Got Guts! A Guide to Prevent and Beat Colon Cancer

By Joseph Weiss, Nancy Cetel and Danielle Weiss

Colon cancer is one of the most common and deadly cancers. It is both preventable and curable when found early, but devastating when discovered too late. It begins silently without any signs or symptoms, and rarely gives any warning until too late. In spite of painless, accurate and 

• Language: English
• Publisher: SmartAsk Books
• Release date: Oct 12, 2020
• ISBN: 9781943760992

Joseph Weiss

Joseph Weiss, MD, FACP, FACG, AGAF is Clinical Professor of Medicine in the Division of Gastroenterology, Department of Medicine, at the University of California, San Diego. An autodidact and aspiring polymath, he was accepted to university at age sixteen and attended the University of Michigan, University of Detroit, and Wayne State University. Reflecting his broad interests, he had three separate majors in Medieval English Literature, Astrophysics, and Invertebrate Zoology. Following his graduation from the Wayne State University School of Medicine in Detroit, Michigan, he completed his internship and residency in Internal Medicine at the University of California, Irvine Medical Center in Orange, California. Dr. Weiss is a Fellow of the American College of Physicians and a Senior Fellow of the American College of Gastroenterology. Under the auspices of the World Health Organization and others he has pursued interests in Tropical Medicine and International Medicine with extended stays in Africa, the Middle East, and Latin America. Subsequently completing a clinical and research fellowship in Gastroenterology at the University of California, San Diego, he has been active on the clinical faculty. Board certified in Internal Medicine and Gastroenterology, he has over thirty years of clinical, administrative, and research experience. Dr. Weiss is a Fellow of the American College of Physicians, Fellow of the American Gastroenterological Association, and a Senior Fellow of the American College of Gastroenterology. He is the prolific author of several dozen books on health (www.smartaskbooks.com) and papers published in prestigious national and international medical journals, as well as in the lay press. Dr. Weiss is an accomplished professional speaker and humorist, having given over two thousand invited presentations nationally and internationally. He has presented at universities, medical schools, hospitals and medical centers, pharmaceutical companies, YPO/WPO, Aspen Institute, Bohemian Grove, Esalen Institute, IDEA World Convention, International Destination Spas & Resorts (Golden Door, Canyon Ranch, Rancho La Puerta), corporate events, etc. Co-hosting a popular health care radio program on a major network affiliate in Southern California showcased his skills as a communicator.

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Got Guts? A Guide to Prevent & Beat Colon Cancer/ Weiss, Joseph B.  ; Cetel, Nancy S. , Weiss, Danielle E. - 1st ed.

Library of Congress Control Number: 2019905547

ISBN: 978-1-943760-97-8 (Color Print 6x9)

ISBN: 978-1-943760-98-5 (B&W 6x9)

ISBN: 978-1-943760-99-2 (e-book)

SmartAsk Books ©2020

Rancho Santa Fe, California, USA

www.smartaskbooks.com

Disclaimer

Medicine is an ever-changing field. The authors have made every effort to provide accurate educational information as of the date of publication. This book is not intended as a substitute for the medical advice of physicians or other health care professionals. For diagnosis, treatment, prevention, screening, or surveillance of any medical condition, concern, or problem, consult your own physician or health care professional.

Dedication

This book is dedicated to our many patients, friends, colleagues, and loved ones who are directly or indirectly affected by cancer. We have in mind especially those who have battled colorectal cancer and offer this book as hope for the future, that new methods of detection will lift this terrible burden from our society.

Acknowledgment

We appreciate the comments, feedback, and encouragement offered by our family, friends, and colleagues, who understand the depth of our concern about the high rate of colon cancer in our society. The untimely and avoidable death of a dear friend helped spark our desire to spread the word to a larger audience, so that needless suffering can be averted. It is our hope that Got Guts? will lead to the prevention of disease, to early diagnosis when it occurs, and to the avoidance of unnecessary pain, illness, expense, and the loss of so many lives. The great news is that we can improve the outcomes for our whole society.

Contents

Preface

Introduction

Chapter 1 : Prevention of Colorectal Cancer: What You Must Know!

Early Detection of Colorectal Cancer

Key Points on Colorectal Cancer Prevention and Screening

Chapter 2 : Pros and Cons of Colorectal Screening Tests

Screening Techniques

Chapter 3 : Colorectal Cancer Myths

All Odds Considered

Anatomy of the Colon

FIT (Fecal Immunochemical Test)

Conventional (Standard) Optical Colonoscopy

Myth #1: Conventional (standard) optical colonoscopy is the gold standard.

Myth #2: Colorectal cancer affects only those over the age of 50.

Myth #3: Lifestyle has no effect on colorectal cancer risk.

Myth #4: Women and men have similar colorectal cancer risks.

Myth #5: Colorectal cancer screening requires sedation.

Myth #6: Colorectal cancer screening is expensive.

Myth #7: Fecal tests are embarrassing and ineffective.

Myth #8: Colorectal cancer screening is not for those under age 45.

Myth #9: Colorectal cancer screening is not for those over age 75.

Myth #10: Flexible sigmoidoscopy is ineffective.

Myth #11: All colon polyps should be removed.

Myth #12: Conventional (standard) optical colonoscopy quality is consistent.

Myth #13: A negative colonoscopy assures you are safe from colon cancer for 10 years.

Myth #14: Virtual/capsule colonoscopy is not approved by the FDA.

Myth #15: Urine, blood, or saliva tests are not available.

Myth #16: Any positive screening test requires optical colonoscopy.

Myth #17: Colon-cleansing preparation is always effective.

Myth #18: Financial interests do not influence screening.

Myth #19: Doctors keep current with recommended practices.

Myth #20: The colon is a vital organ required for life.

Chapter 4 : olorectal Cancer Impacts Everyone

Preventive Measures Throughout Life

A Word about Statistics

Belief, Truth, Knowledge, and Wisdom

Insurance: Population versus Individual

Proactive Approach to Detection and Prevention

Appendix : Colorectal Cancer Prevention Comprehensive Resource

Chapter 1: Colorectal Anatomy and Physiology

Chapter 2: Colorectal Polyps

Chapter 3: Colorectal Cancer Statistics

Chapter 4: Colorectal Cancer Genomics

Chapter 5: Colorectal Cancer Risk Factors

Chapter 6: Diet, Supplements, and Epigenetics

Chapter 7: Alcohol, Tobacco, and Pharmaceuticals

Chapter 8: Gender Differences

Chapter 9: Digital Rectal Examination

Chapter 10: Fecal Occult Blood Test

Chapter 11: Urine Metabolomics Test

Chapter 12: Multitargeted Stool DNA Test (Cologuard®®)

Chapter 13: Gene Sequencing Mutation Test

Chapter 14: Blood Tests ELISA-Based MultiAnalytic Assay of Blood

Chapter 15: Barium Enema

Chapter 16: Flexible Sigmoidoscopy

Chapter 17: Conventional (Standard) Optical Colonoscopy

Chapter 18: Virtual Colonoscopy/Computed Tomography Colonography

Chapter 19: Capsule Colonoscopy

Chapter 20: Colorectal Cancer Myths

Chapter 21: Colorectal Cancer Prevention and Screening Strategy

Chapter 22: Colorectal Cancer Prevention and Screening Economics

Chapter 23: Comparison of Colorectal Screening Tests

Chapter 24: Advanced Technologies

About the Authors

Preface

Each year more than 1.8 million people globally are diagnosed with colorectal cancer, with more than 800,000 deaths attributed to the disease.

More than 140,000 Americans will be diagnosed with colorectal cancer this year, and more than 51,000 will die from this preventable disease.

Colorectal cancer can be prevented more than 90% of the time, and can be diagnosed early with regular screening, reducing illness, death, and health care costs. 

Fewer than 62% of people in the United States undergo screening tests as recommended.

Optical colonoscopy offers important diagnostic and therapeutic advantages but has significant disadvantages in terms of expense and risk of complications compared with other screening methods. 

This book is a valuable resource on the prevention of colorectal cancer.

This book is not a substitute for a health care professional.

As the title suggests, this book offers readers tools to save their lives, health, and wealth. Following the prevention guidelines outlined herein will without a doubt reduce your risk of developing colorectal cancer or polyps. This information can potentially save tens of thousands of lives each year, including your own! 

Most doctors mean well, but the majority do not appreciate that public health guidelines are designed for the average person, following the common but incorrect belief that what is best for the average person is best for everyone. Doctors, just like many people, often cannot distinguish between medical practices based on scientific knowledge and those based on an unproven belief. Most doctors and people do not know their limitations and may not recognize what they do not really know. The result is that they may well be wrong, even when they believe they are right.

The illusion of knowledge, and the illusion of superiority, are very common among doctors and other professionals. Ninety percent believe they are well above average in their knowledge and more skillful than most other doctors, even though statistics allow only half to be considered above the average. Colon cancer screening is widely promoted in the United States because colorectal cancer is a common cause of illness and death. It is easily prevented and up to 90% of the 140,000 cases and 51,000 deaths in the United States each year can be avoided with lifestyle changes and routine screening. Conventional (standard) optical colonoscopy is upheld as the gold standard for screening by the influential and highly profitable U.S. colonoscopy industry. While it has great value as a diagnostic and therapeutic procedure, we believe that optical colonoscopy is overutilized and inappropriate as a screening test, particularly for the person who is at only average risk of contracting colorectal cancer. We advocate a safer, noninvasive, inexpensive, painless, more accurate, proven and effective approach, using the quick, convenient, and widely available FIT (fecal immunochemical test) for occult blood. 

On average it takes 1,000 screening colonoscopies costing over $3 million to identify one case of colorectal cancer. While colonoscopy has a low overall complication rate of 1% to 2%, ironically a life-threatening complication from colonoscopy will occur at nearly three times the rate of finding a cancer. On average it will take 1,000 noninvasive, painless, FIT for occult blood to also identify one case of colorectal cancer, at a cost of less than $100,000. This simple and inexpensive test does not have any direct potential complications, discomfort, dietary restrictions, colon-cleansing preparation, time off from work, transportation needs, scheduling arrangements, or coordination of insurance coverage of hospital, surgery center, gastroenterologist, anesthesiologist, pathologist, or prescribed medications or laxatives.

The main argument in favor of using conventional colonoscopy as a screening test is the ability to remove a polyp or biopsy a cancer as quickly as it is identified, and that the optical colonoscopy method is more sensitive than others in detecting polyps. The ability to biopsy or remove polyps is not a requirement for a screening test. A diagnostic or therapeutic colonoscopy to biopsy cancer or remove polyps can be undertaken if and when a noninvasive screening test is positive. While colonoscopy does have greater sensitivity in identifying polyps smaller than 5mm (0.2 inches), this is infrequently considered of clinical significance, as the overwhelming majority of these polyps are not precancerous. The accuracy of optical colonoscopy is also overrated: although it can identify polyps as small as 1 mm, it has a significant miss rate even for larger polyps and colorectal cancer. On average 22% of polyps and 5% of colorectal cancers may be missed during an optical colonoscopy.

There is controversy over whether the identification and removal of small polyps less than 5mm (0.2 inches) are warranted, as this does lead to higher rates of unnecessary complications, as well as greater expense from pathology laboratory and professional interpretation fees. Many specialists advocate leaving these polyps in place, relying on future examinations to identify and remove these lesions if and when they grow larger. Minimally invasive virtual colonoscopy/computed tomography (CT or CAT scan) colonography has the same sensitivity and accuracy as optical colonoscopy for identifying colorectal cancer and clinically significant polyps of 10mm (0.4 inches) in size or larger, at a fraction of the discomfort, expense, and risk of complications or incomplete examination. The disadvantage of CT colonography is the low-dose radiation of 4 mSv to 8 mSv, compared to a normal annual background radiation at higher altitude of 4.5 mSv. The value of having virtual colonography was confirmed by a benefit-to-risk ratio greater than 35:1, which would be terrific odds if you were going to Las Vegas. Alternative technology, such as capsule colonoscopy also offer a minimally invasive approach with good sensitivity and specificity.

In 2018 the United States spent over $3.3 trillion on health care, which represents 17% of the national gross domestic product, the measure of all goods and services produced in the country. Thirty million Americans, 9% of the U.S. population, do not have any health insurance. Eighty-six million Americans, 26% of the U.S. population, are underinsured. The risk of your illness or death from the more common illnesses or causes include cancer at a risk of 1 in 3, heart disease at 1 in 4, accidents at 1 in 20, alcohol or drugs at 1 in 34, diabetes at 1 in 46, suicide at 1 in 63, car accident at 1 in 77, and firearm also at 1 in 77. Airbags add thousands of dollars to the expense of each vehicle, which the public pays for as required equipment at a rate of $4 billion per year, and yet this same safety device tragically has a significant risk and directly contributes to the death of children. The airbag is rarely if ever used during the lifespan of a driver or passenger, and its distributed cost is over $1.8 million per life saved. 

Many people believe they have a good understanding of odds, chances, and statistics. They make a calculated decision about the odds believing that they will be able to go through an intersection before a yellow traffic light changes to red, or whether they can get back to a parking meter that has expired before being issued a citation and fine. Some enjoy games of chance, ranging from poker, office football pools, state lottery, or gambling at a casino. Others invest in the stock market, bonds, real estate, or a mortgage. What is underappreciated is the degree to which people gamble on their most precious and irreplaceable resource: their health and life. 

To improve the statistical odds of making a good decision, collecting valuable information and critical analysis are key. The first questions to ask are: What are you gambling? Can you afford to lose it? What do you have to gain? and Is it worth the risk? Unfortunately, when it comes to health and life, most people ask themselves these questions when it is too late, and after they have lost the bet. The biggest surprise is that they may find that they never really had any chance of winning; the very best they could have hoped for was to not lose. Gambling on your health and life is rarely worth the risk.

Reducing risks means avoiding taking unnecessary gambles on your health and life. Some common sense risk reductions offer benefits in reducing the risk of several major health concerns. Lifestyle changes, such as reducing or eliminating the use of tobacco, alcohol, and red meat, and incorporating a pesco-vegetarian high-fruit, vegetable, and high-fiber diet are associated with risk reduction of cardiovascular disease, obesity, diabetes, and cancers, including colorectal cancer. This book will go into greater detail about the information in the paragraphs above, and much more, reviewing the present state of knowledge on how to prevent and screen for colorectal cancer and polyps. 

 The authors have previously published books and articles that have appeared in prestigious medical journals and the mainstream press, actively participated in significant clinical and basic medical and scientific research and held administrative positions that provides behind-the-scenes knowledge of the health care and insurance industries. They do not have any significant financial conflicts or industry investments to disclose; their opinions are based solely on scientific evidence, clinical experience, compassionate care, and common sense. They respect that other health care professionals may have differing viewpoints and encourage the reader to give thoughtful consideration to their own and other health care provider’s opinions. If necessary, obtaining a second or third opinion may provide further clarity.

When people meet the authors at a social event unrelated to their professions as physicians, they enjoy conversations on a wide variety of topics of interests. At some point they are often asked about their professions, and many new acquaintances will take the opportunity to ask questions that they were uncomfortable or unable to ask their own physicians. The authors then may inquire about the patient perspective, and their experience in identifying deficiencies and challenges in the American health care system. With many decades of personal and professional experience, the authors recognize the critical importance of patient education and advocacy, as well as the need to inform and counsel health care professionals.

Danielle is a specialist in internal medicine, endocrinology, and metabolism, with expertise in obesity, diabetes, thyroid, and other hormone issues. Nancy is a specialist in women’s health, gynecology, and reproductive endocrinology and is a passionate and compassionate caregiver, so questions about hormones, menopause, and relationships are often discussed.

Although Joseph is also compassionate, as a gastroenterologist he has learned to keep his expertise and specialty as a bit of a mystery. When people learn that he is a physician professor with expertise in the bowels, digestion, and other topics, as well as an author of books on intestinal gas, their social embarrassment and inhibitions evaporate. After being treated to several spontaneous graphic descriptions of bowel health concerns, often complete with digital photos, he now has a different answer when questioned about the type of physician he is. Wanting to find the balance between honesty and preserving some distance from their bowels, he describes himself as a forensic psychoproctologist, a nonexistent specialty he invented. As long as he can keep a straight face, that usually suffices to move onto other topics. It also brings to mind the joke that you should not call an ophthalmologist an eye doctor. If it were common practice to identify the types of doctors by the organ they treat, there would not be any proctologists!

On a more personal level the authors have each had family members, as well as friends, colleagues, neighbors, and loved ones affected by colorectal cancer and polyps. They have also themselves been patients with personal experience, with nearly all forms of colorectal cancer screening in the American health care system, and thus are intimately familiar with both its strengths and weaknesses. This abridged, easy-to-read book for the mainstream public, and its more comprehensive companion volume for professional audiences, is based on data from more than 800 current biomedical and scientific references. 

This volume is offered as a consumer-friendly executive summary condensed from a comprehensive  24-chapter volume of more than 600 pages with 200 images and six appendices, which was written for health care professionals and others who wish to explore colorectal cancer and polyp prevention, screening, and surveillance options in greater depth. The key to colorectal cancer and polyp prevention is education, awareness, and a proactive approach. For the typical adult, screening means checking regularly for the presence of disease when there are no signs or symptoms present, while in higher risk populations screening often means using proactive surveillance. The more thoroughly and accurately informed that patients are about risks and options, the greater the likelihood that they will take advantage of and benefit from screening programs.

Conventional (standard) optical colonoscopy has been promoted for years as the gold standard for colorectal cancer and polyp screening with a self-proclaimed 95% accuracy. More recent findings confirm that this figure is unfortunately overly optimistic, and that the actual rate of diagnostic accuracy is considerably lower. Meanwhile painless, simpler, faster, and less expensive tests that do not require extensive and unpleasant colon cleansing are readily available as viable alternatives. While optical colonoscopy offers the advantage of immediate treatment at the time of colorectal polyp diagnosis, the alternative tests are not as invasive procedures and do not require anesthesia or conscious sedation. They do not have the risks of bleeding, perforation, or death that unfortunately can and do occur with optical colonoscopy.

The aversion and fear of complications, high expense, challenging preparation, time commitment, and variable quality contribute to widespread resistance to the procedure of optical colonoscopy. Only 35% of those advised to undergo optical colonoscopy proceed with the examination. Many of those who declined optical colonoscopy were not offered alternatives, and subsequently did not undergo any screening for colorectal cancer or polyps, unnecessarily contributing to the tragic loss of life from this preventable disease. 

Currently only 62% of the population is participating in any colorectal polyp and cancer prevention screening, the tragic result of which is that tens of thousands of easily