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'People should not put off screening'

An estimated 150,000 people in America will be diagnosed with colorectal cancer this year and more than 57,000 will die from it. But when found in the early stages, it can be fully cured more than 90 percent of the time. In recognition of National Colorectal Cancer Awareness month, “Today” features our annual five-part series “Confronting Colon Cancer.” Kicking off the series, NBC’s chief medical correspondent, Bob Bazell reports on the state of colorectal cancer testing and treatment:

We've been doing these updates every year for a while now, and this year there is more progress to report than ever. The death rate continues to decline. Last month two new drugs — different from traditional chemotherapy — won approval for treatment of colon cancer. But still, the biggest part of the story is that far too few people get the screening that can prevent the disease altogether or catch it early. Advanced colon cancer still carries a terribly frightening prognosis.

Julie Coulter is a 39-year-old mother of three boys who all love baseball.

"It's baseball season, and I just don't have time for cancer," says Coulter.

But Julie Coulter has advanced colon cancer. After surgery it spread to her liver. Now she is taking a new drug. 

"We are just hoping and praying that this is the answer," she says.

Late-stage colon cancer presents a harsh reality.

Dr. Alan Venook explains, “The difference between colon cancer caught early, and colon cancer that has spread is the difference in curing a disease and not curing a disease."

But Dr. Venook, a medical oncologist at the University of California, San Francisco, says  patients do have more options: three new chemotherapy drugs and two so-called targeted therapies — Avastin, which blocks blood supply to the tumor; and Erbitux, which blocks a chemical growth signal.

But as Venook tells Mary Katherine Van Laanen, who is newly diagnosed with advanced colon cancer, doctors aren't sure yet which drugs will work and in what combination.

"There's less data. In fact very little data about how to manage someone like you. If you put five experts in a room you'd probably get six different opinions of what should be done," he says.

It will take years of research to sort out the answers. One hope is that the DNA from tumors will help determine which patients will benefit from which drugs. Meanwhile, the newest drugs are enormously expensive — Avastin costs about $4,400 a month and Erbitux $10,000 a month -- and on average patients get only a few months extra life.

Venook explains, "We still treat many patients to benefit the few. And clearly, that's the bad news. But the good news is that it's evolving, and we have more options and are helping a greater percentage of patients than we used to."

Still, the major goal remains finding the cancer very early when it is treatable or preventing it altogether. Doug Holland learned he had rectal cancer with a digital exam from his doctor.

"They found it early on, frankly, the prognosis for me is very, very good," says Holland.

The gold standard for detection remains the colonoscopy. Since Katie underwent the procedure on “Today” in 2000, the number of people across the country having the exam has gone up 20 percent — a result dubbed the "Couric effect" by researchers at the Univeristy of Michigan.

Colonoscopy examines the entire colon and is able to remove the pre-cancerous growths called polyps before they become dangerous. For those who cannot get a colonscopy, other tests available include a sigmoidoscopy, which examines the lower half of the colon, and a test that looks for hidden blood in the stool.

Dr. Bernard Levin of MD Anderson Cancer Center points out that every test can make a difference, and everyone 50 or older — or with a family history of the disease — should get some test.

"People should not put off screening. They should ask their physicians about the available tests they can utilize," says Levin.

Medicare now covers screening. And a recent report card from the National Colorectal Cancer Research Alliance found that 18 states now require private insurance to cover screening — a positive trend, the Association says, but not enough.

For the future, scientists are working on better tests. A computer generated X-ray of the colon — called virtual colonoscopy — could eliminate the need for insertion of a tube and the mild sedation that goes with it, although people would still need a subsequent colonoscopy if they have a polyp. And experimental tests search for DNA, not blood in the stool, so they can more accurately detect polyps or cancer. But experts emphasize these research projects should not be an excuse to avoid getting screened.

"We shouldn't be waiting for better tests. We already have tests available that if widely used, would reduce the colon cancer death rate by up to 50 percent," says Dr. Levin.

In addition, lifestyle changes can reduce the risk for colon cancer: exercising, stopping smoking, eating a diet with lots of fruits and vegetables, and cutting back on red meat and animal fat all help. So, possibly, does a daily dose of aspirin and calcium — either as supplements or from dairy products and other foods.

But of course those preventive measures are too late for Julie Coulter and the 56,000 others diagnosed every year.

"I just kept telling myself, ‘It'll get better; it'll get better.’ And it didn't," says Coulter.

But with so much research activity, it is now possible to imagine a future where far fewer people face the harsh realities of late-stage colon cancer.

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