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Colorectal Cancer Screening Saves Lives
James M. Church, M.D.

We’re all a bit like the ostrich – sometimes we would rather stick our heads in the sand than face facts. For some people, that’s especially true when it comes to getting screening tests for cancer. Whether it’s due to denial, fear or embarrassment, many people don’t get the colorectal screening tests they need.

But pulling your head out of the sand and being screened could save your life. This is especially true for colorectal cancer because early detection of polyps, the precancerous growths that occur in the rectum and colon, can actually prevent cancer from ever developing. And for cancer that has already formed, early detection will improve the chance of a cure. For example, almost everyone with early stage cancer, or cancer that has not spread from inside the colon through the wall of the bowel, will still be alive five years after diagnosis. But if the cancer has spread into the lymph nodes, the chances of surviving five years drop to between 30 and 60 percent.

Because most people with colorectal cancer experience no symptoms, early detection is very critical, and because prompt removal of precancerous polyps can prevent colorectal cancer, the Cleveland Clinic departments of Colorectal Surgery and Gastroenterology offer free screenings. Through a public information campaign, we explain the signs and symptoms of colorectal cancer and urge people to call if they have any of the warning signs (see box at left). In addition, we emphasize the increased risk associated with having a family history of colorectal cancer, and urge these people to call us to discuss their risk.

Our latest screening program in October 1997 prompted 677 people to call about their risk. After assessing each person’s risk, as determined by age, family history and symptoms, we recommended one of several courses of action. If the assessment revealed that a caller did not have an elevated risk, we advised that person to follow American Cancer Society screening guidelines (see box at left). If a caller had a somewhat increased risk, we offered a free flexible sigmoidoscopy examination by a Cleveland Clinic gastroenterologist or colorectal surgeon, or we advised the person to have his or her physician perform this test. And for those with a greatly increased risk, we recommended they have a colonoscopy. While the flexible sigmoidoscopy allows doctors to examine the lower colon, colonoscopy permits examination of the entire colon, which is appropriate for people at higher risk.

Of the 677 people who called, 129 had a flexible sigmoidoscopy, and 73 people underwent colonoscopy.

Cancer Found, Patient Saved
Don Kucia of Cleveland, Ohio, credits last fall’s screening project with saving his life. Mr. Kucia saw the Clinic’s newspaper advertisement for the screening a year after he had returned to Cleveland to care for his sister, who died of colon cancer at the age of 68. “The ad said that the screening was especially recommended for people with a family history of colon cancer. But I wasn’t really worried, because I thought ‘family history’ meant going back generations,” remembers Mr. Kucia, age 59. Nonetheless, he scheduled an appointment with James M. Church, M.D., director of the David G. Jagelman Inherited Colorectal Cancer Registries.

Dr. Church saw the beginning of a polyp and urged Don to have a colonoscopy – seconded by Ellen McGannon, B.S.W., Registries coordinator. “Ellen was a big reason for my follow through,” Mr. Kucia says. “She kept calling me, saying, ‘Don’t let this go, Don. Take care of it.’”

So he did – but because of insurance changes, Mr. Kucia waited and scheduled his appointment a few months later in May of ’97. By that time, the polyp had grown and was found to be malignant. Gastroenterologist, Aaron Brzezinski, M.D., performed the colonoscopy and removed the polyp. Just to be absolutely certain no cancer remained, the next month Don underwent an excision of part of the rectal wall by Scott Strong, M.D., colorectal surgeon.

Afterward, Dr. Strong spoke what Mr. Kucia calls ‘the most glorious words I’ve ever heard.’ “He came into my room, grasped my hand, and said, ‘You’re cancer-free.’ He said what made this possible is that they caught the polyp early, before it had spread.”

Other than quarterly checkups, Mr. Kucia says his life hasn’t changed. He says he has always included lots of fiber in his diet, exercises regularly and hasn’t smoked in 30 years.

“The scary thing is that I didn’t have one single sign that something was wrong,” he says.

“I know people tend to not want to go in for a checkup, because they’re afraid something might be found, or they feel uneasy about the testing,” Mr. Kucia says. “But the tests were easy, and everyone was so comforting and assuring.

“I’m living proof that if there is something there, you want to catch it early. Believe me.”

Early Detection Saves Lives
If you have a family history of colorectal cancer or you experience bleeding or a change in bowel habits, ask your physician about screening tests. Even if you don’t have a family history or symptoms, be sure to follow the American Cancer Society screening guidelines for colorectal cancer as well as other types of cancer. It’s a fact that early detection saves lives.

Results of the Cleveland Clinic Colorectal Cancer Screening Projects
Screening Year		Callers		Cancers found on sigmoid		Patients with precancerous polyps found on colonoscopy		Patients with cancer found on colonoscopy
1991		1,440		2		48		4
1993		747		1		48		0
1995		1,100		0		26		1
1997		677		2		27		4
Total		3,964		5		145		9