Colorectal cancer is the second most common cause of cancer in the United States. The overall mortality rate for this disease approaches 60 percent.

"However, death from colon cancer can be prevented. Effective strategies exist, and it is unique in that respect," says Rakesh Gupta,

M.D. gastroenterologist.

"There are a large number of approaches mentioned for detecting colon cancer early, usually at the stage of a polyp. By diagnosing colon cancer with a screening program, the mortality is anticipated to be much less," Dr. Gupta says.

The challenge for physicians is in determining which individuals should be screened, how often, and with which diagnostic tests, Dr. Gupta says. Dr. Gupta suggests an approach that he feels reflects the consensus in the current medical literature.

"With this approach, we divide people into three risks categories: average, high risk and moderately high risk," Dr. Gupta says.

Average Risk

"This group is the general American population older than 45 years of age. For these individuals, a flexible sigmoidoscopy is

recommended once a year for two years, and every three to five years thereafter," Dr. Gupta says.

High Risk

According to Dr. Gupta, this group includes individuals who have already had colon cancer, a neoplastic polyp. Also included in this group are those who have ulcerative colitis or familial polyposis disease. These individuals may be under 45 years of age.

For these individuals, a colonoscopy is recommended once a year for 2 years, and then every three to five years thereafter. A colonoscopy is an examination of the entire colon with a flexible scope.

Moderately High-Risk Group

This group includes individuals who have had cancer elsewhere, such as breast, uterine or lung cancer. Those who have a family history of colon cancer or colon polyp are also a part of this group, as are those who have had radiation treatment in the pelvic area. These individuals may also be under 45 years of age.

"Nobody knows what is the best approach for this group," Dr. Gupta says. "But a reasonable approach seems to be a flexible sigmoidoscopy annually, along with a fecal occult blood test, or a colonoscopy annually," he says.

The key to treating colon cancer is in detecting it early, Dr. Gupta stresses. Although some polyps are not precancerous, others are, he notes.

"Based on national statistics, we can expect to encounter 100 to 125 cases of colon cancer per year in LaPorte County," Dr. Gupta says.

"With the present knowledge and widely available diagnostic and therapeutic techniques, a wide reduction in the incidence of and mortality from colorectal cancer is more that a theoretical possibility.

"We have the medical technology and an adequate number of doctors in this area to prevent colon cancer. An approach based upon risk seems to be the most effective way of achieving this," Dr. Gupta concludes.

Dr. Gupta attended medical school in India. His gastroenterology fellowship training was at the University of Illinois in Chicago. He has practiced locally since 1983.