“We identified several survivors of colorectal cancer who were well-known, respected members of the community and asked them to participate in the project. We felt that personal stories would be a particularly powerful way to get the message out about this very common, vey preventable, form of cancer,” Dr. Hardy recalls. “But no one wanted to talk about it.”
The social and emotional stigmas associated with cancers of the colon and rectum proved too great. The CCA suspended the project.
Dr. Hardy serves as senior advisor to the Commonwealth Cancer Association, the local cancer support organization for the CNMI. Like many other public health officials, he believes that the need to break through the sensitivity and silence surrounding colorectal cancer has never been more urgent. “There is a high incidence rate here in the CNMI,” Dr. Hardy says. “We absolutely need to talk about colorectal cancer. We need to talk about it openly, and we need to talk about it now.”
What is colorectal cancer?
Colorectal cancer is cancer that develops in either the colon (the longest part of the large intestine) or the rectum (the part of the intestine that is closest to the anus). In most cases, colorectal cancer develops from precancerous, abnormal growths in the colon or rectum. Cancer that begins in the tissues of the colon is called colon cancer. Cancer that begins in the tissues of the rectum is called rectal cancer.
How common is it?
In the United States, colorectal cancer is the fourth most common cancer for men, after skin, prostate, and lung cancer, and for women, after skin, breast, and lung cancer, according to the National Cancer Institute. The CNMI’s cancer rankings are different from the national rankings, however, says local physician Dr. Joel Smith, who attends to all cancer patients at the Commonwealth Health Center. “Skin cancer is rare in the CNMI,” he notes. “Breast, head and neck, colorectal, and prostate cancers are most common [here].”
According to the National Cancer Institute, in 2009 approximately 146,970 new cases of colorectal cancer, and 49, 920 deaths caused by colorectal cancer, were reported in the United States. According to Dr. Smith, three new cases of colorectal cancer were diagnosed in the CNMI in 2009, and three deaths caused by colorectal cancer were reported in the same year.
The CNMI Department of Public Health’s 2007 Comprehensive Cancer Control Plan ranks colorectal cancer as the 6th most commonly diagnosed form of cancer in the CNMI, after breast cancer, lung cancer, cervical cancer, cancers of unknown origin, and head and neck cancer, and the fourth-leading cause of cancer-related deaths.
What are the risk factors?
A risk factor is anything that affects your chances of developing a disease. According to the American Cancer Society, researchers have identified several risk factors associated with colorectal cancer, including: age (more than 90% of people diagnosed with colorectal cancer are older than 50); personal or family history of colorectal polyps or colorectal cancer; personal history of inflammatory bowel disease; smoking; a diet that is high in red meats or processed meats; being overweight or obese; heavy alcohol consumption; physical inactivity; and Type 2 diabetes.
How can risk be reduced?
According to the Centers for Disease Control and Prevention, the most effective way to reduce risk of developing colorectal cancer is to have regular colorectal screening tests beginning at age 50, or earlier if you have a personal or family history of colorectal polyps or colorectal cancer or if other risk factors (see above) apply to you. Screening tests can detect precancerous growths in the colon and rectum, so that they can be removed before they develop into cancer. Screening can also detect cancer early, which is when treatment works best. If all people aged 50 and older were screened for colorectal cancer regularly, over 80% of all cases of colorectal cancer could be prevented, and as much as 60% of deaths from this cancer could be avoided.
Unfortunately, in the CNMI colorectal cancer is typically diagnosed in the late stages of the disease, underscoring the importance of early detection and screening – and public education – in saving lives. Local physicians have also been diagnosing colorectal cancer in individuals younger than 50, a phenomenon that suggests the need for further study by CNMI public health officials.
What screening tests are available?
Several types of tests may be utilized to screen for colorectal cancer, including colonoscopies (using a fiber optic, lighted instrument called a colonoscope that views the entire colon); flexible sigmoidoscopies (using a similar, but shorter instrument); and high-sensitivity fecal occult blood tests (which detect blood in stools). Colonoscopies and fecal occult blood tests may be conducted at the Commonwealth Health Center. Efforts are currently underway at the Department of Public Health to provide additional training and resources to medical providers through the Comprehensive Cancer Control Program.
The U.S. Prevention Services Task Force recommends screening for all people up to the age of 75, and for some people after the age of 75. If you are aged 50 or older, or if any of the risk factors associated with colorectal cancer apply to you, talk to your doctor about getting screened.
What are the symptoms of colorectal cancer?
Many people in the early stages of colorectal cancer exhibit no symptoms, which is another reason why regular screening is so important. When they do appear, symptoms may vary depending on the cancer’s size and location. Check your doctor if you have any of the following symptoms: rectal bleeding or bloody stools; a change in bowel habits such as diarrhea, constipation, or a change in the consistency of stools for more than two weeks; persistent abdominal discomfort, such as cramps, gas, or pain; weakness or fatigue; unexplained weight loss; or a feeling that bowels have not completely emptied.
What is the treatment?
Treatment for colorectal cancer may involve surgery, chemotherapy, biological therapy, radiation therapy, or a combination of these treatments depending on the size and location of the cancer. Surgery is the most common treatment for colorectal cancer. Non-complex colorectal surgeries may be performed at the Commonwealth Health Center, but complicated procedures must be referred off-island. Chemotherapy is generally initiated off-island, and maintenance chemotherapy may be conducted on-island.
