Colons are like cars: Check them regularly Dr. H. David Vargas - special to the Herald-leader

I am not a mechanic, but I suspect that we have all learned — in some cases, the hard way — that car maintenance is all about prevention. If you have your car serviced regularly, you can avoid car trouble and costly repairs down the road.

Prevention of colon cancer works the same way: If you have a screening colonoscopy at age 50, you can avoid colon cancer, surgery and chemotherapy. As a colorectal surgeon at the University of Kentucky, I want to help you avoid learning the hard way about colon cancer.

This message is especially important to you and me, as Kentuckians. According to the latest figures available from the Centers for Disease Control and Prevention, our state has one of the highest rates of colorectal cancer in the country — about 70 cases a year for every 100,000 people. Data from the Kentucky Cancer Registry reveal that Kentuckians with colorectal cancer experience a 17 percent higher mortality rate than the national average. Yet, when it comes to getting the recommended screenings, Kentucky ranks 39th among the states. In fact, less than half of the eligible adults in the state have had colonoscopies.

This is tragic because a screening colonoscopy is the key to prevention of colo rectal cancer. All colorectal tumors begin as tiny growths called polyps. Colorectal cancer can be prevented by removing polyps before they turn into cancer.

"But I feel perfectly fine," you might say. "Why should I get screened now?" Remember, polyps rarely cause symptoms. Polyps grow silently, and over time they develop into cancer. Only then will one experience bleeding, pain and change in bowel habits. Do not wait for symptoms. The time to be checked is when one feels good.

Current recommendations call for average-risk individuals to have their first screening colonoscopy at 50. For people with increased risk, especially a family history of colorectal cancer, regular screenings should begin earlier. Discuss colorectal cancer screening with your personal physician to understand your risk and to see when testing should begin for you.

As a specialist in colorectal surgery, I can provide the most sophisticated techniques for my patients — laparoscopic colectomy, transanal endoscopic microsurgery and sphincter-preserving surgery. All of these result in smaller incisions or no external incisions, much less pain, faster recovery and the rare need for permanent colostomies. Early stage cancer is curable in greater than 90 percent of cases.

Even in advanced cases, chemotherapy and, in the case of rectal cancer, radiation therapy have been shown to provide patients with substantial improvement in survival. Such remarkable advances give patients and their families hope.

But the bottom line is, I would much rather talk with patients and their families about how simple it was to remove a polyp with colonoscopy than speak to them about surgery and all the other issues surrounding cancer treatment.

My advice: Talk to your doctor. Get your colonoscopy — especially if you feel fine. Then go rotate your tires.

Dr. H. David Vargas is an associate professor of surgery at the University of Kentucky College of Medicine and section head of colorectal surgery.

This article appeared in the Sunday, March 22, 2009 Lexington Herald-Leader.

YOU DON’T HAVE TO DIE FROM COLON CANCER

In a span of five days over two consecutive weekends in the month of June 2008, I forever changed the lives of three people (ages 53, 57, and 72) by diagnosing them with colon cancer. All three cancers had progressed to the advanced stage, making it unlikely that any of the three would win the battle against this invader of their bodies. None of these individuals had ever been screened for colon cancer, which makes the diagnosis even more tragic for both them and their families. In all likelihood, all three cancers could easily have been prevented with timely screening and treatment. Giving this diagnosis is a tough talk to have with good people.
Almost 3,000 Kentuckians will have that same dreadful, unnecessary discussion this and every year until individuals, health care systems, and public heath agencies coordinate to take one simple step: identify the at-risk population for colon cancer and screen as many of those people as quickly as possible.

This year, and every year until changes are made, the number of Kentuckians who will die from colon cancer will equal or exceed the number who die from breast cancer, cervical cancer, HIV/AIDS, and tuberculosis combined! No kidding.
Colon cancer is so widespread and devastating that I expect most of you reading this article personally know someone who has fought or is fighting this preventable and tragic disease.

TAKE HOME MESSAGE #1: Knowledge about colon cancer and its causes is essential to prevent this avoidable disease.

An understanding of colon cancer and its prevention starts with an understanding of colon polyps. As we age, growths called “polyps” appear in the colon -- more specifically, adenomatous polyps. Think of them as age spots on the inside of your body. The simple process of removing these precancerous polyps from the colon prevents the development of colon cancer.

One in three people over age 50 have colon polyps. Polyps may form even earlier, at 40 or even rarely in the 20’s and 30’s, in those with a family history of polyps or colon cancer . The risk is increased in patients who have a family history of colon cancer or colon polyps AND in families with early cancer history of other sites of cancer (age , 50 , pancreas, endometrial, ovarian, stomach, small bowel, kidneys or bladder and possible breast.)

Since about 1 in 10 colon cancers occur before the age of 50 , it is important not to ignore or dismiss the signs and symptoms, regardless of your age.
For the most part, these polyps and even the earliest forms of colon cancer do not cause problems or even symptoms. Once a cancer has grown large enough to cause symptoms, it has usually had time to break through the wall of the colon or spread through blood vessels. By the time it advances to this stage, surgery, chemotherapy, and sometimes radiation are necessary to fight the cancer and unfortunately long-term survival rates are not favorable.

TAKE HOME MESSAGE # 2: You should be screened for colon polyps and cancer before you experience any symptoms. You don’t wait to change your car’s oil until your engine is smoking and you’re stranded on the side of the road! The same logic applies here.

Detection of colon cancer or precancerous polyps is achieved through screening techniques such as colonoscopy, sigmoidoscopy, barium enema, or virtual colonoscopy. Colonoscopy is the test that is most frequently used. During a colonoscopy, your doctor examines the interior lining of the large intestine (rectum and colon) using a thin, flexible instrument called a colonoscope.
Using this method, doctors can find and remove polyps before they cause any problems and by doing so, prevent colon cancer from ever developing. Even if a small cancer has developed and is found before symptoms arise, it can almost always be beaten.

Those with the greatest risk for developing colon polyps are 50+ years old and/or have a family history of colon polyps or cancer. But, 80% of colon cancers are not associated with family histories, so screening is important for everyone. Let me repeat that...not having a family history in no way proects you or prevents the development of colon cancer.

In fact, the primary risk factors for advanced colon cancer are age (>50) and never having been screened.

TAKE HOME MESSAGE #3: Don’t ignore symptoms! Most of the time symptoms are not caused by colon cancer, but you can only be sure if you get checked.

People experience a number of gastrointestinal symptoms that could be caused by a variety of conditions, including colon polyps or cancer. The following are several examples:

• Rectal bleeding or rectal pain
• Change in bowel habits (frequency, size, constipation, or diarrhea)
• Abdominal pain or cramping
• Weight loss
• Unexplained anemia
• Low Red Blood Count
• Fatigue
• Vomiting

Other common conditions that may mimice colon cancer are hemmorhoids, inflammatory bowel disease (Crohns disease or ulcerative colitis), irritable bowel syndrome, anal fissures or infections.

If you experience any of these symptoms, schedule a visit with a doctor IMMEDIATELY. Why? To find out what is causing the problem, to get it corrected, and to make sure it is not colon polyps or colon cancer. Most often, your doctor will choose to use colonoscopy simply because it is the most accurate and effective test to diagnose the problem and get you back on track.

TAKE HOME MESSAGE #4: Colonoscopy screening can reduce colon cancer deaths by over 90%. That’s nearly as effective as a vaccine.

Other screening methods exist. However, the reality is that colonoscopy is the preferred test and the most effective strategy to identify and treat colon polyps and cancer. Though the process may seem awkward, the benefits well outweigh any anxiety you may experience. Ask you doctor what test is right for you. ANY TEST IS BETTER THAN NO TEST AT ALL!

TAKE HOME MESSAGE #5: Your state is involved, but can do more. Our state and federal representatives need to hear from you to guide their health funding priorities.

Thanks to nearly unanimous 2008 legislation, colon cancer screening is or soon will be covered for all at-risk Kentuckians.

Senate Bill 96 requires that private and public insurers and health benefit plans cover colon cancer screenings, including colonoscopy, for individuals 50+ years old, in accordance with the American Cancer Society screening guidelines. Don’t waste this life-saving benefit effective in January 2009!

House Bill 415/KRS § 214.540-544 has created a statewide colon cancer screening program for the uninsured and an accompanying educational campaign. Nearly 500,000 Kentuckians have no insurance and, as a result, are less likely to get life-saving preventative screenings. Not only will this program will save hundreds of lives every year, it will save the state $1.5 million on health care costs for every $1 million invested. This is significant given the Medicaid budget for Kentucky in 2007 was $7 billion. As of this posting, the Kentucky Colon Cancer Screening Program is formed but unfunded. YOU can change this.

Other states have implemented similar programs and achieved remarkable results! In 2003, Colorado directed revenue from increased cigarette taxes to fund more than 5,000 screenings over three years. By investing $10 million in screenings, the state saved over $15 million on health care costs associated with treating colon cancer. More importantly, many lives were saved and families were spared the hardship of watching their loved ones enduring battles with colon cancer. Due to its tremendous success, the Colorado legislature continues to fund this program and save both lives and resources for its citizens.

Who wins by increasing colon cancer screenings? We all do. The sooner we let our elected representatives know that we want to make saving lives and resources a priority, the sooner funding will be secured to move forward with these important colon cancer screening initiatives. Contact your representative today.

Every week including this week, I have the unfortunate task of informing another father, mother, husband, wife, daughter, or son that they have colon cancer, knowing that it could have easily been prevented.

Over half of you reading this article have not been checked for colon polyps or cancer. We all lead busy, stressful lives and don’t need another task to worry about. Miss an oil change? Forget to change the furnace filter? Nobody is perfect, but missing this simple preventative check up can cost you your life. Call your doctor and schedule a screening today!

Do the test, find the polyp, skip the cancer.