Colonoscopies recommended to stem rise in fatal cancer

Professor Jonathan Sham has an easy method of determining how big a killer colorectal cancer is in a country.

He looks for Western-style fast-food chains. If he finds them, then chances are the country will have a growing rate of colorectal cancer, he says.

This is because the existence of fast-food chains is evidence that a country has adopted a Western diet and with it the red meat and fats that are known to put people more at risk of colorectal cancer, says Sham, a cancer specialist at the University of Hong Kong.

Throughout the world, colorectal cancer, or bowel cancer, is on the rise with 610,000 new cases in 2008. As a cancer associated with wealth, it was until recently less common in Asia than in the more developed and richer countries.

However, growing affluence and an appetite for Western diets in Asian cities has fed a rise in bowel cancer, making it now one of the region's biggest cancer killers.

In Hong Kong, the number of cases has increased by about 3 percent a year over the past 20 years. It is now the second most common cancer, accounting for 16.4 percent of all new cases of cancer and the second biggest killer, causing 1,686 deaths in 2008.

This alarming trend is echoed in Singapore where it is already the biggest cancer threat, accounting for 6,807 of the 42,000 cancer cases between 2001 and 2005. The same is true in Taiwan, where it overtook liver cancer as the most common cancer in 2006.

There are already signs that bowel cancer is gaining a foothold in Asia with cities like Bangkok and Shanghai already having a much higher rate than the rural areas of those countries.

"There has been a dramatic increase in cases of colorectal cancer and basically it's down to modern city living with people eating more meat and animal fat, especially beef, less vegetables and fruit and not doing enough exercise," Sham says.

This factor alone has been seen to be behind the rise in bowel cancer in Japan, which witnessed a ten-fold increase in meat consumption between the 1950s and 1990s.

The risk also increases with people who smoke and drink, and with age, with about 90 percent of cases occurring in people over age 50. This is another reason why Asian countries with their growing population of elderly are seeing a rise in bowel cancer.

Up to 20 percent of bowel cancer cases are due to a mutated gene, while the remaining 80 percent are said to be sporadic and as a result are more likely to go undetected in the earlier stages when they have a better chance of being successfully treated.

According to Sham, in most cases symptoms such as changes in bowel habits only occur when the cancer is advanced which means around 50 to 60 percent of all cases result in death.

Studies have shown that bowel cancer occurs predominantly as a result of cell abnormalities in the colon that start as small growths called polyps. The majority are harmless, but if left untreated a very small percentage can become cancerous.

This transition normally takes place over around 10 years and it is this timescale that works to our advantage, making it a preventable cancer, says Dr Yuen Siu-tsan, a medical advisor to the Hong Kong Cancer Fund.

Prevention is possible through regular screening called a colonoscopy, or sigmoidoscopy. This involves passing a flexible tube with a camera through the whole or part of the colon via the rectum. This allows the doctor to look for and remove the polyps before they develop into cancer.

"We know that most tumors pass through a stage as a polyp before they become tumors. So if an individual has regular colonoscopy and removal of polyps whenever they appear, then in theory they can prevent colorectal cancer," Sham says.

Sham and fellow experts recommend people undergo a colonoscopy once every 10 years from the age of 50.

German Press Agency

(China Daily 03/16/2011 page19)