Commentary

Pakistanis, Digestive Problems & Colon Cancer: The Dirty Truth
By Aaliya Yaqub
UCLA, CA

Research reveals that about one-third of individuals feel uncomfortable discussing digestive symptoms, particularly bowel habits, with their physician. This places them at an increased risk of developing untreatable problems that can be as severe as colon (large intestine) or rectal cancer.
A recent survey of general practitioners reveals that there still exists a taboo associated with talking about bowel habits. In individuals of Pakistani origin, this taboo may be even greater even though there is no need to hesitate in discussing digestive issues with a physician.
Another dangerous situation that many fall into involves ignoring one's symptoms and not seeking medical attention. This reluctance to address digestive problems is of great concern considering that colorectal cancer is the second leading cause of death from cancer in the US. In many instances, it can be detected early.
The key to maintaining digestive health is awareness. It is crucial to 'listen to your gut' so to speak. If something feels wrong, speak to your doctor without embarrassment. If you notice any persistent changes in bowel habit, any blood in the stool, any unintended significant weight loss, or any new and unusual abdominal symptoms after age 50, consult a physician without delay. In addition, there are preventative measures one can take.
1) Diet: A nutritious diet rich in fruits, vegetables, and fiber may reduce the risk of colon cancer. Limiting animal fats may also reduce risk. The traditional Pakistani diet can, at times, be heavy in animal fats and sparse in fiber. Making matters worse, the Pakistani youth diet is often a combination of traditional Pakistani fare and processed, high fat fast food. These diets should be modified to decrease the risk of developing colon cancer as well as several other chronic medical conditions like diabetes.
2) Exercise: Another protective factor is moderate to vigorous exercise that is recommended for 45 minutes on 5 or more days per week.
3) Vitamins and minerals: Research suggests a reduced risk of developing colon cancer with regular use of a daily multivitamin, adequate vitamin D, and calcium.
3) Nonsteroidal anti-inflammatory drugs: People who regularly use aspirin or other nonsteroidal anti-inflammmatory drugs, such as ibuprofen, have a reduced risk of developing colorectal polyps (sometimes a precursor to colon cancer) and colorectal cancer itself. However, these agents must be used under the care of a doctor because they can also cause serious gastrointestinal bleeding with chronic use.
4) Screening:This cannot be stressed enough. Screening means getting tested before any symptoms occur. By the time you encounter symptoms, cancer has already developed. Colon cancer develops from colorectal growths, or polyps that progress to cancer. By undergoing regular screening, these polyps can often be safely removed before they become cancerous thus preventing colon cancer from developing. Men and women at average risk for colon cancer need to begin screening at age 50.
The American Cancer Society screening recommendations for those at average risk, include one of seven options, some of which are described below:

Tests that detect Polyps and Cancer:	What it is:
Colonoscopy every 10 years; OR	A test where a camera on a flexible tube is passed through the anus to visualize the entire large intestine
Flexible Sigmoidoscopy every 5 years; OR	Another minimally invasive examination where a camera on a flexible tube is passed through the anus to visualize the very end portion of the large intestine only
Double contrast enema every 5 years; OR	A procedure in which X-rays of the colon and rectum are taken after barium dye is placed in the rectum
Virtual colonoscopy via CAT scan (limited availability) every 5 years	A medical imaging procedure using X-rays and computers to construct 2 and 3D images of the colon (large intestine) from the lowest part, the rectum, all the way to the lower end of the small intestine
Tests that detect primarily Cancer:
Guaiac-based fecal occult blood stool test (FOBT) every year	A test that checks for hidden (occult) blood in the stool

In terms of the risk of colon cancer for individuals of Pakistani origin, there is very little to no specific data. However, some research has been conducted on South Asians, but mainly in the form of epidemiological studies. There are some trends that have been noted.
The incidence of digestive tract cancers in South Asians, including Pakistani individuals, is lower in those who live rural environments when compared to their urban counterparts. The incidence of these cancers has also been studied in immigrants to western developed nations. Those individuals of Pakistani origin who have immigrated to the US and UK have a low incidence of these cancers; however, the younger generation of Pakistanis that is growing up in these western nations is facing an increase in cancers of the digestive or gastrointestinal tract. This increase may be due to lifestyle changes that the younger generation faces when compared to their parents' generation.

For instance, these children and adolescents are growing up with diets rich in high fat processed foods and lower in fresh vegetables. A paper published in the British journal of Cancer in the mid-90's details an increase of between 24-28% in the incidence of all cancers afflicting South Asians in the UK. A similar trend most likely applies to those in the US.
In light of these findings, as a community we need to work on overcoming barriers that prevent many from addressing real health concerns due to embarrassment. We can protect ourselves by maintaining awareness, altering our lifestyles, and getting screened at the appropriate time intervals after age 50.