(photo credit: Courtesy)
Although 3,200 new cases of colorectal cancer are diagnosed and 1,500 Israelis die of it each year, fewer than a third of Israelis over 50 go for a simple stool sample screening tests to detect occult blood. A third of those whose results are positive avoid undergoing a colonoscopy to search for and remove pre-cancerous polyps before they become tumors.
The Israel Cancer Association has launched a month-long media campaign to increase awareness of the second most common tumor in both men and women. With early detection at the polyp stage, colorectal cancer can be prevented. Even if the tumor is malignant, the earlier it is caught, the better the prognosis. More information is available from the ICA's Telemeida number at 1-800-599-995 or on its Web site (www.cancer.org.il).
Patients over 50 are advised to consult their family doctors. Patients who have close relatives who contracted colon cancer should consult their doctors after age 40. Inheriting a mutant colorectal cancer gene can double or even triple the risk. Patients should also see their physicians if they suffer from fecal blood, anemia, sudden changes in bowel movements that continue for more than two or three months, unexplained significant weight loss or stomach pains that do not pass. Middle-aged people with chronic inflammatory bowel disease should also go to the doctor for a consultation.
Those with a family history of colorectal cancer will probably be sent for a colonoscopy, in which an endoscope is threaded into sections of or the whole colon while the patient is under sedation. This procedure, which is preceded by the drinking of fluid to empty the bowel, takes about half an hour and is covered by the basket of health services. Anyone over 50 without a family history will be encouraged to take a stool sample at home that is processed in a lab.
Prof. Gad Rennert, head of the National Colorectal Cancer project, said at the ICA's press conference on Monday that he has been working on the project for three years. The initiative aims at getting the four health funds to screen members aged 50 to 74 for occult blood once a year. Regular screening, he said, could reduce the mortality rate from colorectal cancer by 30 percent.
Last year, some 260,000 stool tests were performed, out of a target population of 1.28 million. In addition 100,000 colonoscopies were carried out (mostly by endoscope; some were virtual - using computer scans - but this type is not included the health basket, and a polyp must be removed in a regular colonoscopy.)
The consent rate for occult-blood screening and colonoscopy was only 10% among the over-50 age group in 2006 but has risen to 30%; nevertheless, the ICA aims to reach a consent rate of 70%.
In 2006, 61.3% of colorectal cancer diagnoses were identified at an intermediate stage and 10.3% at an advanced stage. Only 28.3% were diagnosed at an early stage, still an improvement from six years earlier, when only 17.4% of colorectal cancers were identified at an early stage.
Reluctance to undergo a colonoscopy after there are indications of a problem is common. Many Americans became less wary of the procedure after newscaster Katie Couric decided to undergo one on camera following the death of her husband from colon cancer. Asked by The Jerusalem Post if the ICA might try to get a prominent Israeli to do the same, ICA spokeswoman Rivka Froelich-Zeltzer said it was a good idea and could be carried out if a celebrity volunteer were willing.
The Israel Society for Colorectal Cancer has asked the health and finance ministries to add colonoscopies to the health basket for people over 50, and encourages the public to undergo occult blood tests.
New research published in the International Journal of Cancer has shown that a high intake of alcohol significantly raises the risk of colorectal cancer. In addition, high consumption of processed junk food triples the risk of a return of such cancer to patients who already had one bout with it.
A study in the same journal showed that regular exercise significantly minimizes the risk of colorectal cancer.
Fifteen percent to 20% of colorectal cancer is connected to inherited forms such as HNPCC and FAP. However, most of the genetic mutations in families are unknown, so they are not diagnosed with genetic screening. Tests on over 2,500 Israelis by Prof. Nadir Arber of Tel Aviv's Sourasky Medical Center have found an existing colon cancer gene mutation in 1.25% of the population. Among Jews of Sephardi origin, this mutation was more common, and 3% were found to be carriers.
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