As reported by the Hartford Business Journal, August 2, 2010.

Q&A with Gastroenterologist Joseph C. Anderson, UConn Health Center

Colorectal Cancer Screening

Q. You have been selected as the physician spokesperson for the "Stay in the Game CT" public awareness campaign. What is it all about?

A. The Stay In The Game CT Campaign is funded by the Connecticut Department of Public Health and the Center for Disease Control (CDC). It is designed to raise awareness of the importance of colorectal cancer (CRC) screenings among Connecticut residents age 50 years and older. The state ranks 13th in the nation for new colon cancer rates for men and 11th for women. While the benefits of early screening are well known, 30 percent of Connecticut residents over the age of 50 who were interviewed in 2008 had never been screened by colonoscopy or sigmoidoscopy in 2008.

The Department of Public Health hopes to increase the screening rates with this campaign. The decision to use the sports theme was based on the pride that Connecticut takes in the success of their Huskies. My involvement with this program started with the project to screen underserved patients in Long Island at Stony Brook University. In that program, I personally screened 350 patients who did not have insurance that would cover colonoscopy. I also led a similar program which was statewide in Connecticut. In addition, I am serving as the head of the medical board overseeing the current phase of this project.

Q. How prevalent is colorectal cancer? Does it favor one gender over another? Why is 50 the magic age for screening?

A. According to state health officials, colorectal cancer is the fourth most common cancer diagnosed in Connecticut men and the third most common cancer diagnosed in Connecticut women. It is also the third leading cause of cancer-related death in both Connecticut men and women. Although men and women have similar risks, the risk for women appears to lag men by about five years. Thus a man's risk at 50 is similar to a woman's at 55 years but overall the lifetime risk for both genders is 5 percent. The age of 50 is an empiric one and is based on the increase in CRC after this age.

Q. What is the success rate in treating colon cancer? How have rates changed and why?

A. The success for treating CRC is related to the stage of the disease and the extent to which it has spread to other organs such as the liver. We have better chemotherapy and surgical techniques and thus the rates for each stage have improved. The real battle that we are winning is in the prevention and screening realm. By using colonoscopy for screening, we are identifying cancers in patients at an earlier stage and thus improving their chances for survival. In addition, since most CRC develop from polyps or adenomas, by removing these polyps we are probably preventing CRC. This concept of prevention versus screening is reflected in the American College of Gastroenterology' s latest CRC Screening Guidelines, which I co-wrote. In these guidelines, we divide the screening tests into those that detect cancer and those that prevent cancer. The colonoscopy is placed into the prevention category.

Q. How are smoking and colon cancer related? It seems as if there would be no obvious link with smoke being inhaled and not turned into a waste product or is it?

A. In my research, I have observed that smoking increases the risk for advanced adenomas by twofold. The advanced adenomas are the polyps that are important in the development of CRC. Although there are many theories regarding the development of CRC with tobacco exposure, the exact or primary mechanism is not known. The carcinogenic effect is likely related to the compounds that are created with the burning of the tobacco. These compounds are delivered to the large bowel either directly through the contents in the stool or through the blood.

Q. What are some things people can do to prevent colon cancer?

A. My research has shown that being overweight, smoking or drinking more than 2 alcohol beverages per day significantly increases the risk of advanced adenomas. In addition, there are data to suggest that exercise, fruits and vegetables and being thin decreases the risk. These lifestyle changes along with having scheduled colonoscopy screenings can significantly reduce one's risk of the disease.

Q. How did you pick this field of medicine to pursue?

A. I was interested in gastroenterology and colonoscopy in particular because of my background and training as an engineer. I saw a great deal of opportunity in the field with regard to research. I have done research examining the technical performance of colonoscopy. My engineering background has aided me in taking the information from this research and developing a colonoscopy made to allow colonoscopy to be performed in women with more ease. In addition, I have used my statistical background to identify risk factors for advanced adenomas. So the field of gastroenterology has allowed me to use my medical and engineering background to help screen CRC more effectively.