By Dr Harold Munnings
In the year 2000, President Bill Clinton signed a proclamation that brought Colon Cancer Awareness Month into being. In twenty years, the initiative, which spread to Canada, the United Kingdom and The Bahamas, has saved untold lives.
In developed and predominantly Caucasian countries like the USA, Canada and the UK, lung is the top cancer killer, followed by colorectal cancer (CRC). If everyone in these countries stopped smoking, there would be far fewer deaths from heart attack and stroke and colon cancer would replace lung cancer as the top cancer killer.
In The Bahamas, we have fewer cigarette smokers and a predominantly Negro population and this influences our national disease profile. For our men, prostate cancer and in women, breast cancer takes the top spot. However, even here, CRC features in the top two or three or four in our statistics every year.
To appreciate the burden of CRC however, one must look beyond the statistics. Unlike prostate cancer, which is typically a disease of the elderly, colon disease often strikes in a person’s productive years, before or just after retirement when health has hitherto been excellent.
The disease is highly treatable when caught early, but in The Bahamas, it usually is not. It pains my colleagues and me when we have a patient who has presented with advanced disease, having missed the significance of months and months of symptoms.
What are the symptoms?
The things to watch for are subtle and especially for my fellow Bahamian men, too easy to overlook. Painless blood in the stool is the most common. We lose valuable time when we blame the food we have consumed or hemorrhoids that have been a nuisance for a while.
Blood in the stool is a serious symptom that should immediately trigger a call to your physician for an appointment. Another often-overlooked alarm symptom is unexplained gas and bloating. This should also cause you to call your doctor.
Watch out for anemia; if you or a loved one has been placed on iron tablets and the cause for the anemia has not been clearly established, this could be a danger sign. Stool should be examined for bleed that may not be visible and if it is present, a colonoscopy examination is needed.
My cancer patients often begin our meeting with the declaration that “I have no pain”. Far from providing reassurance, it triggers my alarm bells.
Appendicitis hurts. Diverticulitis hurts. Irritable bowel syndrome hurts. Cancer, in its early stages does not. Immediately I am wondering, “is this fine fellow going to be sidelined by surgery and chemotherapy before he is well again?”
That CRC is relatively common and increasing, and the fact that early symptoms are often overlooked is what drives the idea of screening for the disease in persons who have no symptoms.
We know that the disease begins to be a significant risk in men and women from the age of 45, and in persons who have a family history of CRC or polyps, so we target this demographic. We now know that CRC usually begins in precancerous growth called a polyp, and if these can be found and removed before they begin to transform into a malignancy, then cancer can be prevented.
This is why we urge colonoscopy screening. Early detection and cancer prevention is the goal. We will discuss colonoscopy in a future article. Till then, eat healthy, exercise often and see your physician when your body whispers in your ear.
Munnings is a Consultant Gastroenterologist at The Centre For Digestive Health, Grosvenor Close. More information can be found at digestivehealthbahamas.com