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America's war against colorectal cancer is toughening its battle lines, thanks to an effective awareness campaign and government support. But the real tragedy is the inability to convince Americans that early diagnosis can beat this silent killer.

Each year more than 65,000 people die from colorectal cancer. The National Cancer Institute predicts that more than 160,000 new cancer cases will develop in 1999. That puts 80 to 90 million men and women over the age of 50 and with a family history of the disease, at risk.

Behind lung cancer, colorectal cancer is the country's deadliest disease. It attacks the colon and rectum within the body's digestive system. Affecting both men and women equally, the disease can be easily curable when diagnosed at an early stage.

The digestive system is made up of the esophagus, stomach and small and large intestines. The last five to six feet of intestine is called the large bowel or colon. During the digestive process, nutrients (vitamins, minerals and proteins) are removed from the food within the small intestine. The remaining food products are stored as waste until it passes out of the body.

During a person's lifetime, small growths called polyps may develop on the inner lining of the colon. Though some polyps are initially benign, they can become malignant or cancerous, and if left undetected may spread to other parts of the body. Unfortunately, the presence of polyps rarely produces any symptoms.

Although the exact cause of colorectal cancer is unknown, research points to genetic and environmental factors such as a high-fat diet to identify at-risk people. Anyone over the age of 50 is considered average risk. High-risk individuals are people who have had non-cancerous polyps in the colon or possess a family history of colorectal cancer, ulcerative colitis or Crohn's disease (a chronic inflammation of the small and large intestines). Detection and removal of polyps has been shown to be very effective in preventing colon cancer. Additionally, earlier detection of colon cancer significantly increases the likelihood of cancer.

Many safe and accurate screening tests are available. These tests include:

Fecal Occult Blood Test (FOBT)—A test that checks for minuscule amounts of blood in the stool. It can be performed at home or at your doctor's office.

Flexible Sigmoidoscopy—This method examines the inner lining of the rectum and the last two feet of the colon. A small, lighted tube called a sigmoidoscope is used to identify polyps or signs of cancer. The test does not require anesthesia and lasts only a few minutes.

Colon X-ray or Barium Enema—A common test that allows the physician to evaluate the large intestine with an X-ray. Liquid barium is put into the colon through a slender tube inserted into the rectum. As air is introduced into the colon, X-rays are taken. A specialist examines these X-rays for polyps or other irregularities. If abnormalities are found, a colonoscopy would need to be performed.

Colonoscopy—Similar to the sigmoidoscopy, a gastroenterologist uses a long endoscope to view the entire colon. If a cancer or polyp is found, the gastroenterologist can painlessly take a sample to biopsy and completely remove abnormal growths. For comfort, the patient is placed under mild sedation.

Last January, the Federal Government took a first step against colorectal cancer, offering reimbursements for screening support of the nation's 37 million Medicare recipients.

Medicare covers colorectal cancer screening test/procedures for FOBT and sigmoidoscopy; screening colonoscopy for high risk individuals; and screening barium enema as an alternative to a screening sigmoidoscopy or colonoscopy.

The National Colorectal Cancer Round Table, coordinated with the American Cancer Society and the Centers for Disease Control, joined the White House in launching an awareness campaign initiating cancer screening for this disease.

MUSC's Digestive Disease Center is one of the state's leading centers for treating this disease. Responding to new colorectal cancer screening guidelines recommended by the American Cancer Society and the Consortium of Gastroenterology (GI) Societies, the center has responded to the benefits of early detection.

New evidence suggests that certain preventive tests such as the blood test, flexible sigmoidoscopy and colono-scopy are effective early detection methods for average and moderate risk patients.

As the state's only tertiary care facility, the Digestive Disease Center provides various high quality, multi-disciplinary services to support digestive disorders. The center houses a team of highly skilled, world-class specialists, and integrates medical, surgical and radiological specialties in their GI clinic, endoscopy unit and inpatient facility. Digestive services are also offered at the Veterans Affairs Hospital and Charleston Memorial Hospital.

For more information on colorectal cancer, visit the Digestive Disease Center's website at <http://www.ddc.musc.edu>