Cancer of the colon and rectum is the second leading cause of cancer deaths of men and women in the United States. And, yet, experts agree that this form of cancer is nearly always preventable.

"There are only three cancers—skin, cervix, and colon and rectum—that are almost totally preventable," says Richard Billingham, MD, surgeon at the Northwest Colon and Rectal Clinic. "That's because they all have pre-malignant lesions that stay around for a long time and can be detected and removed before they become malignant. In the colon, you can see polyps long before they become malignant."

William Putnam, MD, gastroenterologist with Seattle Gastroenterology Associates, agrees. "Colon cancer is the number two cancer killer in the United States. And, it is a preventable disease. It's preventable by early detection and taking out polyps before they become cancerous."

So, if the disease is preventable, why are so many people dying from it?

In King County more than 1300 people will develop colorectal cancer within the next year and one-third will die from the disease. Nationally, about 131,000 new cases were diagnosed in 1998 and 55,000 died from the disease. Many of the deaths could have been prevented had people been properly screened.

Misinformation about the disease and screening techniques are two reasons people do not get screened, according to Steven Lewis, MD, gastroenterologist with Seattle Gastroenterology Associates.

"Many people feel they must have symptoms in order to be screened. But, the problem with colon polyps and early cancer of the colon and rectum is that there are usually no symptoms. If we wait for symptoms, then it's often too late," Dr. Lewis says. "Cancer discovered during screening of persons with no symptoms is cured 90 percent of the time. The cure rate falls to 40 percent if one waits for symptoms. Screening should never be delayed because there are no symptoms."

"Another reason is that people have a misperception that the screening techniques themselves are going to be painful. The truth is that most people feel nothing unpleasant or only brief discomfort with the procedures," Dr. Lewis says. "Compare this relatively small discomfort with being treated for colon cancer, particularly if it has spread or is fatal, and it's insignificant!"

Cancer is caused by the uncontrolled growth of abnormal cells. Nearly all colon and rectal cancers come from polyps, which are small benign (non-cancerous) growths on the lining of the colon and rectum. Approximately 20 percent of all people will develop polyps. These polyps almost never cause symptoms and most people are unaware that they have them. While not every polyp will turn into a cancer, it is impossible to tell which polyps will go on to become cancers. If polyps are present, and are found early, before they become cancerous, they can be removed, preventing their development into cancer.

"In theory, if people get appropriate screening, 100 percent of the cancers could be prevented." Dr. Billingham says. "In practice, about 95 percent could be prevented."

For most people, the chance of developing cancer is about 1 in 20 if no screening is done. However, some people are at greater risk for the disease. They include people with a personal history of polyps or colorectal cancer, a personal history of breast, ovarian, or endometrial cancer, inflammatory bowel disease, or a family history of colorectal cancer or polyps. People in the higher risk group should check screening options with their physicians.

In addition to getting screened for polyps, there are several lifestyle modifications people can make to reduce the risk of getting colon or rectal cancer. Lifestyle modifications include eliminating smoking (smoking can increase the risk of colon cancer by as much as 25 percent); reducing excessive alcohol consumption; increasing levels of exercise; and reducing animal fat in the diet.

But, lifestyle changes are not enough. "You can do lifestyle changes, and you can still get colon cancer," says Dr. Billingham. "Screening is the most important thing you can do."

Alexandra Read, MD, gastroenterologist with Seattle Gastroenterology Associates, made a point to dispel one popular myth about the disease. "There is a myth that colon cancer is a male disease. Colon cancer does not discriminate between the sexes. Colon cancer likes to kill women as often as men."

In the past there were few role models for colorectal screening. "While there were lots of role models for breast and prostate cancers, there were not a lot of champions for colorectal screening," Dr.Billingham says. "This is a cancer that people didn't want to talk about or hear about. Patients perceive the screening as painful and awful and it's not."

Over the past few years, awareness of colorectal cancer prevention has increased significantly, according to Richard Tobin, MD, gastroenterologist at Seattle Gastroenterology Associates. "Politicians, sports figures, entertainers, and others have gone public with their stories and several local and national organizations, including the American Cancer Society, American Gastroenterology Associates, and the American College of Surgeons have been working to increase awareness of this disease," he says.

Dr. Billingham, a vocal advocate for early and appropriate screening, is on the board of the STOP Colon/Rectal Cancer Foundation, a fledgling organization that is pushing for more visibility for colorectal cancer prevention. "It's a lot simpler to get screened than to get cancer," he says.

Two Patients Say Healthy Lifestyle Not Always Enough

During a routine physical, my wife discovered she had polyps in her colon. They proved to be non-malignant. Then, she said, "You know, Bob, maybe you should have a physical."

My doctor discovered several polyps in my colon. My primary care physician referred me for a colonoscopy.

I was in a state of shock. I had never experienced any problems with my health in my entire life. Here I was the guy who had taken really good care of himself and I'm the guy who gets it. I didn't smoke; I had eaten properlyÑnot much meat and plenty of grains. When this occurred after a life of routinely taking care of myself, I was in a state of shock.

My colonoscopy was performed in February 1999. Fortunately, the polyps were non-malignant.

I absolutely encourage people to have the check up! Had I not done this, in probably two or three years, blood would have shown up and I would have really gone into shock.

Robert West, 62, manager of a family business

Warning Signs of Colon Cancer Blood in the stool. A change in bowel habits not related to a change in diet. Passing pencil thin stools. Unexplained weight loss. Abdominal discomfort (gas or pain). A feeling that you are not able to fully empty your bowel.

I had never been screened for colon cancer. I thought about it a few years ago, but I put it off. Then one day, I just had a feeling that I should have the test—the sigmoidoscopy. I didn't have any symptoms. There was never any blood. But, I had talked to a lady on the bus who had had a colon operation and Today Show host Katie Couric's husband had died of colon cancer and he was only 42.

I just followed my intuition and requested the test.

So, I had the sigmoidoscopy. Polyps were detected. They turned out to be malignant.

I was in denial. Even though my sister, who was a heavy smoker, had died of lung cancer, I did not think I was at risk because I was not a smoker and I had eaten well. I don't know why it happened, but it did.

I'm very fortunate. All of the cancer was removed.

I suggest that every one, especially those over age 50, be screened. You never know what's down the road.

Marie Omdahl, 76, retired electronics sales person

Collaborative Cardiac Program Is A Winner After its first year, the Collaborative Cardiac Program between Northwest Hospital and the University of Washington is a success.

The program links the expertise of more than 20 cardiologists from Northwest Hospital and the UW and four cardiac surgeons from the UW to provide patients with a full range of cardiac services from routine diagnosis to sophisticated interventional cardiology procedures and open heart surgery.

Edward Verrier, MD, cardiac surgeon in charge of the program and chief of Cardiothoracic Surgery at the University of Washington, says the unique partnership is helping hundreds in our community.

"We have performed several minimally invasive cardiac surgery cases and the gamut of routine cardiac surgery at Northwest Hospital. The more complex cases are mutually sent to the University of Washington," he says.

Dr. Verrier says the program's caseload has already exceeded expectations. "Altogether, we have done approximately 200 open heart surgeries in our first year and are ahead of our projections. We project that we'll do about 250 in our second year and will double that in a couple of years."

Although the Northwest/UW cardiac program is new, the cardiac team is extremely experienced, says Gabriel Aldea, MD, chief of Adult Cardiac Surgery at the UW. He recently joined the program after working in a similar capacity in Boston for the past ten years.

"We have one of the best teams anywhere in the country," Dr. Aldea says. "The program provides a great opportunity to offer our patients the experience of an incredibly strong university-based team with expertise in cutting edge facets of clinical and basic research in a setting which emphasizes individualized patient-oriented care and service."

Fred Tobis, MD, cardiologist in charge of the program and director of Cardiovascular Services at Northwest Hospital, says the exceptional patient care and the highly skilled expertise of Northwest and University of Washington physicians make a big difference in patients' lives.

"In our start-up year, we have experienced low mortality and morbidity rates," Dr. Tobis says. "The benefits of the program are that patients are able to get top quality services in a community hospital setting; we're easy to come to; and we can provide exceptional nursing and support services. We're able to take the healing of our personal touch and marry it to the expertise and high tech facilities offered by the University of Washington."

For more information, call MED-INFO at 1-800-633-4636.

Childbirth Center Remodel Update The first phase of the remodel of the Northwest Hospital Childbirth Center is about to begin and is scheduled for completion this fall.

"Now, we'll have a facility to match our staff's reputation which has made Northwest Hospital Seattle's "Best Place to Have a Baby" [as voted by readers of Seattle's Child magazine], says Eric Thomson, registered architect and construction manager for Northwest Hospital.

Thomson and his team, designer Steve Campbell and project coordinator Karen Wood, are collaborating with the design teams of The Retail Group and Seeks Design Associates to complete the $3.1 million project.

Phase one of the remodel includes five rooms in the south wing; phase two includes 14 rooms in the west wing; and phase three is an addition to provide a larger waiting area. The total remodel will feature a Northwest lodge look with warm colors, lots of windows for light, and wood. When completed, all rooms will have a private bathroom. Currently, some rooms share bathing and/or toilet facilities.

"We're taking a boat approach to the rooms. There will be a place for everything and everything in its place," Thomson says, adding that the ergonomic design includes custom cabinetry that will conceal medical equipment in the room. "Previously, medical equipment was brought in as needed. Now every room will have all necessary equipment right in the room."

To make sure the rooms work efficiently for staff and patients, the team has created a life-size model of a room to test the functionality of the design.

Community Events and Classes

Hospital Hosts 20th Annual Children's Health Fair Pre-school children and their parents are invited to the Northwest Hospital's annual Children's Health Fair on Saturday, July 24th, from 10 am to 2 pm. The free informational and fun event will feature lots of information about children. Hospital departments will be on hand to give out free information on such topics as how to deal with childhood illnesses, respiratory ailments, emergencies, safety, immunizations, and more. Businesses that provide services and products targeted at pre-schoolers and their parents will also have informational tables at the fair. Representatives of the Fire and Police departments and several non-profit organizations have also been invited to participate in the fair. For the kids, there will be lots of fun entertainment, including face painting, games, and prizes. For more information, please call Terry Zarker, director of Volunteer Services, at (206) 368-1822.

Community Classes
Pre-registration is required for all classes. Unless noted, print out this registration form to register.

Call 368-1621 for more information.

• Women and Osteoporosis: A Northwest Hospital physician discusses osteoporosis focusing on cause, treatment and prevention. Tuesday, June 15, from 7:00 to 8:30 pm. Lindsay Gould Auditorium. FREE.