Colorectal cancer screening could save lives

FIGHTING AND CARRYING ON ­— Glenn Osaki and Shannon Osaki, his daughter, after his second surgery. photo courtesy of Glenn Osaki

FIGHTING AND CARRYING ON ­— Glenn Osaki and Shannon Osaki, his daughter, after his second surgery. photo courtesy of Glenn Osaki

Colorectal cancer, or cancer in the colon or rectum, affects both men and women and is the second most common form of cancer and third highest cause of cancer-related death among Asian Americans, according to the Asian American Network for Cancer Awareness, Research and Training.

The network, established by the National Cancer Institute to reduce cancer disparities among Asian Americans, says that Japanese Americans have the highest incidence and mortality rates of colorectal cancer among Asian Americans.

“Colorectal cancer is the second most common cancer among Japanese American men and women,” Tung T. Nguyen, professor of medicine at the University of California, San Francisco’s Division General Internal Medicine in the Department of Medicine, said in an e-mail to the Nichi Bei Weekly. “The most common among men is prostate cancer and among women is breast cancer, so if we combine the men and the women, colorectal cancer is the most common cancer among JA(s).”

Nguyen, who is part of the Asian American cancer awareness network’s steering committee, said colorectal cancer rates among Nikkei have been declining for the past two decades, but are still about the same or slightly higher than those of non-Hispanic whites, and screening rates are also about the same. 

“Screening rates for colorectal cancer among JA(s) in California are slightly lower than for non-Hispanic whites,” wrote Nguyen. “In 2009, the rate of ever having had screening was 79 percent for JA and 81 percent for non-Hispanic whites. The rate of being up-to-date for screening was 68 percent for JA and 71 percent for non-Hispanic whites.” 

Preventing Colorectal Cancer

The Centers for Disease Control and Prevention Website said a family history of colorectal cancer or polyps, inflammatory bowel diseases or genetic predispositions, as well as being over the age of 50 can increase the risk of colorectal cancer. However, for Glenn Osaki, who was diagnosed at age 47, screening revealed no predisposition to colorectal cancer. “They didn’t find a gene in me, so I know it wasn’t hereditary, so I don’t know if it was diet or what,” he said. 

Some studies also suggest a poor  diet, especially for Japanese Americans, may cause colorectal cancer. According to a 2004 study by Keiko Honda, researcher at Columbia University’s Department of Epidemiology, Japanese Americans could be predisposed to colorectal cancer through the adoption of a Western diet rich in red meat. Likewise, the CDC’s Website warns lifestyle factors such as a lack of physical activity, a low intake of fruits and vegetables, a low-fiber and high-fat diet, obesity, alcohol consumption and tobacco use could increase the risk of colorectal cancer.

While there is no sure knowledge of what may cause colorectal cancer, what is known is that screening greatly increases chances of survivability. Honda writes, “stage at diagnosis is one of the most important prognostic factors for CRC survival; administering appropriate screening tests is important for improved cancer outcomes.”

Low Screening Rates

Colorectal cancer has a high survivability rate if found in its early stages. The CDC reports that if everyone over the age of 50 received regular screenings, 60 percent of colorectal cancer-related deaths could be prevented. The CDC explains that colorectal cancer usually starts as abnormal growths in the colon or rectum before developing into cancer. “Such polyps can be present in the colon for years before invasive cancer develops,” the CDC’s Website says. “Colorectal cancer screening can find precancerous polyps so they can be removed before they turn into cancer. In this way, colorectal cancer is prevented. Screening can also find colorectal cancer early, when there is a greater chance that treatment will be most effective and lead to a cure.”

While screening is a key factor in preventing cancer, Japanese Americans trail behind in getting screened. Honda, in 2004, found 37 percent of her survey respondents had had a fecal occult blood test to detect blood in the stool that is not visible to the naked eye, and 26 percent had undergone a sigmoidoscopy or colonoscopy. The highest prevalence of testing were among Nikkei between the ages of 60 and 80.

According to a 2013 paper authored by Denys T. Lau, associate professor at the University of Illinois at Chicago’s College of Pharmacy, among other health researchers based in Chicago and the Japanese American Service Committee of Chicago, Nikkei in the United States have a “significantly higher risk for CRC diagnosis and mortality compared to non-Hispanice Whites.” While the paper, authored by Lau et al. says screening rates have improved over the years, “Asian American adults continue to have the lowest CRC screening adherence rate of any racial/ethnic groups.”

The parent-offspring study of Chicago-area Japanese Americans and their knowledge and attitudes toward screening reported parents did not speak to their children about screening after being sent information pamphlets on colorectal cancer screening, while several children spoke to their parents after receiving information. Lau et al. reports, “reasons why parents or offspring did not share pamphlet’s information included ‘not thinking about it,’ ‘maintaining privacy,’ and ‘awkward.’ One offspring reflected on the Nikkei cultural norm saying, ‘Culturally, it is difficult to openly talk about health issues. It’s hard to ask questions about health.’”

Raising Awareness

While fighting cancer, Osaki learned of the low screening rates among Asian Americans, mostly through his first oncologist at Kaiser Permanente who happens to be Japanese American. In finding out about the relatively low screening rates, Osaki said friends and family got together to raise awareness through a program held at the Japanese Cultural and Community Center of Northern California in San Francisco’s Japantown in 2010. “It was just about getting the word out on getting screened and I know a lot of people got screened after that,” he said. “I think a lot of it is that Asians, especially Japanese Americans, just feel embarrassed about getting screened, especially the older generations, so that was the reason for putting together that event.”

For colorectal cancer survivor Osaki, advocacy for screening has become a key issue for him. “Personally, I believe people should start screening even earlier,” he said in an interview with the Nichi Bei Weekly. “I was 47 when I found out, I would say you should even start in your 40s.”

“One of the good things that came out after this was that my whole family got screened for colon cancer after I was diagnosed,” he said. His mother, Sally Osaki, was then also diagnosed with colorectal cancer, but she was able to get treatment soon enough to not adversely affect her health. “So everyone was given a clean bill of health except my mom, and I don’t know if they would have caught it in time if she wasn’t screened either.”

Dealing with Colorectal Cancer

Osaki only found out about his cancer due to a ruptured appendix while vacationing in Hawai‘i. “When the doctor came in to release me, he told me he had good news and bad news. The good news was, I was able to go home. The bad news was that they found cancer, but at the time he didn’t know the extent of it,” he said. Osaki said he doesn’t know if the ruptured appendix had anything to do with the cancer, but said if it had not ruptured, he would likely have never known about the cancer before it was too late.

Once home in California, Osaki was diagnosed with colorectal cancer, and about a month later, had two-thirds of his colon removed. “That’s when they came back with the diagnosis that I had stage four colon cancer. They basically give me a 10 percent chance I would survive five years.” 

Through the summer of 2006 Osaki underwent chemotherapy and radiation. A year later, the cancer returned and Osaki had the rest of his colon removed and underwent another round of chemotherapy and radiation. 

His surgeries, however led to further complications which sent him back into the hospital multiple times and put him on fulltime disability.

After multiple trips to the emergency room due to bowel obstructions, which eventually led to a colostomy surgery — where doctors attached a bag directly to his intestines — and a case of neuropathy, ­­nerve damage, caused by the chemotherapy drugs, Osaki said he is now in constant pain.

“There was a period where I couldn’t eat anything solid for two years,” he said. Being on a liquid diet, Osaki said he rapidly lost weight from 190 pounds to 115 lbs.

While his battle may have brought him closer to his family, he felt dealing with cancer has been hard for him and his family. “I think it was hardest for my daughters … to see me lose all that weight, I at least didn’t lose all my hair,” he said. “Frankly I kinda looked like the walking dead.”

While Osaki says he is still in pain today, he said the biggest issue for him is mental. “You know dealing with being on disability. I may not be able to work for the rest of my life, so I focus on other things, like helping to take care of my dad now — he has Alzheimers and in a home now, so my mom is alone. I’m in the city (Osaki lives in in the East Bay city of Pleasanton, Calif.) three or four days a week to visit them. I try to see my kids and grandkids more,” he said. 

The burden, however, is also financial. “Chemotherapy isn’t cheap, you know? Getting a second opinion, all that, it’s not free.” According to Osaki, he has spent most of his savings over the past decade on medical treatment. “But I’m glad to still be here, as I said, the alternative could be a lot worse.”

Despite the discomfort or embarrassment, screening for colorectal cancer can greatly improve chances of survivability. 

“I think any screening is the most important thing,” Osaki said. “If you feel you should get screened, you should get screened.”

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