Colon Cancer Prevention

September 2022

By Prof. (ret) Jesse (Yishai) Lachter M.D.

How might anyone get YOU to increase your active preventive healthcare?

Knowledge is power; perhaps you can live a healthier, possibly longer life by knowing more. Every March is colon cancer awareness month in Israel and worldwide. Ads on TV, radio, and other mass media encourage people to take their health into their own hands and to prevent this cancer. As the third most common cancer in Israel, the Ministry of Health statistics record roughly 3000 new cases of newly diagnosed colon cancer yearly. Ten new cases get diagnosed every working day. Roughly 1400 Israelis die of this cancer yearly. This scourge could be at least 90% prevented. Our health ministry advises testing from age 50; in the USA, the national authorities recommend starting screening at age 45. This is because 11% of all new diagnoses are in people under 50. In younger people, physicians are less likely to make an early diagnosis. The earlier the diagnosis, the greater the odds of a complete recovery. The later the diagnosis, the worse the prognosis and outcomes are worse.

Colon cancer invariably starts as a small premalignant lesion, usually as a polyp (see photo). Most polyps can be easily removed during a colonoscopy, thus preventing the polyp from developing into cancer. Polyps only rarely cause any symptoms. To find and resect polyps, people must undergo an unattractive, unappealing procedure, which carries very slight risks. Colonoscopy requires a cleanout preparation. Patients in Israel are sedated to not feel the procedure in 99% of cases; very few people choose to not receive sedation, but both options are available. The procedure takes 20-30 minutes. The risk of a significant complication such as surgery is about 1/5000. The prevalence of premalignant polyps in screening exams is about 25-30%.

All four public health organizations in Israel cover colonoscopy screening to prevent colon cancer. Other options for screening and early detection exist. The fecal occult blood test is noninvasive and is a once-yearly test. Most polyps and some cancers do not bleed until the late stages, which are the hardest to treat. If occult (nonvisible) bleeding is found, then colonoscopy is definitely the next step. Sadly, however, Israelis tend to not undergo colonoscopy even if occult bleeding is found in almost half of all such cases.

Newer methods of screening are on the horizon. Cancers tend to shed some cells into the bloodstream. New blood tests have been developed to screen for "circulating tumor cells." These expensive tests have yet to prove their efficacy and thus are not yet covered by our health maintenance organizations. "Virtual colonoscopy" is the alternative (and attractive) name for a CT scan of the colon. The CT scan is performed after a thorough cleanout of the colon, and it involves filling the colon with air; thus, it is not genuinely noninvasive. The risks of CT-colonography (virtual colonoscopy) are slightly less but similar to those of colonoscopy (also called optical colonoscopy).

The Israeli Ministry of Health recommends screening from age 50-75. Why stop at age 75? After the age of 75 years, personalized decision-making is recommended. The risks of procedures are increased over time. The preventive value of a colonoscopy, if all is normal in persons not at a particular risk, lasts for ten years.

What are the risk factors for colonoscopy? How might anyone decrease their risk of this (and many other types of) cancer? Smoking, obesity, sedentary lifestyle (not exercising) are risk factors. Having a family history of colon cancer roughly triples the lifetime risk: genetics matters! People with particular gastrointestinal diseases, including Ulcerative colitis and Crohn's disease, are at increased risk. People with past polyps who thus have shown a tendency to develop polyps should be screened more often than those without.

The Rambam emphasized the need for preventive healthcare. An ounce of prevention is worth more than a pound of curative care (and costs far less). I have cared for patients as a gastroenterologist for 30 years and have performed over 60,000 endoscopy procedures. The diagnosis of a new colon cancer continues to be a sad and moving one for me, as I know that these tumors can usually be prevented. There's a villa Dolorosa for patients with colon cancer, most of whom will need chemotherapy after major surgery. Those 60% fortunate enough to have early detection will be cured.

Each of us can emphasize preventive healthcare and healthy lifestyles. We can encourage others to do the same. The tremendous financial and emotional expenditures and loss of lives could be a tenth of what it is if we take good care of ourselves.

If you have specific questions – ask your family physician, who is undoubtedly very familiar with colon cancer prevention. For further care, see a gastroenterologist!

Wishing you good well-being and a long, healthy life!

Jesse Lachter M.D.