FORT WORTH, Texas — Colorectal cancer — the cancer nobody talked about, even with their doctors, just 10 years ago — has fast become a cancer cause celebre, thanks to people such as baseball star Darryl Strawberry, singer-actress Vanessa Williams and renowned evening wear designer Carmen Marc Valvo, the most recent celebrities to speak out about the disease.

In the eight years since Katie Couric took colonoscopies out of the closet and put them on national television with the broadcast of her own screening exam. Colorectal cancer screening rates have improved 43 percent — from just 42.5 percent of Americans 50 and older meeting screening recommendations in 2000 to 60.8 percent meeting American Cancer Society recommendations in 2006.

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A lot has changed since TV news anchor Katie Couric took colonoscopies out of the closet and put them on national television with the broadcast of her own screening exam. Colorectal cancer screening rates have improved 43 percent — from just 42.5 percent of Americans 50 and older meeting screening recommendations in 2000 to 60.8 percent meeting American Cancer Society recommendations in 2006.

This spring, Strawberry, a two-time cancer survivor, is touring the country, talking about his battles with colorectal cancer. Williams and Valvo, who is a colon cancer survivor, are making it fashionable to talk about the disease with full-page ads in major fashion and lifestyle magazines.

Adding to the chatter, we answer some important questions about colonoscopies and colorectal cancer that you may have been afraid to ask.

Q: Who gets colorectal cancer, and why?

A: No one knows the specific causes of colon cancer, but factors that put a person at higher risk include obesity, high-fat diet, low-fiber diet, smoking, alcohol consumption, physical inactivity, inflammatory diseases of the bowel, such as Crohn's disease and ulcerative colitis, advanced age and a family history of colon cancer, says Dr. Henry Xiong, director of the Gastrointestinal Cancer Center of Excellence in Fort Worth.

Family clusters and inherited forms of colon cancer may account for as many as 45,000 cases each year in this country. Certain rare but high-risk genetic syndromes, including familial adenomatous polyposis and Lynch syndrome, caused by gene mutations that can now be detected with DNA testing, account for about 10 percent of the total cases, and as many as 30 percent are linked to family histories of colorectal cancer or inflammatory bowel diseases, says Dr. Keith Argenbright, medical director UT Southwestern Moncrief Cancer Resources.

Q: Can colorectal cancer be prevented?

A: Colorectal cancer is one of the few forms of cancer that can be prevented with the timely removal of polyps before they develop into cancer.

"We find pre-cancerous lesions all the time, and we can stop them from becoming cancer, stop the cancer in its tracks," says Dr. Dan Morton, one of 14 Fort Worth physicians with Gastroenterology Associates. "This is a cancer we can prevent, if we can just get people in for screening."

Patients at increased risk should be screened earlier and more often, and those at extreme risk because of certain genetic mutations might want to consider surgical removal of the colon to prevent cancer, Argenbright says. Medications, including non-steroidal anti-inflammatory drugs, like aspirin and Aleve, and COX-2 inhibitors, such as Celebrex, have shown promise in reducing colon cancer risk in people with FAP, though more study is needed.

Research shows extra calcium and a multivitamin containing folic acid and magnesium may also be protective, Xiong says.

Q: Who should be screened, and when?

A: The U.S. Preventive Services Task Force and several scientific organizations recommend regular screening for all adults starting at age 50, and for those at high risk at age 40. People with a family history of colon cancer or inflammatory bowel disease, including ulcerative colitis and Crohn's disease, are considered at increased risk.

Screening tests include:

• Fecal occult blood test (FOBT) performed at home (annually)

• Colonoscopy, an examination of the entire large intestine (every 10 years)

• Flexible sigmoidoscopy, an exam of the lower portion of the large intestine (every five years)

• Double contrast barium enema (every five years)

Q: What are some symptoms that might warn me of colorectal cancer?

A: Often there is no warning, but warning signs may include:

• A change in bowel habits, such as prolonged constipation or diarrhea

• Blood in the stool

• Unusual stomach or gas pains

• Unexplained weight loss

• Fatigue

• Vomiting

Q: What's a colonoscopy really like?

A: Most patients who have had a colonoscopy will tell you the bark is much worse than the bite — the bowel cleansing preparation takes more time and effort and is more uncomfortable than the screening test itself, which involves inserting a long, flexible tube containing a light and camera into the colon. The exam itself takes only about 15 minutes. Most patients are so relaxed and sedated during the screening, they fall asleep and are not likely to remember much about it or feel discomfort when they wake up.

Diarrhea and some cramping, as well as hunger from fasting, are associated with the procedure prep, beginning about noon the day before a colonoscopy. For some patients, pills rather than a liquid bowel prep may be appropriate. Patients are advised to discuss the issue with their gastroenterologists. (For more information, go to www.walgreens.com/crc or get a brochure at any Walgreens.)

Stephanie Woodard, a Fort Worth lawyer, who was found to have colon cancer last fall at age 39, says a colonoscopy is a piece of cake compared to major surgery and chemotherapy. "You can avoid all that with a colonoscopy," the mother of three young sons says. "I talk about it all the time with anyone who wants to know more about it. A lot of people are afraid of a colonoscopy, but it's nothing, just a nice little nap. People need to know that."

Q: Wouldn't a virtual colonoscopy be a lot easier?

A: 3D Virtual Colonoscopy uses a CT scanner to capture hundreds of thin slice images and virtual reality computer software to look inside of the colon.

While it does not require sedation and is less invasive than traditional colonoscopy, because no optic tubing is inserted, this method requires the same preparation to clean out the colon the day before, and if a polyp is found, a regular colonoscopy is still required to remove it, Morton says.

Virtual colonoscopy is readily available at hospitals and radiology centers in Tarrant County, including Dynamic Diagnostic Images in Arlington and Harris Methodist Fort Worth for $895 to $960. However, most health insurance will not cover virtual colonoscopy screening exams.

Q: What will happen if the doctor finds polyps or other lesions?

A: Any polyp found during traditional colonoscopy is removed with a wire snare and sent to a lab for testing. Most will prove either pre-cancerous or benign. If cancer is detected but the lesion has cancer-free margins, removing the lesion will cure the cancer, and there is no reason to remove any more tissue, Morton says.

If cancer has spread to the intestine wall, the diseased portion will be cut out and the ends reattached. Surgery alone is the treatment of choice to cure colorectal cancer that has not spread to lymph nodes or other organs.

The golf-ball-size tumor found in Woodard's lower colon turned out to be malignant. She underwent surgery to remove 15 inches of her large intestine and is now undergoing chemotherapy.

"In my mind, I'm lucky I had the kind of cancer they could just go in and cut out," Woodward says. "I don't say, 'I have cancer.' I say, 'I had it.' I think it's gone."

Q: How do I sign up for a colonoscopy and what will it cost?

A: Healthcare plans are required to cover colorectal cancer screening for anyone age 50 or older in Texas, and many allow the patient to call a gastroenterologist and set up an appointment directly. If your insurance requires a referral, call your primary care doctor and ask for one. If not, call a gastroenterologist and ask about insurance coverage when you set up your initial appointment. There will likely be a co-pay of $50 or $60 for the outpatient visit.

A diagnostic colonoscopy costs about $750 to $900 for the physician's fee, plus a facility fee, which is also covered by insurance but requires a separate co-pay. Ask at every step.

If you do not have insurance but can pay up front, the fee may be reduced.

Q: Who should consider genetic screening?

A: If colon cancer runs in your family or if a family member has had colon cancer diagnosed, talk to your doctor about it.

The majority of colon cancers are sporadic, but genetic testing should be considered for anyone who has:

• A close family member who was found to have colon cancer before age 50.

• More than one family member who has colon cancer and a related cancer, including cancers of the endometrium, ovaries, stomach, small bowel or kidney at any age.

• Two generations of family members with colorectal cancer.

• A close family member with a genetic syndrome known to increase the risk of colon cancer.

Q: Where can I get more information?

A: The Colon Cancer Alliance, a national nonprofit providing support to people affected by colorectal cancer, is partnering with Salix Pharmaceuticals and Walgreens to give away free colorectal cancer guides.

For more information, go to www.ccalliance.org or call the colon cancer toll-free hot line at 1-877-422-2030.

Sources: MayoClinic.com, Journal of the American Medical Association, the Merck Manual of Health and Aging