by Dr. Melvin Palalay
In 2005, my patient, a healthy Filipino male, was turning 50. Reflecting the standards of that time period, I advised him to get his first screening colonoscopy.
He was busy working at the bank and raising a young daughter, so he always had some excuse to push it back. With continued encouragement through several years, the patient finally agreed to set up the screening colonoscopy.
In 2008, my patient reported back to my clinic to review the results. I quickly informed him that he did not have cancer, but he did have a particularly aggressive type of pre-cancerous growth in the colon, specifically a tubulovillous polyp.
This particular type of polyp (a growth of tissue in the colon) has a higher-than-average rate of transformation to cancer!
I added that because he had the polyp removed, his risk of developing cancer fell to 0%. Needless to say, the patient and his family were quite relieved, and he has continued to maintain his regular surveillance checks every 5-10 years.
We call patients like him Previvors, since they have taken steps to prevent the onset of cancer. Whenever I see the patient in follow-up, the old Ben Franklin saying always comes to mind, “an ounce of prevention is worth more than a pound of cure.”
Colon and rectal cancer is no joke. When combining men and women, statistics will show that it is the third most common cancer diagnosed in the United States.
The recent trends indicate that this cancer is also beginning to show up in younger populations of patients, such that the screening age has dropped to the age of 45 years. It is also notable that most of the colon cancers are sporadic and only 10% of cases are familial or genetically-linked. Colon cancer remains a highly curable disease and I would encourage everyone to have an honest discussion about timeliness in screening.
Unfortunately, based on a review, the majority of colorectal cancers in Hawaii are diagnosed at an advanced stage (usually deeper tumors with lymph node involvement or metastatic), ~52-65%. Native Hawaiians and Pacific Islanders are disproportionately affected by late-stage presentation, in particular.
I’d advise you to seek advice from your health care professional on what test would be best for you.
While the colonoscopy procedure remains the gold standard, there are other means of screening, including stool tests looking for blood, DNA material, and imaging with CTs to address the integrity of the colon.
Know your family history. Be aware of signs that may indicate a problem such as blood in the stools, constipation, diarrhea, changes in bowel patterns. If you develop iron deficiency without full explanation, you will need to pursue additional testing. I implore you to work with your health team.
Colon cancer remains a significant problem in Hawaii. The incidence is 29.2 per 100,000 persons per year in Hawaii, while the mortality rate is ~10 per 100,000 persons per year (age-adjusted). There has been a 46% rise in colon cancer incidence among those aged 45-54 years, particularly in females.
There is evidence that you can reduce risk by increasing dietary intake of fiber, whole grains, and dairy products, and reducing the consumption of red or processed meats, and lowering alcohol consumption. Higher calcium intake and yogurt will confer a protective effect.
In summary, I hope the resounding message of this piece is that colorectal cancer can be prevented and that early detection will result in improved survival and overall quality of life.
Please share this message with others and you may save a life. Best!
DR. MELVIN PALALAY is a hematologist and oncologist physician partner with Hawaii Cancer Care AON. He is certified by the ABIM and has been a passionate supporter of the Philippine Medical Association of Hawaii and Hawaii Society of Clinical Oncology. He has offices in Kakaako and Aiea, on Oahu.
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