As Randi Eisenshtat smiled and posed for a photo at the, er, exit of a giant inflatable colon in Times Square on Friday, she turned to her brother and chastised him, giggling.
"It's not funny!" Eisenshtat, 26, shouted over her shoulder. "My brother was making farting noises. He's very mature."
It's a pretty normal reaction to the 20-foot, walk-through colon with 3-dimensional representations of Crohn's disease, colorectal polyps and the different stages of colon cancer. It's officially called the Prevent Cancer Super Colon, and it's been displayed around the country for years to draw attention to colon issues and get people talking. On Friday, it was in New York City to kick off National Colorectal Cancer Awareness Month.
"People laugh and they're a little bit shy and embarrassed at first, but then they dive in and share a lot," said Cheryssa Jensen, who has given colon tours for two years as part of her work for the Prevent Cancer Foundation. "I hear graphic details. They talk about everything."
Colorectal cancer, the combined name for colon and rectal cancers, is the third most common cancer diagnosed in the United States, according to the American Cancer Society , which estimates that about 143,000 new cases will be diagnosed by the end of 2013. Colorectal cancer is expected to cause nearly 51,000 deaths in the U.S. this year alone.
Symptoms can include bloody stools, persistent stomach pain or irregular bowel movements that don't go away. And there's an embarrassment factor that can keep patients from going to the doctor, said Dr. Jordan Berlin, a gastrointestinal oncologist at the Vanderbilt-Ingram Cancer Center.
"In Canada, there's a promotion to get people to go to colon cancer screenings that had naked butts on billboards," Berlin said. "They're trying to say, yes, you're embarrassed to talk about it, but it is it really worth risking your life not to talk about this?"
He said colorectal cancer is one of the top five causes of rectal bleeding, but it's the fifth one.
"It's the one you don't want to miss," he said.
Still, he said attitudes are slowly shifting toward more openness about colon problems as people learn that colonoscopies aren't "that bad." A colonoscopy is a 30-minute test in which a doctor inserts a tube with a camera on the end of it into the patient's anus to check the entire colon for cancerous or precancerous growths. The patient, of course, is sedated.
The Centers for Disease Control and Prevention recommends routine colonoscopies for people over the age of 50. However, younger people with other risk factors, such as a family history of colon cancer, polyps or Crohn's disease, should also get routine screenings.
"You don't have to be 50," said Carlea Bauman, president of Fight Colorectal Cancer, a national advocacy group that kicked off its most recent awareness campaign with the giant colon in Times Square. "We're trying to raise awareness among the general population," she said. "When people are diagnosed early, it's very survivable. When people are diagnosed late, it's far less survivable. It can make the difference between life and death."
Pam Seijo, a teacher from West Virginia, was 39 years old and working on bulletin boards for her classroom when her colon ruptured, causing her to double over in pain, she said. Feverish and vomiting, she went to the hospital, and remembers asking the doctor if she had cancer.
"He said, 'You're too young for cancer. You would never have it,'" Siejo said.
About 24 hours after she was admitted, Siejo learned she had stage 3 colon cancer, which soon grew beyond her colon and progressed to stage 4 cancer. When initial chemotherapy and radiation failed, her doctors told her the cancer was inoperable and that she should go home, get her affairs in order and prepare for death.
But another doctor at the University of Virginia was willing to do the surgery, and it was successful. Siejo still takes chemotherapy pills, but she's a 12-year colon cancer survivor.
Wearing her blue colon cancer awareness T-shirt, the 51-year-old Siejo stood with other volunteers outside the inflatable colon to raise awareness.
"We have a voice," she said. "We should use it."
Andrea Kramer, 51, is another colon cancer survivor who was diagnosed before she reached age 50.
"I was experiencing symptoms, but I didn't know they were colorectal symptoms," she said. "I was probably experiencing problems way too long when I went to the doctor."
When the symptoms became unbearable, Kramer went to a doctor and was diagnosed with stage 3 cancer -- an advanced case, but it hadn't yet metastasized to her lungs or liver.
"I was lucky in that regard," she said. "There's no doubt I was embarrassed, and I wish that I hadn't been embarrassed. It would have meant a diagnosis a lot earlier and a lot greater chance of making it."
Berlin said that early detection has actually decreased the number of colorectal cancer deaths in the United States over the years. Two out of three people diagnosed with colon cancer now survive, and survival chances are even greater if it's caught early. More than 90 percent of stage 1 colon cancer patients are cured, Berlin said.
Kramer underwent surgery, radiation and two rounds of chemotherapy, but before she was cancer-free. During one of her sleepless nights before she was cured, Kramer found Fight Colon Cancer on the Internet and decided to participate. She's now on its board.
"If I had known about symptoms, I could have gotten to a doctor much earlier with a much less aggressive form of cancer," she said. "It's important that people stop the silence."
ABC Tweet Chat on Colon Cancer
Please join ABC News chief health and medical correspondent Dr. Richard Besser and ABC talk show host Katie Couric for a tweet chat today at 2:30 p.m. ET about diagnosis, treatment and prevention of colon cancer. You can share your story and get advice from experts at the Centers for Disease Control and Prevention, the National Institutes of Health, the American Cancer Society and others. Click here to learn how you can join in three easy steps.