Screening, early detection saves lives
Colorectal cancer ranks among the top five cancers affecting both men and women in Cayman, yet most people do not undergo the simple screening procedures needed for prevention or early detection of the disease.
Christine Sanders, education and office manager of the Cayman Islands Cancer Society, wants to increase awareness of both basic preventative measures and the various screening methods that are available locally to detect the disease.
She also stresses that both men and women are at risk of colorectal cancer.
‘In the States, a doctor will talk to a man about colon cancer but not necessarily a woman. The main thing is for a woman to be assertive enough to ask the doctor about it, at least to initiate the discussion,’ she said.
Gastroenterologist Dr. Trevor Seaton has been a visiting doctor here for the last seven years, seeing patients at Chrissie Tomlinson Memorial Hospital for one week every two months.
He believes the incidence of colorectal cancer is similar here to what he has seen during his 30-year practice in Ontario.
‘People in Cayman have the impression that there is a lot of cancer in Cayman. But it’s a relatively small community and everyone tends to know who has cancer so it is high profile.
‘My impression is that there is no increased prevalence of colon cancer in Cayman but it is the second most common cancer in people generally: second to breast cancer in women and second to prostate cancer in men,’ Mr. Seaton said.
It is difficult to quantify the specific risk of this type of cancer for people in Cayman, he explained.
‘About 1/16 of the population of Western countries develop colon cancer. People bring to Cayman the risk of their ethnic group. Most of the expats who come from Canada, the US and Europe bring with them six per cent risk.
‘What is not known is the risk of people in the Caribbean. The problem is trying to extrapolate those risks from Western countries,’ he said.
Risk factors
Certain factors that will increase the chances of developing colorectal cancer cannot be modified, such as age. More than 90 per cent of those diagnosed with the disease are older than 50, according to the American Cancer Society.
In addition to age, there are other risk factors for colorectal cancer over which people have no control, such as genetics, ethnic background and family and individual medical history.
‘People with diabetes are also more prone to colorectal cancer, with those who are insulin-dependent at a higher risk.
‘But many of the things you can do to control diabetes can reduce the risk of developing colorectal cancer,’ Ms Sanders said.
Factors that can be controlled include diet, physical activity, obesity, alcohol consumption and smoking, which are all lifestyle issues, she explained.
Ms Sanders addressed these specific factors.
‘Studies indicate that people with diets high in red meats and fatty foods, and low in fresh fruit, vegetables and whole grains, tend to have higher incidences of colorectal cancer than those with diets high in fish and chicken as well as fruits, vegetables and whole grains,’ she said.
A related risk factor is obesity. ‘There is a definite link between obesity and colorectal cancer. If you are obese, risk increases,’ Ms Sanders explained.
The importance of maintaining a healthy weight should be addressed at an early age, she added.
‘By developing good eating habits in our children, they can in the long term reduce their risk of colorectal cancer,’ Ms Sanders said.
Increasing physical activity goes hand-in-hand with a healthy diet and weight, with a sedentary lifestyle adding to the risk, she explained.
In addition, consuming more than one alcoholic drink a day increases the risk. And, smokers are 30 per cent to 40 per cent more likely to die from colorectal cancer than non-smokers, according to the ACS.
Mr. Seaton, however, is not convinced there is a connection between all the various risk factors and the development of colorectal cancer.
While he believes that heavy beer drinkers have an increased risk, he finds the other factors are not so clear cut.
‘The general advice about alcohol consumption, increasing fibre and decreasing animal fat, is good for your health, but there is no hard scientific evidence that they will reduce the risk of colon cancer.
‘I can tell you not to smoke because it causes lung cancer, bladder cancer and heart disease, but I can’t tell you not to smoke because it’s going to reduce your risk of colon cancer,’ Mr. Seaton said.
Ms Sanders believes that people still need to be aware of the possible contribution of these factors to the development of colorectal cancer.
‘The risk factors for colorectal cancer that I have discussed have been identified as such by reputable organizations such as the American Cancer Society, Cancer Research UK and the Canadian Cancer Society.
‘These factors have emerged as possibly increasing your chance of developing colorectal cancer and we want people to have as much information as possible,’ Ms Sanders said.
Screening vital
As well as reducing the possible risk factors that can be controlled, people over 50 should maintain a regular screening schedule. When diagnosed early, 90 per cent of colorectal cancers are completely curable, according to the ACS, but only 37 per cent of these cases are found at an early stage.
Ms Sanders stressed the importance of screening, explaining that 85 per cent of people who develop colorectal cancer do not have any medical history of the disease.
‘If people have certain symptoms, they should be investigated,’ Mr. Seaton said.
The symptoms to look out for are blood in the stool, unexplained change in bowel habit, unexplained abdominal pain and iron-deficiency anaemia, he explained.
The main screening methods are available here and are recommended for people age 50 and over, or younger if they are at a higher risk, according to Ms. Sanders.
The faecal occult blood test checks for hidden blood in the stool. Mr. Seaton explained the benefits of this test.
‘According to three different studies done in the US, England and Denmark, over seven to 13 years, this test has been shown to reduce the risk of death by colon cancer by 15-30 per cent.
Early detection
‘The difference is early detection. It definitely increases the number of early cancers found. Colon cancer is the most curable cancer if found early; the trouble is most people don’t know they have it,’ he said.
A flexible sigmoidoscopy (where a thin, flexible tube connected to a camera is inserted into the rectum) can be performed to look for polyps. To check the entire colon, a doctor will perform a colonoscopy using a longer version of the sigmoidoscope, which requires the patient to be sedated.
The other diagnostic tool is the double-contrast barium enema which allows the colon to be viewed by X-ray.
Procedures such as a colonoscopy can be very expensive, however. The cancer society can help with funding in certain cases, Ms Sanders explained.
‘If a doctor recommends a colonoscopy and the patient needs financial assistance, please contact the cancer society. The patient can apply for a voucher to cover all the costs,’ she said.
This test is considered the best diagnostic tool, Ms Sanders explained.
‘The doctor can view the entire colon and if a polyp is found, it can be removed and sent off for a biopsy,’ she said.
The colonoscopy is the method of choice for Mr. Seaton.
‘The reason I do colonoscopies, and have had two myself, is that colon cancer is one of only two cancers (colon and cervical) that are quite preventable. Colon cancer always starts as a non-cancerous growth and takes up to 10 years to develop from a polyp to cancer. So, the only way to prevent it is to look for polyps,’ Mr. Seaton said.
He explained the importance of the tests from the point of view of a patient.
‘If you don’t want to die of colon cancer, the FOBT reduces your chances of dying by 15 to 30 per cent. If you don’t want to get colon cancer, the only way to do that is to check for polyps,’ he said.
Treatment options
If a patient is diagnosed with colorectal cancer, there are several treatment options, but not all are available on Cayman.
‘People who require radiation as part of their treatment protocol need to go off-island,’ she explained.
Patients can get chemotherapy in Cayman and any necessary surgery can be performed here. No oncologists practise on the island, but a visiting cancer specialist comes in from Jamaica once a month.
‘The more treatment a person can get in their home environment, the better for the patient; they are able to receive more support from their family,’ she said.
Ms Sanders is also working to disseminate information about the disease to the public.
‘We are gradually trying to get back into town hall meetings. We are organising district meetings with doctors, with maybe a survivor and a counsellor,’ she said.
The society will also be publishing related brochures and flyers, and producing television and radio spots.
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