Colon cancer prevention is achievable

MARCH is colorectal cancer awareness month (commonly called colon cancer awareness month). Most Nigerians are not aware of colon cancer; yet it is one of the most common cancers globally. Colon cancer is the third most common cancer in Nigerian men (after prostate and liver cancer) and the fourth most common cancer in Nigerian women (after breast, cervical and liver cancer). Every two hours, a Nigerian is diagnosed of colon cancer.

About 80 per cent of all Nigerians who are diagnosed of colon cancer die from it. This is very unfortunate; given the fact that colon cancer is one of the cancers that is virtually 100% preventable.

The colon and rectum (in our local parlances called abodi, afoanu, etc) are the last part of the bowel that absorbs water and salt from the food matter to form faeces or stool that then passes from the body. The colon is a muscular tube about 5 feet long whilst the rectum, is the final 6 inches of the digestive system, where faeces is stored until it passes out of the body through the anus.

Most colorectal cancers develop slowly, over ten (10) to fifteen (15) years. It usually begins as a small non-cancerous growth, called polyp on the inner lining of the colon or rectum. Overall, the lifetime risk of developing colorectal cancer is about 1 in 20 (5%).

This risk is slightly lower in women than in men. A number of other factors that can also affect a person’s risk for developing colorectal cancer include: several modifiable lifestyle habits such as diet, weight, exercise, smoking and heavy alcohol intake as well as non-modifiable factors like age, family history of colorectal cancer or polyp; type 2 diabetes.

Race and ethnicity also play a role; for example, in the USA, African Americans have the highest incidence and mortality rates of all racial groups. Of these risk factors, the link between diet, weight and exercise and colorectal cancer risk are some of the strongest for any other type of cancer.

Symptoms of colorectal cancer include: change in bowel habit such as diarrhea, constipation, or diarrhea alternating with constipation that lasts for more than a few days; narrowing of the stools; a feeling that you need to pass stool that is not relieved by doing so (tenesmus); rectal bleeding, blood in the stool which may make it look dark (although stool may look normal), cramping or belly pain, weakness and fatigue, unintended weight loss and rarely fever.

It is noteworthy that colorectal cancer may not have obvious signs and symptoms in the early stages. So, people should not wait for symptoms. As mentioned earlier, colon cancer is virtually 100% preventable.

There are countless testimonies to this fact. An example is Justice Ruth Joan Ginsburg, the oldest and only female Justice of U.S. Supreme Court who marked her 82nd birthday on March 15, 2015 (Mothering Sunday). She developed colon cancer in 1999 (16 years ago).

During the treatment, she did not miss a day on the bench. In 2009 (six years ago), she again had successful treatment for pancreatic cancer and did not miss any oral arguments in court. Similarly, Queen Elizabeth, the Queen mother, survived colon cancer and breast cancer at ages of 66 and 83 years respectively; she died cancer-free at the age of 101. Pope John Paul II, the second longest serving pope in history, survived colon cancer and later became a patron of the Global Campaign for Prevention of Digestive Cancers.

These success stories are a result of availability of infrastructure for screening and treatment of cancer in the respective countries of the survivors.

How can we prevent colon cancer? With lifestyle modification (including regular screening) most cases of colon cancer can be prevented. These measures include: intake of diet high in fibre, such as fruits, vegetable and whole grains and low in red meat (such as beef, pork, lamb or liver) and processed meat (such as hot dogs and sausage) as well as liberal intake of water.

It is important to note that fibre supplements have not been shown to be helpful in reducing risk of colon cancers. Rather, the emphasis should be on dietary sources of fibre, such as oat bran, wheat bran, legumes (beans), carrots, oranges, bananas and other fruits.

Avoidance of excessive weight, smoking and excessive alcohol intake while increasing the intensity and amount of physical activity, also help to reduce colon cancer risk. Above all, eligible individuals should undergo screening as recommended. Regular colorectal screening is one of the most powerful weapons for preventing the cancer.

This can in many cases, prevent colorectal cancer, altogether. This is because, with regular screening, most polyps can be found and removed before they become cancers. Screening can also result in finding colorectal cancer early, when it is highly curable.

Screening tests for colon cancer include: stool test, endoscopy (sigmoidoscopy, colonoscopy), as well as x-ray (double contrast barium enema and CT colonography). An important advantage of colonoscopy is that Polyps that are found during the procedure could be clipped off on the spot. In addition, it only needs to be repeated every ten (10) years if the result is normal. The recommended age for commencement of screening in the western world is 50 years.

However, anecdotal evidence shows that the peak age of diagnosis of colon cancer in Nigerians is about 44 years. This is highlighted by the relative youthfulness of some prominent Nigerians that have fallen victim to colon cancer, according to recent media reports.

For this reason, Nigerians should commence screening from the age of 40. Those with a family history should commence screening ten (10) years before the age at which the affected family member was diagnosed.

Sadly, apart from the fact that facilities for colonoscopy are not widely available in Nigeria, its cost is prohibitive and out of the reach of the common man. In Nigeria, most people are not aware of the need for colon cancer screening; most have never had colon cancer screening in their lifetime, accounting for the high mortality rate from colon cancer.

Nigerians in the rural area are worse off, because of the absence of adequate medical facilities for screening, diagnosis and follow-up. There is an urgent need to correct the unfortunate situation. This can be achieved through the use of Mobile Cancer Centres (MCC) which contain colonoscopes, among other equipment.

The current focus of the Committee Encouraging Corporate Philanthropy (CECP-Nigeria) is to acquire and deploy Mobile Cancer Centres across the country in collaboration with the National Cancer Prevention Programme, a non-governmental initiative, thereby making preventive health/cancer care accessible to all especially those in the grassroots. The CECP hereby invites all Nigerians to participate in the upcoming National Cancer Week (June 7- 14, 2015) which is dedicated to fund-raising for the acquisition of the MCC. (Please see www.cecpng.org, for details).

According to the Union for International Cancer Control, “By moving forward together we have the potential to show Cancer: It is not beyond us.” It is our enlightened self-interest to support the Big War Against Cancer in Nigeria. By so doing, we are saving our own lives.

This was the case with Imran Khan, Pakistan’s cricket superstar. Imran Khan established the first Comprehensive Cancer Centre (CCC) in Pakistan (Shaukat Khanum Memorial Centre) in 1994, as a tribute to his mother who died of colon cancer.

At this centre, 75% of all cancer patients are treated free-of-charge. Imran later developed acute intestinal obstruction for which he had to undergo emergency surgery at the Centre he established; that surgical intervention saved his life. Today, he has commenced the construction of a second CCC in another part of Pakistan.

To mark the Colon Cancer Awareness Month, there shall be FREE COLON CANCER SCREENING on Saturday, April 25, 2015, at the National Cancer Prevention Programme Centre, 30 Ishaga Road, off Itire Road, Surulere, Lagos.

This is open to adults aged 40 years and above who have a family history of colon cancer in a parent or sibling. Registration will take place between 12 noon and 12.30 pm same day.

There will also be another in the series of free breast, cervical and prostate cancer screening at 9, 00 am, on Easter Sunday, 5th of April, 2015, at Community Secondary School, Adigboluja, behind Taram Petrol station, Ojodu Abiodun, Lagos.

Vital information about the prevention of colon and other cancers may be gained by tuning in to the radio (Nigeriainfo 99.3FM) every Friday from 8.00am. At the moment, there is an ongoing series of awareness broadcasts titled ‘the 50 ways you can reduce your risk of colon cancer.’ Indeed,“Colon Cancer is Preventable! Treatable!! Beatable!!!” • Dr. Abia Nzelu (Executive Secretary, CECP-Nigeria) can be reached via info@cecpng.org or info@givingtide.org.