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

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That is why some doctors and quite a few activists are lobbying to make colonoscopy the test of choice. They point to small studies of people with a genetic predisposition to colon cancer that show that snipping out polyps on a regular basis decreases chances of developing the disease. Dr. Sidney Winawer of Memorial Sloan-Kettering Cancer Center in New York City is directing a larger study to see if that holds true for the general population.

Until then you could be stuck in a classic medical Catch-22. Most insurance companies won't pay for a colonoscopy unless you have a family history or symptoms. But if you already have symptoms, any tumors the test uncovers are likely to be advanced. The insurance industry insists it is just following procedures. "There isn't enough evidence [on whether colonoscopy screening saves lives] to recommend for or against it," says Dr. Charles Cutler, chief medical officer of the American Association of Health Plans. For years Senator Edward Kennedy of Massachusetts has pushed a bill that would mandate reimbursement for all screening exams. It is still languishing in Congress.

Executives at pharmaceutical giant Eli Lilly aren't waiting for government action. They offer free colonoscopies to all their employees starting at age 40. "The guidelines typically suggest screening at age 50, because that's when the incidence of colon cancer becomes statistically significant," says Dr. Gregory Larkin, director of corporate health services for Lilly. But since it takes precancerous polyps five to eight years to develop, he notes, why wait a decade to start removing them?

Still not ready to sign up for a colon exam? Researchers are trying to perfect the so-called virtual colonoscopy, which doesn't require threading any medical instruments into the colon. Instead, doctors rely on cat-scan imaging to create a computer-generated 3-d picture of the inside of the intestine. It's still not clear, however, how accurate the new technology is. So don't put off getting the tests that are available today in hopes of taking a less invasive one later.

While you're at it, try making a few changes in your lifestyle. Start by eating at least five servings of fruits and vegetables a day (a serving consists of a medium-size banana, apple or orange, half a cup of solid vegetables or a full cup of lettuce). There's evidence that natural compounds found in fruits and vegetables can help protect against colon cancer. Besides, fruits and vegetables lower your blood pressure and help preserve your heart.

If that's too difficult, consider adding a multivitamin with 400 MCG of folic acid (one of the B vitamins) to your breakfast routine. Taking folic acid decreases the risk of developing colon cancer 75% over 15 years, according to a study of 90,000 nurses published two years ago. And don't forget to exercise. Joggers in particular seem to have a lower rate of colon cancer, but any physical activity is beneficial.