It’s colorectal cancer (CRC) awareness month again. I have always supported this campaign, as two of my brothers died from CRC, and a third one from liver cancer. Somehow, I still can’t shake off the thought that they might still be around today had they been screened much earlier.

Surgery could be curative in early CRC. So a high awareness and screening for CRC could be a game changer.

Dr. Jun Ruiz, a highly noted gastroenterologist and committed advocate for CRC screening, discusses the latest guidelines in colorectal cancer screening in the March issue of H&L (Health and Lifestyle) magazine.

He warns us that CRC is now the third most common cancer in the world, and the second most common cancer killer affecting men and women. In the Philippines, it’s also the third most common cancer, exceeded only by breast and lung cancers.

Reducing cancer risk

The good news, though, says Dr. Ruiz, is that colorectal cancer can be prevented, with screening reducing the cancer risk by as much as 70 percent. So, seven out of 10 potential CRC victims could possibly be saved with CRC screening.

“There have been great leaps in public awareness on colorectal cancer and its screening in the Philippines in the last five years,” says Dr. Ruiz, who gave up a lucrative private practice in Kaiser Permanente in Santa Clara, California, when he returned to the Philippines in 2013.

Back then, the only organized activity on CRC awareness was the Colorectal Cancer Awareness program conducted every March by The Medical City Colorectal Clinic under the leadership of noted colorectal surgeon Dr. Manuel Francisco Roxas.

As soon as he got settled, Dr. Ruiz initiated the screening campaign at St. Luke’s Medical Center Global City.

The Philippine Society of Gastroenterology and the Philippine Society of Digestive Endoscopy, as well as other hospitals, conducted their own nationwide campaigns in promoting screening among Filipino patients.

As a result of these annual awareness campaigns, several local hospitals had observed an increase in their screening colonoscopies, especially those included in executive checkups.

Dr. Ruiz regrets, though, that health maintenance organizations (HMOs) are still not covering screening tests, like colonoscopy and the fecal immunochemical test (FIT). The FIT is a special but affordable test to detect bleeding from the big intestines, which may be due to CRC. A screening colonoscopy costs under P20,000 in most hospitals, while the FIT costs around P400.

“It is ironic that preventive health examinations of its members are not paid by the HMOs when this would have been more cost-effective in the long run,” says Dr. Ruiz. “A person diagnosed with a late-stage colon cancer will spend several hundred thousand pesos for surgery and chemotherapy.”

Dr. Ruiz explains that CRC screening strategy can save lives by removing polyps, precancerous lesions that may turn into CRC later on. Even if it has become cancerous, early-stage CRCs could be surgically removed. Successful screening can indeed reduce the cancer risk in an individual by up to 70 percent.

Window of opportunity

There’s a window of opportunity to detect precancerous polyps in early CRC since most CRCs arise over a long period. “Most grow slowly, and it possibly takes around 10 years for some polyps to develop into malignant tumors,” says Dr. Ruiz.

But the problem is that polyps and early CRC have no warning signs and symptoms. When bleeding is detected in the stools during bowel movement, the CRC may already be in an advanced stage.

Dr. Ruiz details the risk factors that predispose an individual to develop CRC. The nonmodifiable risk factors are: 1) age greater than 50; 2) personal history of adenoma or prior colorectal cancer; 3) family history of colorectal cancer; and 4) pre-existing diseases, like inflammatory bowel disease. Age over 50 is the most common risk factor for colorectal cancer, as 90 percent of cancers occur after 50 years old.

The modifiable risk factors are those related to lifestyle, and include cigarette smoking, alcohol consumption, lack of exercise and obesity. There is also a strong association between this cancer and a diet high in saturated fats, low in fiber, and high in red meat consumption.

Guidelines

According to the guidelines, first-tier tests are colonoscopy every 10 years, and annual fecal immunochemical (FIT) test.

Second-tier tests include CT scan colonography every five years, FIT-fecal DNA test every three years, and flexible sigmoidoscopy every five to 10 years.

The so-called capsule colonoscopy is the only test in the third-tier.

For now, colonoscopy and FIT stool test are recommended, and can be done in many government and private hospitals around the country.

Get screened now, so you don’t add to the statistics of CRC victims in the country.