No one wants to have cancer. But when it comes to a certain type of cancer, it sometimes seems as if no one wants to make sure they don’t have it. Even in these candid, health-conscious times, colorectal cancer can be hard to discuss.

But there are compelling reasons to get past the reticence. With about 135,000 new cases diagnosed each year, colorectal cancer is the fourth most common cancer in the U.S., just behind malignancies of the lung, breast, and prostate. The nation’s second-leading cause of cancer deaths, it kills more than 55,000 Americans each year. And yet--when caught early--colorectal cancer is among the most curable, even preventable, of all types of cancer.

“Colon cancer is an easy disease to avoid if people follow screening guidelines,” says Duke’s Kirk Ludwig, MD, a colon and rectal surgeon. “Unlike many other cancers that can appear suddenly and grow quickly, colon cancer has a long precancerous phase as growths or polyps, which often exist for several years before becoming cancerous. If these growths are discovered and removed early, colon cancer can be prevented.”

Even after colorectal cancer has developed, says Stan Branch, MD, a Duke gastroenterologist who specializes in malignancies of the digestive tract, it’s 90 percent curable when found early.The public awareness campaign launched by TV personality Katie Couric after the 1998 death of her husband, Jay Monahan, from colon cancer helped raise the disease’s visibility and led to an increase in the number of colonoscopies performed nationwide that was significant enough to be dubbed “the Couric effect.”

Even so, only a fraction of the people who could benefit from colorectal screening actually obtain it. “We routinely diagnose patients with colorectal cancer,” says Branch, “and whenever we do, we find ourselves thinking, ‘If only we’d gotten them in earlier.’”

Colorectal cancer is sometimes described as a “silent” disease, because it doesn’t cause symptoms in its early stages. Luckily, screening guidelines for catching the beginnings of colorectal cancer are well-established. The American Society of Colon and Rectal Surgeons recommends that, for people at average risk for colorectal cancer, begin annual screenings that include a digital rectal exam and stool-sample test at age 40; at age 50, these annual screenings should be augmented by flexible sigmoidoscopy or colonoscopy every five or 10 years. Newer technologies, such as virtual colonoscopy, a non-invasive technique that uses spiral CT scanners, are also being studied at a small number of institutions, including Duke. Because 90 percent of colon cancers occur in people older than 50, that’s the age at which many doctors recommend that patients begin regular screenings if they haven’t already. But, says Ludwig, “Just because you’re under 50 doesn’t mean you can ignore your colon—especially if you have other risk factors such as a family history of colorectal cancer, or a personal history of other cancers or colon diseases. By the time symptoms such as blood in the stool, a change in bowel habits, or abdominal pain appear, the cancer has been growing for some time.”

Henderson resident Dan Wester, 49, learned that lesson the hard way. “I had blood in my stools for about a year,” says Wester, who underwent successful surgery for stage I colon cancer in May 2001.

“That, combined with the fact that my mother had some polyps removed when she was about my age, should have been a red flag. But, being a typical man,” he adds wryly, “I ignored it.” [In fairness to the male sex, even health-conscious women who get regular mammograms and Pap smears often do not have appropriate colorectal screenings, either.]

“Now, I’m much more aware of the need to act quickly if you have any symptoms or family history that might suggest colon cancer,” Wester says, noting that his four younger brothers and sisters have taken a cue from his experience: All have since received or scheduled colonoscopies.

Part of the widespread reluctance to undergo screening for colorectal cancer is due not only to discomfort with the diagnostic process, but a fear of what would happen should cancer be diagnosed. One of the most common bugaboos is the specter of a permanent colostomy bag. But, even if surgery is necessary, such a scenario is hardly inevitable.

“Our sphincter-preserving surgery techniques leave bowel function intact,” says Ludwig. “Most people are back to a pretty normal life within a few months.” As a leading center of biomedical research, Duke also offers colorectal cancer patients access to clinical trials of novel medical therapies.

Of course, as in all health matters, an ounce of prevention is worth the proverbial pound of cure. The good news is that the healthy lifestyle choices that minimize risk for heart disease, diabetes, and other types of cancer--such as a healthful diet and regular exercise--have also been associated with lower incidence of colon cancer.

But numerous studies make one point clear: The single most powerful preventive strategy against colorectal cancer is overcoming the “see-no-evil” impulse and starting an appropriate screening program. To help raise their patients’ comfort level with the process, Branch and his colleagues are piloting a CD-ROM presentation about colonoscopy. “If patients understand more about the procedure, we figure they’ll be more likely to go forward with screening,” he says.

“Of all the things physicians can do to help our patients maintain their health and extend their lives,” Branch concludes, “screening for colorectal cancer delivers just about the most bang for the buck.”