Government Inflicted Colon Cancer

Life Extension Magazine^® publishes articles that sometimes contain material your government prefers you not read. The reason they don’t want this knowledge circulated is that it increases their medical costs in the short term.

The dilemma is that governments cannot afford their healthcare obligations.^1-8

This happened because free or subsidized medical care was promised, but costs are soaring and people are living longer.^9-11

Medical technology is improving, but not fast enough to bring about needed price reductions.^12-14 The solution will be curative therapies that slash today’s high price of chronic illness, but we are not there yet.

Governments are fighting this cost crisis by reducing healthcare outlays. The human group most targeted is over age 74.

That age group represents many people reading this article, which obligates me to refute what is an illogical rationing of a lifesaving diagnostic procedure.

Earlier this year, a Canadian government task force recommended against screening colonoscopies for citizens aged 50 years and older. They suggested that a fecal occult blood test or sigmoidoscopy were sufficient. For people over 74, the task force recommended no screening for polyps or early-stage colon cancer.¹⁵

The US Preventive Service Task Force made a similar recommendation in 2008 for people over 75.¹⁶ This may be changing to let those aged 76-85 make the choice. As of May 2016, however, draft guidance from the US Preventive Service Task Force recommends against routine screening for colorectal cancer in individuals 86 or over.¹⁷

You’re going to learn about a substantial increase in metastatic colon cancers that will be inflicted by these senseless governmental edicts.

The encouraging news we report this month are documented ways to reduce your risk of developing colon cancer and curtail metastasis in case you are ever diagnosed with this malignancy.

Humans are living longer, yet government policies seek to preclude older groups from accessing diagnostic testing.^18-20

New government recommendations make it appear that once people age past 74 their risk for diseases like colon cancer mystically disappears. As the chart on this page clearly shows, incidence of invasive colon and rectal cancer spirals upwards as people grow older.²¹

There is no reason to deprive a person over 74 of colon cancer screening. It is proven to be effective in detecting early-stage lesions before they progress and spread to the liver, lungs, and other organs.

If a polyp or other suspicious lesion is detected during a colonoscopy, it can usually be removed and biopsied without further procedures. Early removal of polyps reduces future colon cancers.²²

A sigmoidoscopy typically evaluates only one-third of the colon, whereas a colonoscopy examines the entire colon.^23-26 Since the bowel preparation requirements are similar,^27-29 we at Life Extension^® have long advocated colonoscopy over sigmoidoscopy.

We disagree with government recommendations regarding how often one should have a colonoscopy. We suggest individuals over age 40 consider a colonoscopy more frequently than current guidelines of once every 10 years.¹⁶

Troubling Statistics

Colorectal cancer usually (but not always) develops slowly,^30,31 over a period of 10 to 20 years.^32,33 Most cancers begin as a noncancerous growth called a polyp that develops on the inner lining of the colon or rectum.³⁴

When caught at these early stages, polyps and precancerous lesions can be easily removed during the colonoscopy procedure.^35-37 So screening for colorectal cancer is not only diagnostic, but therapeutic when suspicious lesions/polyps are removed during the colonoscopy.^38,39

While colonoscopies have spared countless lives since widespread screening began, about 50,000 Americans still perish each year from metastatic colorectal cancer.^40,41

Most of these deaths would not have occurred had the victim utilized a proven diagnostic procedure. For example, in 2010 only 59% of people age 50 or older reported having received colorectal cancer screening consistent with guidelines.⁴² Yet about 1 in 18 Americans will be diagnosed with colorectal cancer sometime in their life.⁴³

Colorectal cancer is the second leading cause of cancer death in the United States. The American Cancer Society estimates that about 135,000 people will be diagnosed with colorectal cancer this year.⁴⁴

In 2014, about 50,310 people died from the disease.⁴² This number represents a decline in colorectal deaths from previous years and probably reflects removal of polyps and other precancerous lesions during colonoscopy, along with finding early stage malignancies during colonoscopy that are curable.^45,46

With government groups now recommending against colonoscopies and the inconvenience of having it done, an increasing number of unwary humans will not avail themselves to this proven lifesaving procedure.

How Effective Are Colonoscopies?

Initial studies on high-risk patients undergoing colonoscopy indicated a reduced risk of colon cancer incidence by as much as 90%.⁴⁷

An editorial published in Annals of Internal Medicine challenged this assertion. While acknowledging the importance of screening, it suggested that physicians inform patients that for lesions located in the descending or left side of the colon, high quality colonoscopies reduce the mortality risk by 60% to 70% and that limited data exists for reduction of right colon cancer mortality risk.⁴⁸

What we know is colon cancer diagnosis and death from metastatic disease remains rampant. Even curative treatment often inflicts permanent side effects.^49,50 This means you should not wait for symptoms to occur that necessitate surgical removal of a section of your bowel and follow up chemotherapy as a precaution against metastasis.

In seeking to identify the hard facts, we are disappointed by the lack of long-term high-quality studies to validate how many lives are really spared by colonoscopy, and what time intervals are ideal for average-risk individuals to have colonoscopies performed.⁵¹

I’ve therefore taken a common-sense approach in writing this editorial as to what health-conscious individuals should consider in order to reduce their risk of this common malignancy.

Comparing Screening Techniques

A number of investigative studies have been done to compare the benefits of colonoscopy, sigmoidoscopy and/or fecal occult blood testing.^52-56

A fecal occult blood test is done at home by swiping a tiny amount of stool onto a card for three consecutive days and delivering it to your doctor’s office or sending to a laboratory. It is recommended that this test be done annually.^57-59

If traces of blood are present in the stool then additional diagnostics are prescribed, typically colonoscopy.^59-61

When compared to colonoscopies done every ten years, high-sensitivity fecal occult blood tests performed every year showed similar benefits in detecting colorectal cancers.⁶²

Since fecal occult blood tests cost relatively little, health authorities view them as a way of reducing the higher cost of colonoscopy screening.

We take issue with this comparison data because we believe colonoscopies should ideally be done more frequently than every 10 years.

When governments base recommendations to use fecal occult blood tests in lieu of colonoscopy, and compare it to 10-year colonoscopy intervals, they are missing a potential benefit of more frequent colonoscopy screening.

We think colonoscopies performed about every 5 years will yield superior results compared to annual fecal occult blood testing.

My reasons for suggesting more frequent colonoscopies include poor quality of prior colonoscopies and the benefit of more frequent removal of polyps and premalignant lesions (adenomas).^63,64 There is also a small risk of what is termed “interval cancer,” which means a fast growing malignancy that occurs between colonoscopy screenings.^65,66

We’ve reprinted a chart at the end of this article that shows what is currently being recommended as far as time intervals between colonoscopy procedures. As I have written in the past, these kinds of recommendations are based on typical population groups. As a reader of this magazine, you expect better than “average” as far as your longevity is concerned.

Common-Sense Suggestions

The Canadian Task Force on Preventive Health Care is recommending fecal occult blood screening or sigmoidoscopy in lieu of colonoscopy for non-high-risk people aged 50-74.⁶⁸ This recommendation is based on data showing only slightly better detection with colonoscopy compared to the cheaper fecal occult blood tests.

What’s being overlooked, however, is that when blood is detected in the stool, the patient may have been growing polyps or developing colorectal cancer years prior to this. We think more frequent colonoscopies will lead to more polyps and other suspicious lesions being identified and removed before early stage colon cancer develops.

While polyps can also bleed, and the blood can show up in the stool, their diagnosis and removal still requires a scoping procedure of the colon.

Health “authorities” are now proposing that people forgo colonoscopy screening and instead deliver each year to their doctor’s office three consecutive days of stool samples to be fecal occult blood tested.

If traces of blood are detected, the patient is then usually told to undergo a colonoscopy to ascertain what is causing blood to appear in their stool.⁶⁹

Once a person reaches age 75, the Canadian task force says no screening is needed,⁷⁰ which is analogous to what the US Preventive Services Task Force published in 2008.¹⁶ We at Life Extension disagree with these recommendations for most healthy individuals.

We suggest that low-risk individuals over age 40 consider having a colonoscopy about every 5 years to reduce risk of developing advanced or metastatic colorectal cancer.

What’s missing from all these analyses is direct evidence, i.e. randomized, controlled trials over long time periods on large human populations showing how frequently colonoscopies should be performed.⁷¹

Rather than wait for results from conclusive trials, the common-sense approach we advocate is colonoscopies done more frequently than every 10 years for low-risk individuals.

Putting This in Perspective

By the time the typical person (who neglects their health) ages past 74, they often suffer from so many chronic disorders that their lifespans are limited.

It may thus be understandable for a government task force to recommend against colonoscopy for the general population over age 74 as they may not derive much real-world benefit.

When it comes to the general population, the government sees cost savings in sigmoidoscopy, which does not always require sedation as do most colonoscopies.^72,73 Sedation adds costs to any medical procedure. Although serious complication rates are very low for both colonoscopies and sigmoidoscopies, colonoscopies have higher rates of serious complications compared to sigmoidoscopies.⁶² To save money in the short term, governments are looking to reduce the number of colonoscopies performed.

Readers of this publication are different. We take extraordinary measures to slow aging, prevent disease, and extend our healthy longevity. We don’t fit in with the “average” American or Canadian, who lets nature and deadly lifestyle choices accelerate degenerative processes.

We’re also privileged to know about age reversal research that may enable us to purge our bodies of multiple pathologies while our cells simultaneously become biologically younger. (Refer to article on page 54 of this month’s issue.)

Life Extension participants have huge incentives to protect against common disorders of today such as colorectal cancer, so they can remain healthy and alive to benefit from pending breakthrough biomedical advances.

What Should You Do?

Colonoscopies do not guarantee one will never die of colon cancer. The encouraging news is that the healthy lifestyle programs most of you practice have been shown to reduce (but not eliminate) colorectal cancer risk.

Colon cancer prevalence is so high that we suggest low-risk individuals should make an effort to undergo colonoscopy about every 5 years. Those with certain risk factors like inflammatory bowel diseases or history of adenomas may want to have colonoscopies more frequently.

Governmental edicts that people over age 74 should forgo colonoscopy may not apply to individuals who plan on living far longer, healthier lifespans.

Conventional medicine is recognizing the role of aspirin,^74-76 calcium,^77,78 vitamin D,^79,80 and healthy dietary choices in reducing colorectal cancer risk. An article in this month’s issue of Life Extension Magazine delves into this topic in detail.

The point I need to emphasize is that while many of the supplements you are taking have shown a profound effect in reducing colorectal cancer risk, they do not protect against the disease completely.

In addition, certain upper digestive tract malignancies are increasing in prevalence, such as esophageal cancer.⁸¹ If you are going to schedule a colonoscopy and be sedated anyway, it makes sense for people at risk to ask their gastroenterologist to perform an endoscopy and colonoscopy at the same visit.⁸²

By having these two procedures performed, lesions can be detected from the throat to the anus when they are likely to be treatable before a metastatic disease manifests.

I realize these screening suggestions are in opposition to governmental guidelines that seek to cut back on healthcare outlays. There are also side-effect risks associated with any invasive diagnostic procedure such as colonoscopy and endoscopy.

My mission, however, is to keep you alive and healthy. I yearn for the day when the scourge of cancer will become a relic of the past, just as smallpox is today. Until that time, we should remain vigilant, even if we happen to be over 74 years of age.

For longer life,

William Faloon

References

1. Eklund W. Japan and its healthcare challenges and potential contribution of neonatal nurse practitioners. J Perinat Neonatal Nurs. 2010;24(2):155-66.
2. Poses RM. A cautionary tale: the dysfunction of American health care. Eur J Intern Med. 2003;14(2):123-30.
3. Fletcher T. The impact of physician entrepreneurship on escalating health care costs. J Am Coll Radiol. JACR. 2005;2(5):411-4.
4. Suter E, Oelke ND, Adair CE, et al. Ten key principles for successful health systems integration. Healthc Q. (Toronto, Ont.). 2009;13 Spec No:16-23.
5. Thomas D, Sarangi BL, Garg A, et al. Closing the health and nutrition gap in Odisha, India: A case study of how transforming the health system is achieving greater equity. Soc Sci Med. (1982). 2015;145:154-62.
6. Okello DO, Lubanga R, Guwatudde D, Sebina-Zziwa A. The challenge to restoring basic health care in Uganda. Soc Sci Med. (1982). 1998;46(1):13-21.
7. Wang C, Rao K, Wu S, et al. Health care in China: improvement, challenges, and reform. Chest. 2013;143(2):524-31.
8. Grosios K, Gahan PB, Burbidge J. Overview of healthcare in the UK. EPMA J. 2010;1(4):529-34.
9. Muka T, Imo D, Jaspers L, et al. The global impact of non-communicable diseases on healthcare spending and national income: a systematic review. Eur J Epidemiol. 2015;30(4):251-77.
10. Kreatsoulas C, Anand SS. The impact of social determinants on cardiovascular disease. Can J Cardiol. 2010;26 Suppl C:8c-13c.
11. Salomon JA, Wang H, Freeman MK, et al. Healthy life expectancy for 187 countries, 1990-2010: a systematic analysis for the Global Burden Disease Study 2010. Lancet. 2012;380(9859):2144-62.
12. Kumar RK. Technology and healthcare costs. Ann Pediatr Cardiol. 2011;4(1):84-6.
13. Arora S, Thornton K, Komaromy M, et al. Demonopolizing medical knowledge. Acad Med. 2014;89(1):30-2.
14. Ventola CL. Challenges in evaluating and standardizing medical devices in health care facilities. PT. 2008;33(6):348-59.
15. Care CTFoPH. Recommendations on screening for colorectal cancer in primary care. CMAJ. 2016;188(5):340-8.
16. Available at: http://www.uspreventiveservicestaskforce.org/page/document/updatesummaryfinal/colorectal-cancer-screening. Accessed May 10, 2016.
17. Available at: http://www.uspreventiveservicestaskforce.org/page/document/draft-recommendation-statement38/colorectal-cancer-screening2. Accessed May 10, 2016.
18. Barberis M. America’s elderly: policy implications. Popul Bull. 1981;35(4 Supplement):1-13.
19. Christensen K, Doblhammer G, Rau R, et al. Ageing populations: the challenges ahead. Lancet. 2009;374(9696):1196-208.
20. Jin K, Simpkins JW, Ji X, Leis M, et al. The critical need to promote research of aging and aging-related diseases to improve health and longevity of the elderly population. Aging Dis. 2015;6(1):1-5.
21. Available at: http://seer.cancer.gov/archive/csr/1975_2012/browse_csr.php?sectionSEL=6&pageSEL=sect_06_table.11.html. Accessed May 11, 2016.
22. Citarda F, Tomaselli G, Capocaccia R, et al. Efficacy in standard clinical practice of colonoscopic polypectomy in reducing colorectal cancer incidence. Gut. 2001;48(6):812-5.
23. Macafee DAL, Scholefield JH. Population based endoscopic screening for colorectal cancer. Gut. 2003;52(3):323-6.
24. Boland CR, Demarco DC. Invited commentary: Preventing colon cancer: looking over the horizon. Proceedings (Baylor University. Medical Center). 2003;16(3):344-5.
25. Simon JB. Screening colonoscopy: is it time? CMAJ. 2000;163(10):1277-8.
26. Church JM. Colon cancer screening update and management of the malignant polyp. Clin Colon Rectal Surg. 2005;18(3):141-9.
27. Available at: http://www.cancer.org/healthy/findcancerearly/examandtestdescriptions/faq-colonoscopy-and-sigmoidoscopy. Accessed May 10, 2016.
28. Available at: http://www.mayoclinic.org/tests-procedures/flexible-sigmoidoscopy/basics/how-you-prepare/prc-20014697. Accessed May 10, 2010.
29. Available at: http://www.mayoclinic.org/tests-procedures/colonoscopy/basics/how-you-prepare/prc-20013624. Accessed May 10, 2016.
30. Brenner H, Kloor M, Pox CP. Colorectal cancer. Lancet. 2014;383(9927):1490-502.
31. Stathopoulos GP. Survival of untreated advanced colorectal cancer patients. Oncol Lett. 2011;2(4):731-3.
32. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003170-pdf.pdf. Accessed May 11, 2016.
33. Winawer SJ, Zauber AG. The advanced adenoma as the primary target of screening. Gastro Endosc Clin N Am. 2002;12(1):1-9, v.
34. Loeve F, Boer R, Zauber AG, et al. National polyp study data: evidence for regression of adenomas. Int J Cancer. 2004 Sept. 10;111(4):633-9.
35. Aarons CB, Shanmugan S, Bleier JI. Management of malignant colon polyps: current status and controversies. World J Gastroenterol. 2014;20(43):16178-83.
36. Rutter MD. Evolving protocols in colorectal cancer surveillance. Gastroenterol Hepatol (NY). 2008;4(2):114-6.
37. Delavari A, Mardan F, Salimzadeh H, et al. Characteristics of colorectal polyps and cancer; a retrospective review of colonoscopy data in iran. Middle East J Dig Dis. 2014;6(3):144-50.
38. Bari Z, Fakheri H, Sardarian H. Large bowel obstruction after colonoscopy; a case report. Middle East J Dig Dis. 2015;7(4):253-6.
39. Geiger TM, Ricciardi R. Screening options and recommendations for colorectal cancer. Clin Col Rectal Surg. 2009;22(4):209-17.
40. Litvak DA, Malad S, Wascher RA, et al. Laparoscopic splenectomy in colorectal cancer patients with chemotherapy-associated thrombocytopenia due to hypersplenism. Case Rep Oncol. 2012;5(3):601-7.
41. Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol. 1997;15(3):938-46.
42. Available at: http://www.cancer.org/research/cancerfactsstatistics/colorectal-cancer-facts-figures. Accessed May 11, 2016.
43. Amersi F, Agustin M, Ko CY. Colorectal cancer: epidemiology, risk factors, and health services. Clin Colon Rectal Surg. 2005;18(3):133-40.
44. Available at: http://www.cancer.org/cancer/colonandrectumcancer/detailedguide/colorectal-cancer-key-statistics. Accessed May 11, 2016.
45. Available at: http://seer.cancer.gov/statfacts/html/colorect.html. Accessed May 11, 2016.
46. Available at: http://www.cancer.org/acs/groups/content/documents/document/acspc-042280.pdf. Accessed May 11, 2016.
47. Winawer SJ, Zauber AG, Ho MN, et al. Prevention of colorectal cancer by colonoscopic polypectomy. The National Polyp Study Workgroup. The N Engl J Med. 1993;329(27):1977-81.
48. Ransohoff DF. How much does colonoscopy reduce colon cancer mortality? Ann Intern Med. 2009 Jan 6;150(1):50-2.
49. Hellinger MD, Santiago CA. Reoperation for recurrent colorectal cancer. Clin Colon Rectal Surg. 2006 Nov;19(4):228-36.
50. Denlinger CS, Barsevick AM. The challenges of colorectal cancer survivorship. J Natl Compr Canc Netw.: JNCCN. 2009;7(8):883-93; quiz 894.
51. Available at: http://canadiantaskforce.ca/files/crc-screeningfinal031216.pdf. Accessed May 12, 2016.
52. Holme O, Bretthauer M, Fretheim A, et al. Flexible sigmoidoscopy versus faecal occult blood testing for colorectal cancer screening in asymptomatic individuals. Cochrane Database Syst Rev. 2013 Oct 1;9:Cd009259.
53. O’Leary BA, Olynyk JK, Neville AM, et al. Cost-effectiveness of colorectal cancer screening: comparison of community-based flexible sigmoidoscopy with fecal occult blood testing and colonoscopy. J Gastroenterol Hepatol. 2004;19(1):38-47.
54. Cheng TI, Wong JM, Hong CF, et al. Colorectal cancer screening in asymptomaic adults: comparison of colonoscopy, sigmoidoscopy and fecal occult blood tests. J Formos Med Assoc. 2002;101(10):685-90.
55. Graser A, Stieber P, Nagel D, et al. Comparison of CT colonography, colonoscopy, sigmoidoscopy and faecal occult blood tests for the detection of advanced adenoma in an average risk population. Gut. 2009;58(2):241-8.
56. Sung JJ, Chan FK, Leung WK, et al. Screening for colorectal cancer in Chinese: comparison of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. Gastroenterology. 2003;124(3):608-14.
57. Available at: https://www.nlm.nih.gov/medlineplus/ency/article/003393.htm. Accessed May 12, 2016.
58. Barry MJ. Fecal occult blood testing for colorectal cancer: a perspective. Ann Oncol. 2002;13(1):61-4.
59. Available at: http://www.ncbi.nlm.nih.gov/books/nbk445. Accessed May 12, 2016.
60. Available at: https://www.ucsfhealth.org/tests/007008.html. Accessed May 12, 2016.
61. Hubbard RA, Johnson E, Hsia R, et al. The cumulative risk of false-positive fecal occult blood test after 10 years of colorectal cancer screening. Cancer epidemiol Biomarkers Prev. 2013 Sep;22(9):1612-9.
62. Available at: http://www.uspreventiveservicestaskforce.org/page/document/recommendationstatementfinal/colorectal-cancer-screening. Accessed May 12, 2016.
63. Jang JY, Chun HJ. Bowel preparations as quality indicators for colonoscopy. World J Gastroenterol. 2014 March 21;20(11):2746-50.
64. Chokshi RV, Hovis CE, Hollander T, et al. Prevalence of missed adenomas in patients with inadequate bowel preparation on screening colonoscopy. Gastrointest Endosc. 2012 Jun;75(6):1197-203.
65. Holt PR, Kozuch P, Mewar S. Colon cancer and the elderly: from screening to treatment in management of GI disease in the elderly. Best pract Res Clin Gastroenterol. 2009;23(6):889-907.
66. Samadder NJ, Curtin K, Tuohy TM, et al. Characteristics of missed or interval colorectal cancer and patient survival: a population-based study. Gastroenterology. 2014;146(4):950-60.
67. Lieberman DA, Rex DK, Winawer SJ, et al. Guidelines for colonoscopy surveillance after screening and polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer. Gastroenterology. 2012;143(3):844-57.
68. Available at: http://canadiantaskforce.ca/news/2016-02-22/canadian-medical-association-journal-publishes-ctfphcs-guideline-on-colorectal-cancer-screening-in-adults. Accessed May 12, 2016.
69. McLoughlin MT, Telford JJ. Positive occult blood and negative colonoscopy--should we perform gastroscopy? Can J Gastroenterol. 2007 Oct;21(10):633-6.
70. Available at: http://canadiantaskforce.ca/ctfphc-guidelines/2015-colorectal-cancer. Accessed May 12, 2016.
71. Available at: http://www.ncbi.nlm.nih.gov/books/nbk65825. Accessed May 12, 2016.
72. Available at: https://www.nlm.nih.gov/medlineplus/colonoscopy.html. Accessed May 12, 2016.
73. Aljebreen AM, Almadi MA, Leung FW. Sedated vs unsedated colonoscopy: A prospective study. World J Gastroenterol. 2014 May;20(17):5113-8.
74. Drew DA, Cao Y, Chan AT. Aspirin and colorectal cancer: the promise of precision chemoprevention. Nat Rev Cancer. 2016;16(3):173-86.
75. Wakeman C, Keenan J, Eteuati J, et al. Chemoprevention of colorectal neoplasia. ANZ J Surg. 2015.
76. Jung YR, Kim EJ, Choi HJ, et al. Aspirin targets SIRT1 and AMPK to induce senescence of colorectal carcinoma cells. Mol Pharmacol. 2015 Oct;88(4):708-19.
77. Shaukat A, Scouras N, Schunemann HJ. Role of supplemental calcium in the recurrence of colorectal adenomas: a metaanalysis of randomized controlled trials. Am J Gastroenterol. 2005 Feb;100(2):390-4.
78. Han C, Shin A, Lee J, et al. Dietary calcium intake and the risk of colorectal cancer: a case control study. BMC cancer. 2015 Dec;15:966.
79. Klampfer L. Vitamin D and colon cancer. World J Gastrointest Oncol. 2014;6(11):430-7.
80. Pereira F, Larriba MJ, Munoz A. Vitamin D and colon cancer. Endocr Relat Cancer. 2012;19(3):R51-71.
81. Chai J, Jamal MM. Esophageal malignancy: a growing concern. World J Gastroenterol. 2012;18(45):6521-6.
82. Triadafilopoulos G, Aslan A. Same-day upper and lower inpatient endoscopy: a trend for the future. Am J Gastroenterol. 1991;86(8):952-5.