Cologuard: A lifesaver

In the United States, colorectal cancer (cancer of the colon and the rectum) is the second leading causes of cancer deaths. This year, 2019, the projected number of new cases:  colon cancer – 101,420, and rectal cancer -44,180. Colorectal cancer is the third leading malignancies in the Philippines, 8000 cases projected to afflict Filipinos. About one third of Americans are not up-to-date in their screening tests for these cancers, and I suspect the number is greater in the Philippines. The more recently introduced Cologuard test would surely increase the compliance for screening.

What causes colorectal cancer?

The exact cause is not know, but the risk factors contributing to the development of colorectal cancers are well-publicized. Age is a factor: the chances of getting colorectal cancers (and some other malignancies) increases as individuals get older. Most of those who developed colorectal cancers (91 percent) were older than 50. The average ages at the time colon cancer is detected are 68 for men and 72 for women.

What are the risk factors?

Besides age, the other risk factors include: Race (African-Americans appears to have higher predisposition to develop this cancer); a family history of colorectal cancer; a personal history of colorectal cancer or polyps; Crohn’s disease and other inflammatory bowel conditions; a diet high in red meat, processed meat, low in fiber, high in fat; lack of daily physical exercise; smoking, alcohol use, obesity, diabetes, and past history of radiation treatment for cancer, where the radiation was aimed at the abdomen. All these are factors.

Do young people get this cancer?

Yes. Although the incidence of colon cancer appears to be going down among 50 and older, colorectal cancers are increasing among people under 50. Those in their 30s are about 30 percent more prone than any other age groups to be found to have later stages (III and IV) of these cancers. The American Cancer Society projects that “by 2030, colorectal cancer incidence rates will be up 90% in people between ages 20 and 34, and 28% for people between ages 35 and 49.”

How does cancer develop?

Following repeated exposures to the risk factors and carcinogens in our food and environment, the healthy cells in our colon undergoes transformation (mutation) in their DNA, which is the brain and “GPS” of the cell. The DNA has within itself instructions (directions) that command the cell what to do. Normally, the cell divides according to the need of the body, and in an orderly and timely fashion. When the DNA is adversely affected and damaged by all those insults (our abuses and bad behavior and habits, plus environmental pollution), the DNA goes haywire and keeps instructing the cells to divide and multiply rapidly without control, leading to the formation of a tumor that grows non-stop. The cancer cells travel (metastasize) to he liver, brain, bones, etc., which spread ultimately kills the victim.

What are the signs and symptoms?

In many cases, there were no signs or symptoms, the very reason why colorectal screening tests are vital for early detection and treatment, to assure a cure. The common signs, when present, are: persistent change in bowel habits, constipation or diarrhea, shape and consistency of stools; rectal bleed or blood in the stools or black stools; frequent abdominal discomfort, cramps, gas; a sense of incomplete bowel emptying; tiredness, loss of strength; and surprising weight loss.

How is colorectal cancer detected early?

Early detection, second to prevention, provides the best strategy to deal with all cancers. The method is called screening and the simplest screening test for colorectal cancer used to be Fecal Occult Blood (FOBT) annually after age 50, and even at age lower thjan 30 for those with familial history of colon cancer. The new test is called Cologuard, a more accurate test, that detects at least 92 percent of colorectal cancers and 42 percent of advanced (precancerous) adenomas (polyps). This test is a life saver.

How is colorectal cancer prevented?

The old cliché that an ounce of prevention is worth a pound of cure is indeed true, more especially for cancers. Having a healthy environment helps greatly, but our world today is so polluted all around (air, water, land), that we, the people, and governments around the globe, must address this issue soon before we lose Mother Earth. Besides making our homes safe and healthy, we must also live a healthy lifestyle (view, for our overall health to prevent illness, like hypertension, diabetes, heart attack, stroke, Alzheimer’s and all cancers. Lifestyle changes could dramatically reduce the risk for colorectal cancers and all other diseases.

Does aspirin reduce the risk for this cancer?

The regular use of aspirin and non-steroidal anti-inflammatory drug (NSAID) has been associated with reducing the risk for precancerous polyps or colon cancer in some studies. The dose and details of this observation have not been fully determined. The option to use these pills for prevention is only for those with a high risk for colorectal cancer and not for those with average risk. The use of mini-dose (81 mg) aspirin for cardiovascular health under medical supervision is very popular. These over-the-counter drugs have the potential side-effects of gastrointestinal/ulcer bleeding. It is prudent to consult a physician before starting it.

What are those lifestyle changes?

Diet: Reduce meat intake to once or twice a week; stay away from processed meats (hot dogs, bacon, salami, pepperoni, ham, etc.) and other processed foods; eat fish at least 3 times a week (Salmon, small -not king- mackerel, sardines, trout, small – light canned – tuna safer than albacore tuna which is a large fish and contains a lot of mercury, like all large fishes), not farmed but wild-caught fish; eating a lot of varieties of vegetables, and some fruits, nuts, and whole grains; staying on low-carb diet, minimizing (or abstaining from) rice, pasta, bread, sweets, and any soft drinks which are all toxic, especially to children.

Behavior/habits: Have a positive attitude; abstinence or moderation from alcohol; no smoking or vaping; daily physical exercise for 30 minutes, at least 3 times a week; disciplined and safe use of cell phone, computer and television; stress management/frequent mini-vacation or staycation. Maintain a normal weight by diet and exercise, not by pills or potion, which are toxic to the body. Adjust daily caloric intake to maintain desired weight.

Our health and longevity are, to a significant extent, within our control.

Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: and  Email: [email protected]