Screening for cancer saves lives.

Byline: GUEST VIEWPOINT By William Wu and Dee Tvedt For The Register-Guard

It is the cancer nobody wants to discuss. Cancer of the colon and rectum is the second-most lethal form of cancer in the United States; only lung cancer is more deadly. The Centers for Disease Control estimate that cancer of the colon affects approximately 145,000 men and women in the United States every year, resulting in 58,000 deaths.

It is tragic that appropriate colon cancer screening could prevent most of these deaths.

On Nov. 19, 1999, the United States Senate designated March 2000 as the first National Colorectal Cancer Awareness Month. Each March is an opportunity to highlight the importance of screening for colorectal cancer - a very curable cancer if detected early.

Most colorectal cancers begin as polyps - wart-like growths arising from the lining of the large intestine. While most polyps are benign, precancerous ones can grow larger, mutate, and then become malignant. It typically takes from five to 10 years for a polyp to develop into cancer. This gradual process allows a window of opportunity during which polyps may be removed and cancer can be prevented.

A number of options exist for colon cancer screening: fecal occult blood cards (checking for hidden blood in the stool), flexible sigmoidoscopy (which uses a short, flexible scope to examine the lower portion of the colon), barium enema (an X-ray of the colon), and colonoscopy (which uses a long, flexible scope to examine the entire colon).

Colonoscopy is the only test that can directly remove any abnormalities such as polyps and early cancer at the time of the procedure.

The American Cancer Society states, "Colorectal cancer screening by colonoscopy is regarded as the gold standard because this procedure is the most highly sensitive compared to other tests; examines the entire colon; and allows for screening, diagnosis and removal of polyps in a single visit."

Performed under sedation, colonoscopies are more comfortable than flexible sigmoidoscopies or barium enemas, but carry a slight risk of complication from bleeding and perforation. The critical value of colonoscopy, however, is clear: All the other screening tests are useful only if abnormal results are evaluated further by colonoscopy.

Colonoscopy is the most expensive of all screening tests, but is cost effective when compared with screening for other conditions. A review prepared for the U.S. Preventive Services Task Force in 2002 found that all types of colon cancer screening (including a colonoscopy every 10 years) are effective in reducing premature deaths from colon cancer and can be done at an acceptable cost to society. The cost of resources needed to prevent each colon cancer death compares favorably to widely accepted interventions such as Pap smears and mammography.

The National Cancer Institute reports that approximately 50 percent of Americans 50 years of age and older are being screened for colon cancer. People avoid screening for many reasons: lack of time, modesty, fear and simple denial of the risk of colon cancer.

Efforts of celebrities such as Katie Couric, Heidi Klum, Eric Davis and our own Bob Welch have helped to raise the awareness of colon cancer.

As Couric testified before the U.S. Senate Select Committee on Aging in March 2000, "A lot of people don't want to talk about it. Colons. Rectums. Bowels. Not exactly the stuff of cocktail party conversation. ... But if you recall, not that long ago people felt uncomfortable talking about breast cancer ... and men rarely discussed their prostates. Now these cancers are routinely discussed with family, friends ... and most importantly, doctors. We have to do the same for colon cancer."

As a society, we need to move beyond the squeamishness of discussing our colon health to a mature and informed dialogue of colon cancer screening.

Maintaining health involves eating sensibly, exercising and avoiding smoking and excessive alcohol consumption. If you are 50 years of age or older, it also includes undergoing screening for colorectal cancer.

We need to spread the word: colon cancer is preventable; colon cancer screening saves lives; colonoscopy is the gold standard for screening.

William Wu, M.D., is one of seven physician partners of the Eugene Gastroenterology Consultants. Dee Tvedt is a certified gastroenterologic registered nurse and a staff endoscopy nurse at the Oregon Endoscopy Center.