By Brian R. Landzberg, M.D.

Recently I saw a 60-year-old woman whose history I encounter all too often in my gastroenterology practice.  She came to see me because she had had a few months of constipation, with blood streaks in the bowel movement. She had diagnosed the problem as “hemorrhoids,” but when she saw her general doctor for an evaluation, her blood tests showed that she was anemic and that she had low iron levels in her blood.

I asked her if she had ever had a colonoscopy, and she replied that she had meant to do it, but, balancing home and career duties, she had simply never found the time. She told me that since no one in her family had ever had colon cancer, she hadn’t worried about it.  She assured me that she was up to date with mammograms and Pap smears, which she knew were important for women.

Colonoscopy confirmed my worst suspicion. This was colon cancer, and a bad one—large, obstructing, and too advanced to be surgically curable.

 

 

 

 

Colonoscopy photographs. Left  shows full-on colon cancer; right, a single pre-cancerous polyp. (Photos: Brian R. Landzberg, M.D.)

In the 21st century, cases like this are unnecessary tragedies!  If this patient had begun her screening colonoscopy at age 50, not only could this cancer have been caught at an early, curable, stage, but, more likely, it could have been completely prevented.

 

This tumor likely began its life several years prior as a pre-cancerous growth, or polyp (see below) ,which could have been easily removed at a screening colonoscopy.  This patient could have avoided the colon cancer that ultimately caused her death.


Photo: Brian R. Landzberg, M.D.

Left, biopsy with polyp indicated by  a cautery snare; right, site post-biopsy.  Photos ©Brian R. Landzberg, M.D.

In the United States each year, about 150,000 people are diagnosed with colorectal cancer and around 50,000 people die of colon cancer.  Research published in The New England Journal of Medicine last month, and reported in The New York Times, confirms what we have long known: Screening colonoscopy prevents deaths from colon cancer. In the often quoted National Polyp Study, led by Dr. Sidney Winawer at Memorial Sloan-Kettering, 2,602 patients with polyps removed at screening colonoscopy at seven major centers have now been followed for two decades.  This group clearly demonstrated a markedly reduced risk of dying from colorectal cancer relative to the general population.

 

 

 

Are mammograms and Pap smears important?  Of course they are, but my experience has been that most women know that already.  Over the years, I have heard female patients tell me that their husbands worry about colon and prostate cancer screening, and they worry about breast and cervical cancer screening.  Colon cancer is an equal-opportunity killer; it doesn’t discriminate!

 

Brian R. Landzberg, M.D., is a gastroenterologist and liver specialist affiliated with the Weill Medical College of Cornell University, New York-Presbyterian Hospital, and Hospital for Special Surgery, where he serves as Clinical Assistant Professor of Medicine in the Division of Gastroenterology and Hepatology. His particular areas of clinical interest are celiac disease; functional gastrointestinal disorders, including constipation, diarrhea, and irritable bowel syndrome; inflammatory bowel disease, gastritis, GERD, and liver disease. He has published and lectured on these topics and maintains a very active clinical practice on the Upper East Side of Manhattan.

 

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