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.

Read Full Post »

Hoist the Flag

There is a quote from H. L. Mencken that reads, “Every normal man must be tempted at times to spit on his hands, hoist the black flag, and begin to slit throats.” Since first reading it, I’ve been struck by those words and have remembered them. Every normal man must sometimes want to throw caution to the wind and be a pirate, it says, to slit throats with abandon and claim the spoils regardless of consequence. It is tempting. But I also read a deeper meaning in it. A rallying cry, a warning, a call-to-arms. There comes a time, these words say, when every man will have to take action, make a stand, and risk everything to fight for what they value or else lose it to another’s plundering.

I’ve never read that line in its original context. Those sentiments may not be remotely near what the author intended when writing it. But a learned man once told me that what we see on our own is more important than what we are told to see. You can be taught to see more, to see better, he said, but never fully trust what you are told. So Mr. Mencken will have to pardon my conclusions; they are mine alone.

Hoist the black flag, he said. Slit throats. To war, then, and to the victor goes the spoils. It strikes me that much of American society is already busy at pirating, or was until the Big Bust of 2008. Wanting a large payoff from a smaller, somewhat riskier investment seemed to be the prevailing modus operandi. Flip houses. Flip cars. Flip companies. Trust Bernie with your money. Cheat (but slyly) on your taxes. In fact, cheat at anything if you think you won’t get caught. Score as much credit as possible. Buy things you can’t afford with someone else’s money. Lie and steal from your government, your employer, your family, your fellow man. Anything for the almighty dollar.

If you were in construction, you threw together as many buildings as possible and waited for fat profits to roll in, and who cares about the structural integrity of those houses and business spaces. So what if the floor joists won’t last five years, and the basement leaks if so much as a dog takes a whizz two doors down, and the wallboard emits poisonous gas? Sorry, buddy, you were dumb enough to sail into my harbor and your throat just got slit. Thanks for the booty. Besides, that’s what homeowner’s insurance is for.

If you were in insurance you issued thousands of policies that were useless and refused to pay claims, slitting more throats and raking in treasure chests of booty. Your house burnt? Oh, so sorry, we won’t pay for anything damaged by smoke or water or heat or any wall left standing. Tell you what, we’ll give you this month’s mortgage payment plus an extra $50. We’re feeling very generous today. A hurricane you say? Your house flooded? Oh how awful. But no, sorry, we don’t pay off on damages from storm surge. Nope, it’s not a flood, it’s a wave, and we don’t cover that. Sorry. Don’t forget, your next payment is due in two weeks. Bye bye now.

And of course there were still the usual rackets of car sales, internet companies, Wall Street, and, well, anything run by the government. Anything to make another dollar, and the less honest the better. Hey, that’s the new American Dream: getting something for nothing. From the world’s largest corporation to grade schoolers, everyone’s playing pirate.

But someone somewhere is losing. Someone is watching their house or car or savings or future circle the drain when that newest chest is drug on board the winning ship and its golden contents are revealed. With a pirate on every side wondering how they can get their hands on it next.

So what does this have to do with Mencken’s quote? I think the deeper meaning behind it says you have to be your own pirate, be prepared to fight for anything you want, and if you really want it you can’t let others stand in your way. If keeping your job means someone else goes unemployed, so be it. If keeping your house means another family goes homeless, that’s something you’ll just have to face. It is, in a way, Darwin’s evolution in action. No one ever wrote a treatise on the survival of the nicest.

The sad fact of life on this planet is that not everyone will have what they want, and many will not have what they need. And to have anything at all, you will have to fight for it. We do not live in a global utopian society, and if you do not take it you will likely die waiting for it to be given to you.

That goes for liberty as much as for anything else. If you do not fight for your freedoms, you can hardly expect anyone to grace you with them out of the goodness of their heart. Governments, for instance, were not constructed out of goodness but out of fear and desire … even our own illustrious “city on a hill.” It’s nice to stand safely on the sidelines and speak of pacifism and conscientious objections, but in reality they don’t work. At some point, the theory breaks down. Even one man sitting alone in the middle of a garden will have to fight if he wants to eat, fight weeds and animals and drought and frost. Idealism has yet to feed a hungry belly.

I think Mencken’s words reveal that life is simply one fight after another, and if you want to do more than simply survive, you’ll have to do so at someone else’s expense. Is your life more important than someone else’s? Is someone else’s life more important than yours? How can anyone possibly know? So hoist your flag, brandish your sword and pistol, and let the blood run.

Read Full Post »