Is it because of the bum?
March is colorectal cancer awareness month and darn, are we ever missing the mark, more than 1 in 18 Canadians will be diagnosed with colorectal cancer in our lifetimes: your dad, your brother, your wife, your mom, your daughter, you. It is a largely treatable cancer when caught early enough, yet still, my own practice has been numbered by too many lives taken too soon.
And so I ask, why?
Yes, there’s the awkward embarrassment of something related to the bum - from the anus to the rectum into the large intestine through to the cecum, we might say in medical speak. Maybe that’s why some homophobia persists - an awkward discomfort related to the ickiness of what comes out (or goes in) the bum. But, as they say, even the Queen of England (or the King, as it were) wipes their own arse.
A few people stand out to me in my past decade as a doctor - the eight year old son of a woman whose life was taken all-too-soon by colorectal cancer, leaving her orphaned son to wonder what life would be without his mom; the daughter whose alcoholism was borne from the potentially deep trauma of sitting beside her abusive father swearing through his last breaths dying from rectal cancer.
There’s all of the operations I have assisted in - mostly in Montreal and Dauphin, Manitoba, holding retractors and laparoscopy cameras for my surgeon colleagues as they excised cancer from colons. Sometimes leaving an ostomy bag. Sometimes reconnecting a shortened colon.
And there’s the patients I have cared for working in GP-Oncology in Manitoba and then Victoria, reviewing chemotherapy medication combinations and treating side effects, as we balanced the cure versus the poison.
Yes we saved a lot of lives. But we lost too many.
With colorectal cancer, perhaps as much as anywhere else in healthcare, an ounce of prevention is worth a pound of cure. For all adults between 50 and 74, screening is a stool test - fecal immunochemical test “FIT” - every two years or colonoscopy every 10 years. If you have a first degree relative with colorectal cancer, start screening a decade before they were diagnosed. And if you have a familial genetic syndrome or inflammatory bowel disease, you will want to get colonoscopies sooner and more frequently. If you’re older than 74 but anticipate living more than a decade, keep getting screened.
Here on the North Island, one of our challenges is a lack of primary care providers. A wiser person than I once said, “We have a two-tier healthcare system - those who have a family doctor and those who do not.” While I am deeply committed to recruiting doctors and expanding my own capacity through hiring associate physicians and physician assistants, we remain shorthanded in our ability to provide primary care on the North Island.
Thus, with the writing of this column, I commit to you, residents of the North Island, that I - even if I am not your stated primary care provider - will, for those of you without a primary care provider (family doctor or nurse practitioner) be willing to be listed as the receiving doctor of your screening test, if a family doctor’s name is needed, and assist in whatever specialist/surgeon/oncologist care is needed. All you need to do is go to your nearest lab and request a FIT test (or the more appropriate screening if you fall into one of the groups described above).
Health care is about people. Relationships. Responsibility for our health, and for the health of those we serve.
When we leave it to faceless bureaucracies, health care soon falters, weighed down by the cruelty of institutions - and the suits behind them - that fail to take responsibility for the patient.
And so, start today: Check to see if you’re up to date with your colorectal cancer screening. It could save your life. It could save your loved one’s life. I am here to help.
For ideas/topics you would like explored, please email suggestions to: alexnatarosMD@gmail.com or find me online Facebook/Twitter “Alex Nataros MD” Note this is Not for personal medical questions – for these you should present to clinic/emerg or call 8-11.