Katie's Crusade

TED THAI FOR TIME
INSIDE VIEW: Dr. Moshe Shike of Memorial Sloan-Kettering conducts a guided tour of a patient's colon

(3 of 5)

Your best bet to beat colon cancer today is to catch it early--and that means regular screening. It would help if there were just one screening test and some simple rules to follow about when to get it done, but that's not the case. So pay attention to the following guidelines:

First, a warning. If you experience any symptoms--especially bleeding from the rectum, unusual constipation, abdominal cramping or a narrowing of the feces--talk to your doctor immediately about taking a peek inside your colon.

All other things being equal, you should start screening by age 50. (Some doctors lean toward 40, but more on that later.) If you have a family history of the disease, particularly among your siblings or parents, you may need to start in your 30s or 40s. A good rule of thumb is to begin getting tested 10 years before the youngest age at which colon cancer was diagnosed in any member of your family. "Don't wait for an invitation," says Dr. Bernard Levin of M.D. Anderson Cancer Center in Houston, Texas. "Tell your doctor, I want to get screened."

It's a good idea to keep track of other diseases that have affected your family. There's growing evidence that uterine and ovarian cancer may be genetically related to colon cancer. So if your Aunt Mary died of uterine cancer, don't assume you're in the clear if you've had a hysterectomy or if you're a man. You could be at greater risk of colon cancer as well. The same holds true if you suffer from inflammatory conditions of the intestines, like Crohn's disease or ulcerative colitis.

That's the "when" part of the equation. Now for what you should do. There are three different ways to get screened for colon cancer. Which method you choose depends a lot on your wallet--and the level of risk you're willing to live with.

If you go for the least expensive method--because it's the one most often covered by insurance--make sure you get both parts: a stool test, which looks for the presence of hidden blood, and a flexible sigmoidoscopy, in which a lighted tube is inserted into the lower third of the colon. The stool test should be repeated annually, since only 1 out of 3 tumors bleeds enough to be picked up by the test and then usually only after it's grown in size. The "flex sig" should be performed every five years, provided there's no change in symptoms or family history. Cost over five years: $100 to $200.

If you're not satisfied with checking out only part of your colon, you have two other options. Both require going on a liquid diet for 24 hours before the procedure and involve flushing the colon ahead of time. But they give more of the big picture.

In a double-contrast barium enema, a technician coats the inside of the intestine with the metallic dye and pumps the colon full of air. Then an X ray of the large intestine is taken, allowing doctors to visualize the outline of most abnormal growths. Provided the colon is clear, a barium enema should be repeated every five to 10 years. Cost: $200 to $400.

The other option is a colonoscopy, the procedure Couric underwent for the Today show. At $1,000 or more a pop, it's both expensive and invasive. Under normal circumstances you have to do it only once a decade.

"The prep is a pain," Couric admits. The colonoscopy itself is conducted under a mild sedative. "I was chatting the whole time," Couric recalls, "bossing my camera crew around." There is a risk, albeit a small one, that the device can slip and punch a hole in the intestinal wall. Yet a colonoscopy offers a distinct advantage in that the doctor can remove any small precancerous polyps as soon as they are found, making it the only screening test that can prevent cancer, not just detect it.