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Katie Couric confronts colon cancer

March is Colon Cancer Awareness Month. Katie Couric urges all Americans to "Get tested!" to safeguard your health against the deadly disease.

By Patrick Perry

From the January/February 2004 Issue

Three years ago, veteran coanchor Katie Couric bravely tackled a topic many considered too personal and embarrassing to discuss--colon cancel In her Today show series "Confronting Colon Cancer," Couric underwent an on-air colonoscopy, hoping to demystify the procedure and, in the process, prompt more Americans to go to their physicians for proper screening. According to the National Cancer Institute, fewer than half of Americans are adequately screened for colon cancer, despite the fact that the disease is the second leading cause of cancer death in the United States. Colon cancer strikes nearly 150,000 Americans each year and claims more lives--60,000 Americans annually--than breast cancer and AIDS combined.

Using her celebrity to champion the cause, Couric has made a tremendous impact on the screening rate. With the Entertainment Industry Foundation, she established the National Colorectal Cancer Research Alliance (EIF's NCCRA). After the series and the launch of NCCRA's colon cancer campaign, the number of colonoscopy screenings nationwide increased by almost 20 percent. Researchers following the trend actually published a study in the Archives of Internal Medicine, which found that the higher rate of colonoscopies was sustained for almost a year after the show aired. Researchers officially dubbed the phenomenon "the Couric effect," demonstrating the impact celebrities can have in influencing public behavior and attitudes.

While the main focus of Couric's life certainly is her role as mother to daughters Elinor and Caroline Monahan, she has been a tireless advocate for colon cancer, raising much needed funds for educational and research efforts. Her passionate advocacy earned the esteem of the Harvard School of Public Health, which recently awarded Couric its highest honor--the Julian B. Richmond Award.

"Katie Couric has courageously and unselfishly promoted the power of prevention to save lives," noted Dr. Howard Koh from the Harvard School of Public Health. "We all honor her as a public-health hero."

The Post certainly agrees. Our nonprofit society also honors Ms. Couric's heroism by presenting her with its highest distinction--the Benjamin Franklin Literary & Medical Society Award--for her courageous battle against colon cancer.

As Ms. Couric tirelessly says, early detection is the key to saving lives. Colorectal cancer is curable 90 percent of the time with early detection. Screening tests can also detect pre-cancerous growths in the colon and rectum, which can be removed before they develop into cancer.

Cancer can occur anywhere in the colon (percentages show incidence). But since a large percentage of colon polyps and cancers can occur higher up in the colon outside the range of a flexible sigmoidoscopy, it is important to examine the entire colon. The colonoscopy, allowing gastroenterologists a complete view of the colon, is considered the gold standard.

President George W. Bush understands the importance of early detection. Two benign polyps were removed from the President when discovered during routine colonoscopies; follow-up tests showed no danger signs. A vocal advocate for colon screening, he has officially proclaimed March as National Colorectal Cancer Awareness Month.

"I recommend this procedure for anyone over 50," President Bush said after receiving a clean bill of health following his 2002 colonoscopy. "They say it will help reduce the chances of colon cancer....As unpleasant as it may sound, it is necessary and worth it."

After presenting our society's award, the Post interviewed Ms. Couric, whose passion and energy for this cause are more fervent than ever--all underscoring her goals of saving lives through early detection and of raising research funds to discover new screening and treatment tools and, ultimately, a cure for the disease.

Post: The Post applauds your work in raising awareness of colon cancer and the lifesaving benefits of early detection through screening. Recently, the Archives of Internal Medicine reported on the "Couric effect"--a 20 percent increase in the number of people who underwent colonoscopies--after your televised colonoscopy on the Today show. Did you realize at the time you could have such a tremendous public-health impact?

Couric: We were certainly hoping to have an impact, but I never dreamed it would be so significant. Here's what we knew at the outset. Colon cancer, the second leading cancer killer, is curable 90 percent of the time if detected early; screening is critical. Colonoscopy is a procedure that can save lives, but "extreme fear factor" sums up how many people felt about colonoscopies.

We wanted to give viewers a sense of just what to expect--from the prep to the procedure itself to how they would feel afterward. By providing an "up close and personal" account of my colonoscopy, they could see firsthand that it's not that bad.

Shortly after the segment aired, we began to receive letters from viewers who decided to get tested. Many had precancerous or cancerous polyps removed; others were diagnosed with full-blown colon cancer and had surgery and were undergoing chemotherapy. Receiving that feedback has been incredibly gratifying, but there's still a lot to do on the awareness front.

Post: You lost your husband, Jay Monahan, to colon cancer in 1998 when he was only 42. Two years later, you established the NCCRA, under the auspices of the Entertainment Industry Foundation (EIF). What are you trying to accomplish?

Couric: Jay's disease had progressed to an advanced stage by the time it was detected, so it was very difficult to treat. His death was devastating. I wanted to share what I had learned about colon cancer in the hope of sparing other families from losing a loved one so unnecessarily and so prematurely.

EIF's NCCRA has two fundamental goals. The first is to educate people about this disease, so they'll talk to their doctors about screening. The second goal is to raise desperately needed funding for new prevention strategies, screening techniques, treatment options, and, ultimately, a cure.

Post: There are many screening tests available. How does an individual know which is most important and at what time? For example, is the fecal occult test an adequate screen for a certain age group?

Couric: Colonoscopy is the "gold standard" for colon cancer testing. That's because, as of right now, it is the most complete test available. If a polyp--a growth that can over time turn into cancer--is found, it can be discovered and removed right then and there during the procedure. Beginning at age 50, everyone should have colonoscopies, but many people have circumstances, lifestyles, or risk factors that mean they should be screened earlier.

Really, the best advice is to talk with your doctor about your individual risk factors, then work with your doctor to determine what's right for you. It's certainly important to be informed about the different tests, but to me, the question to ask your doctor is why you aren't having a colonoscopy--why you aren't getting screened.

Post: We've talked about educating the public. What other successes has EIF's NCCRA had?

Couric: Our generous supporters have helped raise millions of dollars to advance research that may otherwise have gone unfunded. Nine renowned scientists, who serve as our medical advisors, are conducting major research projects around the country.

In just three years, they have made extraordinary progress--developing a new method to detect cancer from DNA in a stool sample and discovering two genes that provide insight into the origins of colon cancer. These breakthroughs are only the beginning.

Post: Is finding appropriate candidates to participate in these studies a big challenge for researchers?

Couric: Finding the right participants to enroll in these studies can be a huge challenge for scientists, and studies are essential to our understanding of why cancer develops and how to beat it. People are often reluctant to enroll in studies because they don't know what is involved--another area where increased awareness can help.

One of our investigators, Dr. Sanford Markowitz, and his team wanted to examine siblings of individuals who had been diagnosed with colon cancer or precancerous polyps. During one colon cancer series that we did on the Today show, we reported on the study and encouraged potential candidates to apply. More than 3,000 people contacted the NCCRA's Clinical Trials Research Center, and the study was filled in less than two months. A typical recruitment time frame is more than two years, so in this case, getting the word out to the public actually helped fast-track science.

Dr. Markowitz and his colleagues discovered a genetic sequence that may be responsible for the development of colon cancer, and these genes could one day be targeted to prevent and treat colon cancer.

Post: What general role does family history play in colon cancer?

Couric: One important fact is that only 15 to 20 percent of colon cancer cases involve people with family history, which means that in 80 to 85 percent of all cases, there are no family ties to the disease. Readers shouldn't disregard screening just because their families have not yet been affected. Family history might begin with you.

Some families are predisposed to colon cancer. High-risk individuals should get tested for colon cancer before age 50. If one of your parents, brothers, or sisters has had polyps or colorectal cancer, speak to your doctor about when to begin screening and whether you need to undergo exams more frequently than what is normally recommended. If an immediate family member has had a glandular cancer (such as colon, breast, prostate or testicular), it's wise to get tested when you are ten years younger than he or she was when diagnosed.

Post: What is the biggest misconception about colon cancer you have encountered?

Couric: I've had women tell me they think of colon cancer as a man's disease, when, in fact, women and men are diagnosed with the disease in nearly equal numbers. And, colon cancer claims about the same number of women's lives as breast cancer.

When you consider how far we've come with mammography and annual visits to the OB-GYN, women have a long way to go in terms of colon cancer screening. Less than a third of women aged 50 or older are getting screened, despite physician recommendations.

Post: We've talked about education and research. What about patient care?

Couric: Learning that a seemingly healthy person is seriously ill is overwhelming, and the running around you have to do from place to place for tests and treatment worsens an already nightmarish situation.

I'm very excited about the new Jay Monahan Center for Gastrointestinal Health at NewYork-Presbyterian Weill Cornell Medical Center, due to open in 2004, which will address this problem head-on. Named after my late husband, the Monahan Center will serve as a unique model of multidisciplinary care, with convenient and seamless coordination of all needed health and support services for patients and families.

Post: What do you want Post readers to know? What is your take-home message?

Couric: Our most important message is: "Get Tested." It's just that simple. Colon cancer is treatable when caught early. People must talk with their families, friends, and loved ones to ensure they get tested for colorectal cancer.

You can go to www.eif.nccra.org or call 1-800-872-3000 for more information about this disease.

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