By Dr. Karen Szauter

When former NBC Today Show co-host Katy Couric lost her first husband to colorectal cancer in 1998, Americans mourned her loss. But when Couric used her sadness and celebrity status to spread awareness of the taboo subject throughout the United States and beyond, we realized something very powerful was coming from something very tragic.

Colorectal cancer is the second leading cause of cancer in the United States. In 2001 it was estimated that 135,400 people would be diagnosed and 56,700 people would die from this preventable disease.

If we catch something early we can make such a difference. If a patient skips (a colorectal screening) just because of apprehension and then comes in two to three years later with a lesion we can’t treat – that would just break my heart.

Only lung cancer kills more people in the United States, but colorectal cancer is easy to detect and can be cured in a simple procedure if detected early.

It takes at least 10 years to go from normal to the polyp phase. The polyp gets larger and larger and then can transform into cancer.

According to the American College of Gastroenterology, colorectal cancer is most likely to strike in those above the age of 50, and it is recommended that anyone age 50 or older should be screened for colorectal cancer on a regular basis. Patients who have a history of colorectal cancer in their families should consult their doctors and begin screenings at an earlier age. Removal of polyps can reduce chances of colorectal cancer by 90 percent and deaths by nearly 100 percent.

Polyps are asymptomatic, meaning that patients with them don’t have symptoms. If you don’t have a history of colon polyps or colorectal cancer, you should start to be screened at age 50 and have a colonoscopy every 10 years.

There are several different screening methods to test for polyps in the colon, including sigmoidoscopy, barium X-ray and fecal occult blood testing, but none are as thorough as the colonoscopy.

A sigmoidoscopy is highly accurate in discovering polyps in the lower third of the colon, but because it only screens the lower part of the colon, polyps in the upper colon can go undetected.
A barium X-ray can detect the presence of large polyps and cancers; however, it may identify as few as half the amount of polyps in the entire colon. If a polyp is found, a colonoscopy must be performed.
An FOBT can be performed at home and mailed to a lab to be tested for blood that may indicate the presence of polyps; however, according to the Journal of the American Medical Association, researchers at the Mayo Clinic found these tests to be only 30 percent accurate in detecting early signs of colorectal cancer.
The sigmoidoscopy, barium X-ray and FOBT tests can detect polyps, but because they are not as accurate as a full colonoscopy, they should only be used to complement that procedure.

Colonoscopy is the optimal means by which to screen for colorectal cancer. Just as physicians screen for both breasts and both lungs for breast and lung cancers, they shouldn’t assess just part of the colon. Doing a sigmoidoscopy is like doing a mammogram on only one breast.

We know that the idea with colorectal cancer prevention is to identify the polyp and take it out so it can never develop into cancer, or – worst case – find a cancer that’s early, because if you find a cancer early before it’s spread into the bowel wall you can cure the patient’s cancer. The best way to find those polyps and that early cancer is with a colonoscope.

Although the thought of a colonoscopy may strike fear into the hearts of many, the procedure is thorough, quick and well tolerated.

The outpatient procedure involves a day of preparation during which the patient is on a liquid diet and drinks a laxative to cleanse the system. The next day the patient is sedated while a gastroenterologist inserts an endoscope, a thin flexible tube with a video chip, into the colon to explore for abnormalities.

Although colonoscopies are a daily practice for the doctors in UTMB’s division of gastroenterology, our physicians understand the apprehensions a patient may have.

Before her husband’s death, Couric had never thought much about colorectal cancer, but since his passing her efforts to spread awareness of this common but deadly disease have been broadcast into living rooms across the country. She even had NBC tape her own colonoscopy and air it on the Today Show to demonstrate the ease and simplicity of the procedure.

Couric has helped shed some of the mystery surrounding colorectal cancer and preventative screenings and patients feel more comfortable communicating their feelings and questions about colonoscopy. Importantly, me and my colleagues always take the time to listen and answer patients’ questions openly and honestly. We talk to patients about the procedure. The personal connection really helps people.

Dr. Karen Szauter is senior medical educator in the Office of Educational Development, medical director of the Standardized Patient Center and an associate professor in the Department of Internal Medicine-Gastroenterology at the University of Texas Medical Branch at Galveston.
The Your Health column is written by health and medical experts at the University of Texas Medical Branch at Galveston. The column focuses on topical health issues that we believe are of interest to your readers. It is e-mailed every Tuesday. If you have any questions about the column, or would like to suggest topics, please contact John Koloen, media relations specialist, at (409) 772-8790 or email

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