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Addressing the stigma of colorectal cancer

March is Colorectal Cancer Awareness Month

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Butts are on the line. That’s the Colorectal Cancer Alliance’s message for its digital campaign to raise awareness about the importance of getting screened for colorectal cancer and that all ages can be affected. The in-your-face message is designed to get people talking about a subject that most people avoid. 

Colorectal cancer occurs in the colon or rectum. The colon is the large intestine or large bowel, and the rectum is the passageway that connects the colon to the anus. Sometimes abnormal growths, called polyps, form and over time, may turn into cancer. It is the third leading cause of cancer-related deaths in the United States and the third most common cancer in men and women.

Kara Sheeley, director of Oncology Services at Bothwell Regional Health Center, said risk factors for colon cancer can include age, personal or family history of colorectal polyps or previous colorectal cancer, inflammatory bowel disease, racial and ethnic background, and Type 2 diabetes.

“There also are risk factors that we can control to help prevent colon cancer,” she said. “People can reduce their risks by staying at a healthy weight, increasing physical activity, eating a healthy diet and not smoking.” 

Sheeley said signs and symptoms that something could be amiss can include changes in bowel habits that don’t resolve, constant urge or feeling to have a bowel movement, rectal bleeding, blood in bowel movements, prolonged abdominal pain, unexplained fatigue and weakness and unexplained weight loss.

Patricia Harris, of Lincoln, had none of those symptoms. Last August she and her husband, Kenny, went to see their family doctor, Dr. Julie Cahill at Bothwell Family Medicine Associates, for a wellness checkup. Dr. Cahill performed a stool-based FIT test that looks for blood in the stool. 

Harris, 76, was surprised to learn the test was positive for blood. She then had a colonoscopy where colon cancer was discovered.

“The doctor showed me a picture of a good colon and a picture of mine,” she said. “I told the surgeon, ‘Well, let’s get it out.’” 

In September she had surgery to have part of her colon removed and since then is doing well. She didn’t have to have chemotherapy or radiation and gets her blood checked every three months with Bothwell oncologist Dr. Matt Triplett.

In addition to the FIT stool test, which is recommended to be performed annually, other types of screenings include a FIT-DNA test and a colonoscopy. FIT-DNA tests look for both blood in the stool and DNA changes and should be done every three years. A colonoscopy checks for polyps inside the rectum and the entire colon and should be done every five to 10 years depending on a person’s age and risk factors. Polyps can also be removed during the procedure before they become cancerous. The colonoscopy also is used as a follow-up test if anything unusual is found during one of the other screening tests. 

Dr. Stuart Braverman, who leads Bothwell’s Medical Executive Committee and is a surgeon, said the FIT-DNA test is known commercially as Cologuard.

“It requires a prescription, and a stool sample is collected at home and sent back to a lab for testing,” Braverman said. “It’s important to know that with each negative result, the test needs to be repeated every three years. Many people believe it only needs to be done every 10 years, and that’s inaccurate. There’s also an 8% chance of someone who has cancer getting a negative result.”

Surveys indicate people are hesitant to talk about colorectal cancer because of the stigma associated with the body parts involved and aversion for the various screening options; however, Braverman said the colonoscopy is the “gold standard” of screenings for colorectal cancers. 

“We know a lot of people avoid them either because they are scared and don’t want to admit something could be wrong or the prep involved and the procedure itself,” he said. 

People of average risk factors should begin screening at age 45. People with increased risk factors should consult their physicians and begin screening at an early age. According to the American Cancer Society, one in three people in the United States who should get tested for colorectal cancer has never been screened.

“Symptoms of colorectal cancer don’t necessarily show up right away,” Sheeley said. “Screening can lead to finding the cancer in an earlier stage and be easier to treat and have a much higher cure rate.” 

Harris agreed and said she had never before had a colonoscopy. 

“I hardly ever went to the doctor; we just didn’t need to,” she said. “But don’t avoid the colonoscopy. That finds out things that maybe you don’t know your body is doing.”

While Braverman said the average age of his colon patients is 70, the youngest was 22 and others have been in their 30s and 40s.

“Most of the people I see haven’t had a colonoscopy,” he said. “People may not like the thought of getting one, but every colon cancer patient I’ve had in the last 30 years wishes they had had one.”

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