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Colon Cancer: Talk for Women & High-Risk Individuals

March 16, 2009 11:59 AM with Dr. Laura Bianchi

Laura Bianchi, MD, Gastroenterologist, discusses colon cancer screening and prevention with a special focus on screening strategies for women as well as for individuals at high risk for colon cancer.

Kristin Philbin (Moderator) - 11:57 AM:
Welcome! Today’s chat: Colon Cancer: Candid Talk for Women & High-Risk Individuals will begin shortly. Please start submitting your questions and Dr. Laura Bianchi will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the Colon Cancer department to obtain more information about colon cancer.

Dr. Laura Bianchi (NorthShore) - 12:03 PM:
Hello. My name is Laura Bianchi. I am a gastroenterologist at NorthShore University HealthSystem and am also the Director of the newly established Women's GI Cancer Risk and Prevention Center and have also been a part of creating our Multi-disciplinary High Risk Colon Cancer Center. I look forward to your questions today!

  Anna (Park Ridge, IL) - 12:05 PM:
What’s the difference between colon cancer and colorectal cancer?
Dr. Laura Bianchi (NorthShore)
Colorectal cancer is a term that encompasses both colon cancer and rectal cancer. Rectal cancer occurs in the rectum which is typically the final 10-15 cm of your colon. Colon cancer occurs anywhere in the remainder of the colon.

  Karen (Schaumburg, IL) - 12:08 PM:
Are women who have been diagnosed with breast cancer more likely to develop colon cancer?
Dr. Laura Bianchi (NorthShore)
Having a history of breast cancer does not increase your risk of colon cancer. Thankfully, we have good screening tests for colon cancer and if you are asymptomatic and do not have a family history of colon cancer we recommend you undergo a screening test (ie. colonoscopy) at the age of 50.

  Lauren (Glencoe) - 12:11 PM:
I'm considering having a screening done and am doing some research on different tests just so I know what's going on. What is the difference between a colonoscopy and a flexible sigmoidoscopy? Is one a better screening test than the other?
Dr. Laura Bianchi (NorthShore)
Great question. The colonoscopy is a test that examines the entire colon and requires an oral bowel preparation prior to the test. On the day of the test you would receive sedation (medicines to make you sleepy) and after the test you would not be able to go back to work that day. The benefit of this test is that we are able to visualize the entire colon. A flexible sigmoidoscopy examines only the rectum and the sigmoid colon which make up about 1/3 of the colon. The preparation involves enemas (rather than an oral bowel preparation) and there is no sedation. If there is a polyp found during the flexible sigmoidoscopy you would need to return on another day for a complete colonoscopy. Since there is no sedation you can go back to work that day. The limitation of flex sigmoidoscopy is that it is only a partial examination and some people, especially women, will have polyps on the other side of the colon that could be missed.

  Suzanne (Chicago, IL) - 12:16 PM:
What is the ideal diet to prevent colon cancer?
Dr. Laura Bianchi (NorthShore)
Another great question. We used to advocate a high fiber diet for colon cancer prevention. More recent data questions whether fiber actually prevents colon cancer. That being said fiber is never bad for you. What we do know is that obesity increases a person's risk of developing colon polyps and/or colon cancer, so the best prevention is to have healthy eating habits and an active lifestyle in order to maintain a healthy weight.

  Karen (Schaumburg, IL) - 12:21 PM:
What are the major risk factors associated with colon cancer?
Dr. Laura Bianchi (NorthShore)
Risk factors for colon cancer include: age (polyps are more common as we age); having a close family member who has a history of colon cancer; obesity; and tobacco use.

  Donna A. (Glenview, Illinois) - 12:23 PM:
Two of my extended relatives have Crohn's disease. Is Crohn's a risk factor for developing colon cancer?
Dr. Laura Bianchi (NorthShore)
Some patients who have Crohn's disease that involves their colon have an increased personal risk of colon cancer. Having a family member with Crohn's disease will not increase your own risk of colon cancer.

  Farrah (Lake Forest, IL) - 12:25 PM:
I was very surprised to learn that women are less likely to follow their screening for colorectal cancer than men. Why is this the case?
Dr. Laura Bianchi (NorthShore)
Studies have examined this question and have found that women have greater fears and anxiety about colonoscopy (which is commonly recommended for colon cancer screening) than men do. This is part of the reason we have developed the Women's GI Cancer Risk and Prevention Center. It gives women who are interested in undergoing colon cancer screening an opportunity to talk with a female GI doctor and/or a GI nurse and to have all of their questions about colon cancer screening, colonoscopy, etc. answered prior to the procedure. This helps to reduce pre-procedure anxiety and will hopefully improve screening among women!

  Anna (Park Ridge, IL) - 12:28 PM:
What is Hormone Replacement Therapy, and how does it affect colon cancer?
Dr. Laura Bianchi (NorthShore)
Hormone replacement therapy is sometimes prescribed by a person's doctor, for instance to help deal with symptoms of menopause which is a time when female hormones may be at lower levels. Hormone replacement therapy was shown in the Women's Health Initiative study to be associated with a reduced risk of colon cancer.

  Suzanne (Chicago, IL) - 12:32 PM:
If a person has had non-cancerous polyps removed once, how likely is it that they will have them again? Do colonoscopies detect early stages of these growths?
Dr. Laura Bianchi (NorthShore)
30-50% of Americans over the age of 50 will develop colonic adenomas (pre-cancerous colon polyps). Adenomas are the earliest stage of pre-cancerous lesions that are visible on colonoscopy. Only 1-10% of adenomas, if left alone and not removed, would progress to colon cancer in the next 5-10 years. We use colonoscopy to detect these polyps and remove all of them since we don't know which ones will progress. Having a history of adenomas, especially multiple adenomas or large adenomas (> 1cm), increases your risk of developing future adenomas. That is why we will have you come back sooner for a repeat colonoscopy if you have had an adenoma detected.

  Karen (Schaumburg, IL) - 12:38 PM:
Are there any supplements that I can take to lower my risk for colon cancer?
Dr. Laura Bianchi (NorthShore)
Right now we do not have evidence to support use of any particular supplement which will prevent colon cancer. There are many studies underway investigating things like folate, calcium, and vitamin D for colon cancer prevention so there will hopefully be more information about colon cancer prevention in the coming years. At NorthShore we are starting a study investigating Miralax (an over the counter medicine used for treatment of constipation) and its use in colon cancer prevention.

  Elena (Vernon Hills) - 12:42 PM:
My grandmother died of colon cancer and my mother has had uterine and breast cancer. Since different types of cancer are prevalent in my family, am I at greater risk for getting colon cancer? I'm only 34 and feel I'm a bit young to be considering any type of cancer screening test. But I'm not sure.
Dr. Laura Bianchi (NorthShore)
Anytime a person has a strong family history of cancers it requires a bit of investigative work to find out the types of cancers, the age the family members were at diagnosis and the relationship to the individual (you!). We see patients like you at our Multi-disciplinary High Risk Colon Cancer clinic at Glenbrook Hospital. You could meet with a genetics counselor who would review your family history and help to determine if you are at increased risk for colon cancer or other cancers. You can also meet with a gastroenterologist at the same visit if you were to need to undergo screening. To schedule an appointment for this clinic you can call 847 657 1900.

  Karen (Schaumburg, IL) - 12:46 PM:
Are there any risk factors that would necessitate a screening before age 50?
Dr. Laura Bianchi (NorthShore)
A family history of colon cancer or colon polyps can be a reason to start screening earlier. The recommendation about the age to begin will vary based on how closely the person with colon cancer is related to you and at what age they were diagnosed with either colon cancer or polyps. For instance, if you have a mother who was diagnosed with colon cancer at age 50, then you should start screening at age 40.

Kristin Philbin (Moderator) - 12:49 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

  Patty (Morton Grove) - 12:50 PM:
I'm a little confused by all the different types of screening tests available for colon cancer. Do you recommend a certain screening type or does it depend on the individual's medical situation?
Dr. Laura Bianchi (NorthShore)
Our current practice guidelines recommend choosing from a variety of screening tests that are all reasonable options. Some of these tests are stool tests which examine your stool and can be positive if a person has colon cancer, but are not able to pick up pre-cancerous polyps. The colonoscopy and flexible sigmoidoscopy are procedures that I described in reply to a previous question and these can identify colon cancers and pre-cancerous polyps. The other screening option is "virtual colonoscopy" which uses a CT scan to look for polyps. This technology may not be covered by insurance and does require a bowel preparation like conventional colonoscopy. Virtual colonoscopy is a good test for people who have a reason that they cannot undergo colonoscopy.

  Suzanne (Chicago, IL) - 12:55 PM:
Last time I had a colonoscopy I had a hard time completing the preparation. I couldn't keep the last drink down and when I got to the test, I was not completely cleaned out. The doctor went ahead with the test. Might he have missed something? Should I have rescheduled?
Dr. Laura Bianchi (NorthShore)
The bowel preparation can be difficult to tolerate for some people. A good bowel preparation helps the doctor looking at your colon get the best look possible. The person who did your procedure is the best person to comment on how good a look he/she got.

Dr. Laura Bianchi (NorthShore) - 12:59 PM:
Thank you all for participating in the chat today. It was a really interesting discussion. As I mentioned, people interested in either our Women's GI Cancer Risk and Prevention Center at Evanston or our Multi-disciplinary High Risk Colon Cancer Center can call 847 657-1900 to schedule an appointment. Thanks again! Laura Bianchi

Kristin Philbin (Moderator) - 1:00 PM:
Thank you again for participating in our chat today. For more information please visit our Screening pages.

Also, a transcript of this chat will be available shortly.

This chat has ended.

Thank you very much for your participation.