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High Risk Guidelines
The most important thing is to recognize that you are at increased
risk. In particular, individuals with a family history of colon
cancer, a previous history of colon polyps or a history of another
cancer, should be considered at increased risk for colon and rectal
cancer. There is no foolproof way to prevent colon cancer in patients
who are at increased risk. Surgery and drugs have been proposed,
but both have risks as well as possible benefits, and neither has
been shown to reduce risk without some significant side effects.
Surgery and drugs both attempt to reduce the risk of colon cancer
by decreasing the amount of cellular turnover and colonic mucosal
abnormalities, which might eventually develop into colon cancer.
Aspirin and related drugs have been shown to reduce the rates of
cell turnover in the colon and, therefore, reduce the rate of polyp
and cancer formation. These are recommended in many patients for
preventative reasons, particularly patients at high risk. In addition,
regular colonoscopies to identify the precancerous polyps and remove
them are clearly associated with a decreased risk of developing
colon and rectal cancer. Finally, living a healthy lifestyle includes
physical exercise, high fiber, and low fat intake have been suggested
as reducing the risks of colon cancer.
In unusual situations with patients who are at very high risk of
developing cancer (familial polyposis), preventative removal of
the colon and rectum has been recommended. Surgical techniques have
been involved to preserve continence under these circumstances.
Agents to Prevent Colon Cancer
This is a difficult question to answer. The results are controversial
in the literature. Some results have suggested that an adult-size
aspirin twice a week will reduce the risk of cancer by as much as
40% and the results of death of colon cancer by as much as 60%.
Celebrex has a strong relationship of aspirin, and therefore is
thought to have the same effects as aspirin. Nevertheless, the results
have not yet been confirmed that either of these agents will prevent
the development of colon and rectal cancer. It is recognized, however,
that aspirin might have other side effects including the prevention
of cardiovascular disease. If this is the case, then the prudent
person may very well want to add aspirin to their weekly regimen.
Whether the increased risks of a family cancer syndrome or hereditary
polyposis would benefit more or less from these drugs remains unclear.
Reduce My Risk by Diet
A high fiber (up to 35 grams) diet will help. Similarly, reducing
the amount of red meat in the diet is thought to help. These studies
are difficult to perform. They are usually based on following patients
over the course of many decades and the results, therefore, can
be confusing and difficult to interpret. Furthermore, it is very
easy to criticize these types of studies. They are also based on
dietary analysis.
You can imagine how difficult it is to accurately record or interpret
what people eat based on interviews and trying to remember what
the individual ate last week. Nevertheless, this is the best information
available. The dietary changes that are involved to increase fiber
and decrease red meat are not onerous and, therefore, it would seem
reasonable to consider making these changes if you are concerned
about your risks of developing colon and rectal cancer.
Hormone Pills
There is no evidence that suggests that women who are taking birth
control or hormone pills are at an increased risk of developing
colon or rectal cancer.
There is no evidence that it will increase the risks of polyps,
or that there are any contraindications to taking birth control
pills or hormone replacement.
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