EXPERT INTERVIEW
Clinical Considerations to Reduce Risk of Colon Cancer An interview with Editor-in-Chief Tina Kaczor, ND, FABNO
Colon cancer is one of the most preventable cancers, and yet it is the third leading cause of cancer deaths after lung cancer, and prostate for men and breast cancer for women. Natural Medicine Journal’s publisher, Karolyn Gazella, recently sat down with our editor-in-chief, Tina Kaczor, ND, FABNO, to discuss how clinicians can help patients reduce their risk of developing colon cancer. Kaczor has been working in oncology for 2 decades and is a Fellow of the American Board of Naturopathic Oncology. This was an excerpt of our conversation. You can listen to our whole discussion here, on iTunes, or wherever you listen to our podcast.
Question: Colon cancer is considered a preventable cancer, and yet it’s still a leading cause of cancer death. Why is that? Answer: Many of the risk factors for colon cancer are a product of our modern lifestyles—lifestyle habits, what we’re eating, how we’re sleeping, and our stress levels. Colon cancer rates are higher in Westernized societies in general.
How and when it’s diagnosed has a lot to do with why it’s a leading cause of cancer death. Ultimately, it’s not just the prevalence and the incidence of colorectal cancer, but at what stage it’s diagnosed. The higher the stage that it is found at, the more likely it will be to result in death. Question: That brings us to an important topic, which is screening. Can you take us through the types of screening tests and recommendations? Answer: Screening for colorectal cancer, just like any cancer, is really governed by the country. So what we do here in the United States is not the same in other countries. But the US Preventative Services Task Force recommendations include stool tests, endoscopy, and imaging.
There are three types of stool tests: • Guaiac-based fecal occult blood test that’s sometimes done in office or at-home. It is looking for blood in the stool. • The fecal immunochemical test (FIT) test is similar to the guaiac test, it just uses antibodies to detect blood in the
stool. What I like about this test is that vitamin C doesn’t interfere with the results as it can with the guaiac-based test. • The FIT test combined with a DNA test looks for blood as well as abnormal DNA, so it’s a more sensitive test. This one requires an entire bowel movement to be collected and sent out to a lab, so it’s more involved. But it does offer a little bit more specificity since blood in the stool can be from so many causes besides colorectal cancer. Endoscopy includes flexible sigmoidoscopy, which looks at the rectum and the descending colon but not the transverse or ascending colon. That’s usually done every 5 years, unless it’s done with those stool tests for blood, in which case it can be done every 10 years. The other type of endoscopy is colonoscopy, which scopes the entirety of the colon. It’s an intervention of sorts, because it will remove polyps, it’ll remove suspicious lesions, and it will biopsy suspicious areas. There is one imaging that is approved and it’s a virtual colonoscopy. Sounds great, no invasion, but it involves the same prep as a colonoscopy. Then they insufflate, which is a fancy word of saying they pump air into your whole colon, which can be uncomfortable. After that they put you through a CT scanner, so there’s a mild amount of radiation involved. If they see a polyp or anything suspicious, they still have to go back and do a colonoscopy with a real scope to get a sample. The other reason I’m not a huge fan of virtual colonoscopies is that they can miss one of the most likely polyps to become cancer, and that’s the sessile polyps. The recommendation for which type of colonoscopy to get has to do with patient preference, other medical conditions they may have, and risks and benefits to each of these.
26 ©2020 NATURAL MEDICINE JOURNAL. ALL RIGHTS RESERVED. NMJ, MAY 2020 SUPPLEMENT—VOL. 12, NO. 51 (SUPPL)
