Pat, I’d Like to Buy A Bowel

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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Stick Your Finger Where?!

I last wrote about breast cancer in my informal “medical series” here on the blog so, to be fair, I’ll now address prostate cancer. Unlike the enthusiastic pink-banner-waving breast warriors-of-awareness, prostate cancer’s agents of information fly below the radar with little hoopla, few public endorsements, and no ribbon brigades. But statistically, prostate cancer is just as prevalent as breast cancer and results in about 30,000 deaths annually.

But how about a bit of good news to start? Most guys are familiar with the “probing finger” method of prostate examination, but how many have heard of the PSA blood test that can also be used? Ideally, the American Cancer Society suggests they be used in conjunction to help identify prostate issues, and generally only after age 50. But, fellas, there’s our loophole; you have the right to request the blood test and forego the finger.

Now, back the issue at hand (no pun intended). Prostate cancer, like many other cancers, increases in probability with age. Roughly two-thirds of cases are diagnosed in men 65 and older. And whereas a 40 year old man has only a 0.01% chance of being diagnosed with prostate cancer, a man aged 75 has a 12.5% chance. Which, incidentally, is twice the odds of a woman the same age being diagnosed with breast cancer. In fact, from age 55 on, men are at a higher probability of prostate cancer than women of the same age are of breast cancer. And over the course of a lifetime, men are over 30% more likely to develop prostate cancer than women are breast cancer. I don’t recall seeing any blue ribbons for that in the New Yorker.

And although men make up less than half of the country’s population, they are more likely to develop cancer of any major class but one. Digestive cancer? More prevalent in men. Respiratory cancer? Men. Bone, skin, brain? Men. Lymphoma, myeloma, leukemia? Still men. The only major class not led by men is cancers of the endocrine system, involving hormones. (And I dare say most men could offer an explanation for why women are number one in that.)

So I think we should begin a blue-ribbon brigade, to save the men. They are a minority in the populace, suffer a shorter average life span than women, and are at higher risk for debilitating disease. If that doesn’t deserve a ribbon, I don’t know what does. But I don’t think we can rely on super-aid-celebrities like Bono to go waving any flags for the cause (mostly because I think he needs to grow a pair first), so men, take a stand for yourselves. Wave your own banners and be your own warriors-of-awareness. And women, if you support the pink ribbon then you need to support the blue one, too. We have to fight for equal rights, equal awareness, and equal funding together, breasts and prostates alike.

Go blue!!

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Scaring the Girls

The American Cancer Society estimates there were a total of 254,650 new diagnoses of breast cancer in 2009 (actual records are only available until 2005; newer information has not been compiled). As a member of the female population, I am very aware of these numbers. Television commercials, full-page magazine ads, and a virtual who’s who of celebrity sponsors make it hard not to be. Everywhere I look is the ACS “pink warning,” in ribbons, scarves, posters, bumper stickers, etc., trying to “raise awareness” about breast cancer. (Personally, I’m wondering what rock a person could be living under to not be aware.) And, as usual, I felt the need to question the authorities that be and look into these numbers more closely.

First off, let’s take that number of expected new diagnoses – 254,650 – for the 2009 calendar year and compare it to the female population of 2009: 154,000,000 (roughly, estimated from Census Bureau population charts). So with no more than a pocket calculator, I can conclude that, in 2009, any given female’s chance of being found to have breast cancer was essentially 0.00165%. There are other factors, of course, especially age and family history, but this wasn’t exactly the death sentence I was expecting. From all the media hype and social awareness I had expected much higher numbers. But 0.00165%? That means you’d have to get 1,000,000 women together to find 17 with new breast cancers (and that’s rounding up). That means if the entire metropolitan area of Memphis, Tennessee, were female, less than twenty would have been diagnosed with breast cancer during the year. I’m as likely to be killed in a freak accident involving jalapeno poppers and a road grader. Okay, maybe not, but it’s still pretty remote.

Now before anyone gets their bra in a bunch, I understand that it should not be dismissed. Like any disease, I think it should be kept in the back of your mind and those more likely to be affected (women over 45, smokers, of African heritage, or with family history of breast cancer) should take whatever steps they feel are necessary to protect or treat themselves. Breast cancer contributes to some 40,000 deaths each year; that cannot be ignored. Period. But I don’t believe it’s the plague it is played up to be. For instance, according to the National Safety Council, women under age 45 are more likely to die of accidental poisoning than to develop breast cancer.

So – to continue poking around these ACS estimates – women under 45 were expected to comprise only 25,100 of the new diagnoses. Which drops the chances to a whopping 0.00027%. Did you catch that extra zero in there? Now scrounging up 27 new diagnoses would require 10,000,000 women. That’s only slighty less than the entire Paris metropolitan complex … or the populations of Los Angeles, Chicago, Houston, and Phoenix combined. And this is supposed to be a major concern? I’m more likely to be shot; to drown in a swimming pool; to die in a plane crash or from heatstroke; or even to suffocate in bed (according to the National Safety Council). I don’t see a lot of warnings about the dangers of bed-clothes. But maybe Martha Stewart has more up her sleeve than white sales and stock tips, eh?

The American Cancer Society’s own documents state, “95% of new cases and 97% of breast cancer deaths occurred in women aged 40 and older.” In fact, most breast cancers occur in women 70 and older, when chances of being diagnosed “skyrocket” to 0.016%. And one last percentage to throw at you … taken as a whole, over an entire lifetime, the average woman has a 0.125% chance of being diagnosed with breast cancer.

So why the media frenzy? Why the pink and celebrity sponsors and full-page ads? Why are they worrying college students and the MTV generation about something that really begins to pose a threat only at retirement age?

I don’t know, but it has provoked me to look into other concerns and do some digging. Consider this post the first of a series exploring medical concerns. And remember to take media “warnings” with a grain of salt.

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Father Used to Know Best

After visiting a friend’s blog, I discovered that I had completely forgotten Mother’s Day. I’m not a mother myself, and have no mother or maternal relations, so I often forget. But I think fathers are getting a raw deal.

Mother’s Day gets splashed all over the television, newspapers, and internet advertising like a second Christmas. You’re encouraged to buy jewelry, flowers, flashy cards, expensive dinner reservations, vacations, etc. But come Father’s Day, what do advertisements push? A lawnmower. A leafblower. A new golf club. What’s Dad likely to get? Some god-awful tie and a pair of socks or, if he’s lucky, a wrench set. And since Father’s Day comes about six weeks later, all the money seems to get sucked up by Mother’s Day and the Memorial Day binge that marks the beginning of summer.

What’s left for dear old Dad?

I don’t enjoy the commercialization of holidays but I do think it can be a useful indicator of our society, namely in that the level of commercialization is dependent on how important that holiday is rated. And Mother’s Day would blow Father’s Day right out of the water any day of the week. I’m not against mothers (please, how could anyone be?) but I think fathers are becoming more and more marginalized in our society. Their roles are considered expendable.

Movies, television, and commercials paint men as lust-hungry fools. And while, true, some men are lust-hungry fools, many are not. Nor are fathers’ roles quaint but expendable.

With relatively few restrictions, single mothers can draw thousands of dollars in local, state, and federal aid each year to supplement their household, in addition to receiving various other subsidies. Single fathers often can’t. Two people, of identical race, income, background, number of children, medical issues, etc., are judged unequally based on gender alone.

The man is expected to work and bring home a paycheck whether he is trying to raise children alone or not. With that check he is expected to pay the rent, or mortgage, and utility bills; keep food on the table; pay medical, dental, and optometry bills; provide suitable clothing, shoes, school supplies, etc.; pay for child care and or hire babysitters; make vehicle payments and provide for repairs, maintenance, and fuel costs; and, of course, pay his taxes.

The woman is expected to be a stay-at-home mother. In many cases, the state will help with or fully cover her mortgage or rent payments; pay part or all of her utility bills; provide hundreds of dollars in food stamps per child; provide full coverage for medical, dental, and optometry; pay for child care; provide transportation; and often supply her hundreds of dollars, per child, for other expenses. All tax-free, of course.

Though legislation surrounding it is slowly changing for the better, fathers are still often forgotten.

And on television sitcoms, it’s Dad who makes all the idiotic blunders, who is usually cast on a couch or behind a grill or clumsily fooling in a garage. Mom is Heroine Extraordinare while Dad is, at best, Bumbling Sidekick.

I’m all for Mother’s Day. I think parents are terribly overlooked and under-appreciated by their increasingly rude and selfish offspring in today’s world…

But don’t forget Dad.

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