Dear Nurse Bonnie:

I am confused! A few years back my dear friend, aged 63, died of colon cancer. Six months before she had been given a sigmoidoscopy and it didn't find anything. What could have been done to find her cancer before it had spread?
E.A.

Dear E.A.:

I am very sorry for your loss….but grateful for your question and the opportunity it raises to hopefully prevent this from happening to someone else.

Screening for colorectal cancer is the most effective way to find, eliminate and prevent deaths. Screening has been underutilized, done too late or not thoroughly enough. In 1999 only 44% of adults aged 50 and over had ever had a sigmoidoscopy (examination of the lower portion of the colon and rectum) or colonoscopy (examination of the entire colon). It sounds as if your friend's colon cancer was not visualized by the sigmoidoscopy. A colonoscopy would have seen the cancer and your friend would probably have been scheduled for surgery and follow-up treatment.

Screening Guidelines for ColoRectal Cancer

It is basically between you and your doctor or health care professional to decide what screening test to recommend.

Please keep in mind when deciding that finding and removing precancerous polyps and cancer is the best way to either prevent the development of colorectal cancer or to detect it at an earlier and more treatable stage.

• FOBT (fecal occult blood test): This is a chemical test for blood which is visually undetectable in a stool sample. To be effective, three complete stool samples in a row should be tested. This is not foolproof but is recommended annually.
  
  
• Flexible Sigmoidoscoy: A hollow, lighted tube inspects the rectum wall and only part of the colon. Guidelines recommend every five years….but as we have seen, this can and does miss abnormalities located beyond the sigmoid colon.
  
  
• Total Colon Examination by colonoscopy or double contrast barium enema every 5 - 10 years.

THE ADVANTAGE TO COLONOSCOPY IS THAT POLYPS AND PRECANCERSOUS TUMORS CAN BE REMOVED ON THE SPOT. If these are found, more frequent testing is recommended. Screening is recommended for those over 50 or younger if there is a family history.