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For today’s consideration I offer up some statistics and information about two cancers common in both men and women, bladder and colorectal, along with some pointers about risk and detection.

For starters, how about a little definition of what exactly we’re talking about. First, the bladder. If you remember anything of biology or health and fitness classes, you might recall that the bladder stores urine until certain signals tell you it’s “full,” and then it contracts to help push the urine down the urethra and out of the body. Secondly, the colorectal area. Since they are connected physically and work in tandem as part of the digestive system, the colon and rectum are often grouped under the collective “colorectal” description. Essentially, the colon is the large intestine, and the rectum is the last six inches or so before the anus.

Okay, with the anatomy lesson over, lets get to the bits that actually matter. Bladder cancer is one of the more common cancers found in men and women but is rarely publicized. According to the American Cancer Society (ACS), in 2009 some 52,810 new cases of bladder cancer were expected in men. Using Census Bureau population estimates, that means any given man had a 0.00035% chance of being diagnosed with a new bladder cancer. Those are whopping odds, I know; and, ladies, you’re numbers are even lower. For 2009, any given woman had a roughly 0.00012% chance of being diagnosed with a new bladder cancer. The 18,170 estimated new cases of bladder cancer in women in 2009 means that men are several times more likely to develop bladder cancer than women are. In fact, the ACS reports that “bladder cancer incidence is nearly four times higher in men than in women and more than two times higher in white men than in African American men.” Sorry Team Blue.

But don’t let the numbers get you down. For men, the cumulative chances of developing bladder cancer remain less than 1% until age 70 and beyond. Lifetime odds are less than 4%. And the odds of dying from it? One-fifth the chance of developing it. Women, as the earlier numbers indicated, have even less to worry about: bladder cancer odds never breach 1% by age group and is only 1.2% over the course of a lifetime. So not exactly a raging pandemic by any means. Which is especially good because bladder cancer has no good method of early detection. The most effective assessment of bladder cancer involves running an endoscope up the urethra and taking a look around. For obvious reasons, this is a procedure to be avoided unless you happen to fall among a high-risk group and or show troubling signs (especially painful urination or bloody urine). For the vast majority of us, this will never be a problem, so don’t concern yourself over it too much.

Colorectal numbers are higher. The ACS expected 75,590 new cases in men and 71,380 new cases in women in 2009, making it “the third most common cancer in both men and women.” Those numbers are also fairly even between the sexes, unlike bladder cancer. However, like bladder cancer and prostate cancer and breast cancer and most other cancers as well, the highest odds come later in life. “91% of [colorectal cancer] cases are diagnosed in individuals aged 50 and older,” reads the ACS statistics release. But it also related that in both men and women, the odds of developing colorectal cancer are less than 1% until age 60. Again, little reason to worry.

But if the 5 – 5.5% chance of developing colorectal cancer over your lifetime have you on edge, there are several methods of early detection. Most of us are familiar with the colonoscopy procedures as described (and sometimes filmed) on TV, where an endoscope is run through the large intestine in search of suspicious lesions or polyps. But if that’s too invasive for your tastes, you might consider a sigmoidoscopy, where physicians examine the rectum and lower third of the colon for abnormalities through a thin device called a flexible sigmoidoscope. It takes about 15 minutes, is less invasive, and can still take biopsies of anything suspicious. It’s recommended every five years and, like conventional colonoscopy, can occasionally (but not commonly) cause bleeding or tears in the intestinal walls, both requiring surgery to repair.

If those don’t fit your fancy, perhaps a double-contrast barium enema (DCBE) would do the trick. Recommended every five to 10 years, it involves a very thorough barium sulfate enema that physicians use to examine the lower digestive tract via x-ray. It exposes the patient to less radiation than a typical CT scan (also called CAT scan) and is somewhat less invasive than colonoscopies or sigmoidoscopies. However, if you don’t mind an enema or the slightly higher radiation of CT or MRI scans, you might opt for the virtual colonoscopy. After an enema, a small tube pumps air into colon (for better differentiation) while CT or MRI scans provide images of the intestinal tract. It’s still less invasive than traditional colonoscopies but does not allow for biopsies or as thorough an internal view. However, it does allow for imaging of surrounding tissues and produces more accurate images than DCBEs.

But if you’re not fond of any foreign materials up the backside, you might just opt for the simplicity and complete non-invasiveness of fecal blood tests. There are two types but both are quite accurate and inexpensive. One type, called FOBT (fecal occult blood test), tests feces for the heme blood component (“heme” as in hemoglobin, part of our red blood cells). The other, called FIT (fecal immunochemical test), is more sensitive and tests for the globin blood component. Pre-cancerous polyps in the colon or rectum often bleed into the fecal matter passing through the digestive tract, which can be detected by these tests. They are simple enough to do at home and are sometimes handed out free of charge at proctology centers, clinics, and other medical service providers. Doctors recommend triple-testing to reduce false positives as the body expels small amounts of blood in feces under normal circumstances. But the tests return positive results for bleeding anywhere between the mouth and anus, so don’t automatically assume colorectal cancer even if there is blood. These fecal blood tests are considered a line of primary identification, as are the similar fecal DNA tests, but for conclusive diagnoses you’re still expected to see a doctor and perhaps choose a colorectal treatment of a more invasive kind.

I think the most important thing to remember is how unlikely these cancers are. And being diagnosed with cancer is a long way from dying of it. So keep an eye on yourself, and get your regular medical check-ups if you like, but don’t waste time and energy worrying about something so unlikely. No matter what you hear on the news.

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The blog is now back up and running, with it’s usual unpredictable schedule.

And to start off a new year, a new infringement on our rights. Unless you were buried in an avalanche for the last two weeks, you’ve heard about the purported “underwear bomber” (who, luckily, managed only to injured himself) on Christmas Day. This sent airlines and government agencies into a frenzy of bad judgement and over-reaction. So what’s new, you ask? Well, it’s not so much what’s new as what is on-going … namely the hacking away of our constitutionally amended rights. Including our right to privacy (specifically, the fourth amendment; the right of the people to be secure in their persons, houses, papers, and effects, against unreasonable searches and seizures). In case you hadn’t guessed, I’m talking about the full-body scanners. (Yes, it’s a much-discussed topic at the moment, and I’m just going to have to throw my two cents in as well.) And in case you hadn’t guessed by now, I’m not a supporter.

Let me preface the heart of this by saying that I do not wholly oppose the full-body scanners. I support them as an option to the current metal detector screening process. I do not support them as a mandate and the only alternative to full-body pat-downs.

First of all, even the most effective scanner is only effective against those it actually scans. Full-body scanners were in use and available in the Amsterdam airport where the (alleged) bomber Umar Farouk Abdulmutallab boarded his flight for the United States. They certainly didn’t ward him off from a distance or go red alert as he walked into the terminal. He wasn’t suspected of criminal intent, and so he wasn’t scanned. It seems a person-by-person scanning process is as time-consuming as the metal detector queue (or moreso) so airports that do use the scanners do so with passengers who volunteer, or with passengers at random, or when someone rouses suspicion. Which Mr. Abdulmutallab did not.

Obviously, random screenings are hardly worth the effort; we would likely be as safe employing lie detectors. Because even at the absolute best, the penultimate of body scanning proficiency, it is no more effective than a metal detector and a full-body pat-down … because anyone can forego the scanner if they choose. So why the trouble and expense if the results are no different than the original conditions? Abdulmutallab’s “accessories” wouldn’t have been any easier to detect than when he went through screening at Amsterdam. And while I bet the TSA would gladly strike down that ability to choose between the scanners and the pat-down, I don’t believe it would pass legislature in the near future; it is not accepted widely enough for that. In fact, several European nations – including Belgium, Spain, Germany, and France – remain unimpressed with the scanners and unconvinced they are necessary.

According to the travel website Jaunted, the scanners are currently used in only 19 U.S. airports (listed at the bottom of this post), though the TSA intends to roughly quadruple the number of working scanners in 2010. Of course, that’s just in the States. Hundreds of international airports offer direct flights to U.S. soil … so getting everyone up to speed would be a multi-year, multi-billion dollar, multi-national project. That sounds quite easy. What could possibly go wrong? Oh, and did I forget to mention the fact that these scanners aren’t exactly accurate? How clumsy of me. Although the scan images are clear enough to violate child pornography laws, they show nothing under the skin, between sections of skin, or in orifices. Which means would-be terrorists still have plenty of options and the body scanners are, at best, mediocre in their results. Multi-billion dollar, multi-national mediocrities. Feel safer yet?

All that aside, there is still the fact that these scanners are designed to essentially strip-search thousands of innocent, law-abiding passengers (although that number will quickly rise to millions if the TSA has anything to say about it). Shouldn’t that fall somewhere under “unreasonable searches?” Especially considering you are more likely to be struck by lightning than injured in a terrorist attack in the United States. Quick, outlaw clouds! Jail anyone in possession of kites and keys! Strip-search the occupants of all vehicles and households for the presence of positive and or negative ions!

It’s ridiculous, and luckily not yet law. In fact, last summer the House of Representatives passed legislation limiting the use of the full-body scanners. But the Senate never took it up, and with Obama’s conference on airport security, I don’t expect those limits to stand long. However, what bothers me most is the American response. Countless authors of article comments and forum posts agree: “I’ll do anything the government wants if they say it’ll make me safer.”

Except we aren’t any safer. It doesn’t matter if there’s a full-body scanner on every street corner, it’s not improving the safety of passengers nor reducing the likelihood of a terrorist attack. Get over your sexually repressive phobias, supporters say, it’s just a quick naked peek and off you go, safe and secure, without even having to take your jacket off. But we aren’t any safer or more secure, and this isn’t about being digitally naked. This is about government officials wanting to mandate needless and ineffective infringements on personal freedoms protected by the Constitution’s Bill of Rights. It is the continued ruination of the singlemost important document protecting citizens’ rights which the government is supposed to answer to. Terrorists win because we allow them to win. It has nothing to do with the number of people they kill, or how they kill, or where or when. Merriam-Webster defines terrorism as “the systematic use of terror especially as a means of coercion.” Which basically translates to scaring people to force their choices or circumstances. Which the U.S. government is doing bloody brilliantly to its own people. What more could terrorists hope for?

“Those who would give up essential liberty to purchase a little temporary safety deserve neither liberty nor safety.”
– Benjamin Franklin

The following airports currently use (or allow the option of) full body scanners:
(ABQ) Albuquerque International Airport
(ATL) Atlanta Hartsfield-Jackson Airport
(BWI) Baltimore-Washington International Airport
(DFW) Dallas/Ft. Worth Airport
(DEN) Denver International Airport
(DTW) Detroit Metro Wayne County Airport
(IND) Indianapolis International Airport
(JAX) Jacksonville International Airport
(LAS) Las Vegas-McCarran Airport
(LAX) Los Angeles International Airport
(MIA) Miami International Airport
(PHX) Phoenix Sky Harbor Airport
(RDU) Raleigh-Durham International Airport
(RIC) Richmond International Airport
(SLC) Salt Lake City International Airport
(SFO) San Francisco International Airport
(TPA) Tampa International Airport
(TUL) Tulsa International Airport
(DCA) Washington DC’s Reagan National Airport

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