to determine the presence or absence of polyps in your colon. Knowing the health status of your colon is a great anxiety reducer and a good first step toward developing a continued prevention or treatment strategy. Colonoscopies have been responsible for saving lives and reducing the costs of cancer treatments simply by discovering a lot of pre-cancerous polyps. I usually recommend that people get their first colonoscopy at age 50, regardless of health or medical history.
The focus of modern medicine is on prevention. I like to tell people that we treat patients, not diseases. It’s so important to keep people healthy, and not just handle health issues as they arise. Insurance companies in the United States seem to have caught on to this wisdom. Early cancer detection results in lower costs for them as well. But insurance companies in countries with low CRC prevalence haven’t started covering cancer screenings yet. Colonoscopies can be expensive – this is no secret. But it is the best assessment tool we currently have. If you need a colonoscopy, it is absolutely worth your while to get one.
As economies become more developed, dietary options begin to include more processed and fried foods, and people’s stress increases. All of these are potential causes of CRC. Even if you’re mostly healthy, your gastrointestinal (GI) system may be struggling, especially if you’re not careful about what you put into your body or about managing your stress levels.
Therefore, if your GI system is having trouble, sit down with your physician, go through your medical history with him/her, and consider some lifestyle changes. Your goal is to maintain a healthy metabolism. Metabolism is the body’s way of achieving and restoring balance. When metabolism slows, your body becomes more susceptible to disease and cancer. This is why you rarely see cancer in young people, but you often see cancer in the elderly, people who are obese, and people who experience chronic inflammation. Their system has become too weak to naturally restore its own balance.
Eat right. Sleep well. Take care of yourself. Treat GI symptoms in a timely fashion. Keep that GI system healthy. And share this information with people you know. We’re more interested in preventing diseases than in curing them, and I’m fairly sure your friends and family would agree.