Related topics: •  Colorectal Cancer

As Nancy Robison belatedly discovered, colon cancer can strike women, too.

So entrenched was her idea that only men tend to get colon cancer, that despite her training as a licensed practical nurse, Robison, 52, of Franklin, Pennsylvania, dismissed the possibility of colorectal cancer when she began experiencing rectal bleeding and other symptoms, which she attributed to hemorrhoids.

Six months later, in mid-1997, surgeons at the Cleveland Clinic removed two large tumors from her colon, or large intestine. "People think that because there's so much money behind breast cancer research and it’s talked about so much, that's the only cancer women die of," Robison says.

In fact, colon cancer -- also known as colorectal cancer -- is the third leading cancer killer among women (behind lung and breast cancer, respectively) and affects both genders at virtually identical rates. About 148,810 new cases will be diagnosed and about 50,000 people are expected to die of the disease in 2008, according to the Centers for Disease Control and Prevention (CDC).

For people over 50, screening would prevent at least a third of deaths from colon cancer. Still, screening rates remain stubbornly low. Between 2001 and 2005, the screening rate among US adults increased from 42.5 percent to 46.8 percent.

How did the myth about women and colorectal cancer take root? As Robison suggests, media neglect is one likely culprit.

Cancers that strike women exclusively -- ovarian, cervical, or endometrial cancer -- or nearly exclusively, such as breast cancer, have commanded much of the media spotlight over the years, says Dr. Amy Halverson, a colorectal surgeon at Northwestern Memorial Hospital in Chicago.

Yet, somewhat ironically, research shows that women with a history of ovarian or endometrial cancer, especially when it's diagnosed at an early age, are at increased risk of developing colon cancer, too -- perhaps, Halverson notes, because they have a genetic predisposition for malignancies.

It doesn't help that bowel function is an embarrassing topic -- one bordering on taboo for many people. Even if patients suspect something is wrong, they may be too embarrassed to mention it during a visit to the doctor, closing the door on early detection and treatment, says Bernard Levin, MD, chief of the Division of Cancer Prevention at the University of Texas Anderson Cancer Center in Houston.

One person who regrets letting shame get the upper hand is actress Barbara Barrie, a co-star of the former TV sitcom Suddenly Susan whose movie credits include Breaking Away and Judy Berlin. She wrote a book in 1999 titled Don't Die of Embarrassment that chronicles her battle with colorectal cancer. She won the battle with treatment that included a colostomy so she can manually discard wastes collected in an external pouch.

The disease caught up with Barrie in April 1994 after decades of rectal bleeding and denial on her part. Clinicians in those early years theorized at different times that she suffered from hemorrhoids, a fissure, nerves, and stress.

More recently, Barrie ignored a doctor's recommendation that she get a colon exam.

"How stupid was I?" she wrote in her book. "This delay had probably harmed me. So much for a college degree, a thousand years of psychoanalysis, health foods, high fiber, low fat, and 40 years of exercise programs. Dumb." Barrie subsequently learned from a cousin that colon cancer ran in the family, a hush-hush topic among her relatives up until then. She went on to endure two operations and the painful aftermath.

Jeanette Leathers, a 63-year-old interior designer in Alpharetta, Georgia, knew little if anything about colorectal cancer until her surgery for the disease a year ago, even though it had claimed the life of a friend's husband. Only after the operation, when she mentioned her personal struggle to others, did numerous people cite relatives or acquaintances who also had battled the disease.

During her chemotherapy, the vivacious Leathers has managed to take care of her grandchildren, work part-time, and travel to Washington, D.C. for her sister's 50th wedding anniversary, where she danced and talked until midnight.

"There are a lot more people who have it than you would think," says Leathers, whose daughter had three precancerous polyps, or growths, removed from her colon at age 29.

Medicine scored a coup against such secretiveness in March 2000 when Katie Couric, then co-anchor of the Today show and contributing anchor on Dateline NBC, underwent a colonoscopy on camera. Couric's husband died of colon cancer at age 42.

The broadcast had such an impact that the number of colonoscopies nationwide jumped nearly 20 percent in the subsequent 40 weeks, according to Dr. Peter Cram at the University of Michigan Health System, lead author of a study that looked at what has since come to be known as the "Couric Effect."

There are few legitimate reasons these days for people 50 or older and with a family history of colorectal cancer not to undergo routine screening. A range of tests -- fecal occult blood test, flexible sigmoidoscopy, colonoscopy, double contrast barium enema -- is available, and many insurers pick up the tab for one or more of these tests.

According to the American Cancer Society, all adults past the age of 50 should be screened with one of the following options: a fecal occult blood test or a fecal immunochemical test once a year, a flexible sigmoidoscopy, a double-contrast barium enema or a CT colonoscopy (virtual colonoscopy) every five years, or a colonoscopy every 10 years.

In some situations, screening is recommended at an earlier age. These are usually cases in which there is a strong family history of colon cancer or in the cases of patients with certain diseases (inflammatory bowel disease, for example) that increase the risk of colorectal cancer.

Each test has its pros and cons in terms of effectiveness, cost, ease of use, invasiveness, and risk of complications, and individuals should discuss these with their doctors before deciding which test or tests to take. But the bottom line is that all of these tests are believed to be effective in saving lives when done at the recommended time intervals.

The future is encouraging in this regard. Dr. Halverson, the surgeon at Northwestern Memorial Hospital, notes that more-patient-friendly screening techniques involving computed tomography (CT) scans and DNA testing are just over the horizon. A lot more research will be needed before either of these tests can be recommended on a routine basis, however.

Meanwhile, health advocates will continue chipping away at the embarrassment factor. Says Nancy Robison, "It shouldn't take a [colorectal cancer diagnosis] or the death of a family member to motivate others in the family to undergo screening."

In March 2008, the American Cancer Society joined with other national health groups to issue the first-ever joint consensus guidelines for colorectal cancer screening. The groups recommend all men and women get screened beginning at age 50. They divide screening tests into two groups - those that can detect polyps and cancer and those that only detect cancer - and note a preference for those that detect polyps, since they can be removed before cancer is present. The screening options recommended:

Tests that find polyps and cancer (preferred): flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years, or double contrast barium enema every 5 years, or CT colonography (virtual colonoscopy) every 5 years.

Tests that mainly find cancer: fecal occult blood test (FOBT) every year, fecal immunochemical test (FIT) every year, stool DNA test (frequency undetermined).

•If an examination reveals polyps, they should be removed.

•Meanwhile, eat a health diet with an emphasis on plant sources. Eat 5 or more servings of fruits and vegetables each day, choose whole grains, and limit meat consumption.

•Don't smoke.

•Exercise regularly.

•Some studies have shown that nonsteroidal anti-inflammatory drugs (such as ibuprofen) may be associated with reduced risk of colorectal cancer. However, because the risks of these drugs may outweigh the benefits, experts do not recommend that people with average risk of developing colorectal cancer take them as a prevention strategy.

-- Paul Engstrom is the former health and science editor of the San Jose Mercury News.

References

National Cancer Institute. Colorectal Cancer Prevention (PDQ). Feb 29, 2008. http://cancer.gov/cancertopics/pdq/prevention/colorectal/healthprofessional/

First published March 24, 2004
Last updated May 6, 2008
Copyright © 2004 Consumer Health Interactive

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