Medical Mystery: At peak of Cold War, Reagan's cancer diagnosis

March is colon cancer awareness month, so you may have been noticing more frequent public health messages about the national's second-leading cause of cancer death.

But this wasn't the case back in 1985, when President Ronald Reagan, then 74, was found to have the classic symptom of colon cancer, blood in the stool.

The nation's 40th president, grappling with the climax of the Cold War, was sworn in for his second term on Jan. 20, 1985. Less than two months later, his physicians conducted a follow-up check on Reagan, who had had a small, benign colon polyp removed after a 1984 proctoscopic exam. Most colon cancers arise in the lower colon, which can be examined with a foot-long tube called a proctosigmoidoscope.

With the March 1985 stool test positive for blood, doctors feared that another polyp had developed. Reagan's diet was changed to eliminate the possibility of a false positive test from blood in meat. In those days, there were no specific tests for human blood in stool,  cancer cell DNA tests, or the fecal immunochemical test (FIT) that today can be used even at home.

Reagan's March 1985 checkup – conducted through a partial bowel examination -- detected another polyp, which was also benign. But he had another cause for concern: His brother Neil Reagan had recently been found to have colon cancer, raising the possibility that the president might be at additional risk for the disease.

Still, Reagan did not receive the most complete test of the colon until July, when he underwent a full colonoscopy.  A colonoscope is a long, flexible fiber-optic instrument that is passed through  the rectum all the way through the sigmoid, left colon, transverse colon, and right colon toward the cecum and appendix. The examiner can visually inspect the inside of the intestinal wall directly through the instrument optics, camera, and video screen.

Reagan's  colonoscopy of July 12, 1985, resulted in the sighting of a new polyp in the right colon that was biopsied. The microscopic exam report declared it a "villous adenoma," suspicious of malignancy. Though first lady Nancy Reagan preferred to delay surgery until the following week on the advice of her astrologer, the president's physicians won the debate, and surgery was scheduled for the next day.

Did putting off the colonoscopy until July have a long-term impact on the president's health? And how did the American people react to learning of Reagan's condition?

At surgery, a "white glistening polyp the size of a golf ball" was seen in President Reagan's colon — a growth that could have cost the president his life.

The surgery lasted nearly three hours, during which about two feet of the president's colon was removed, and the end of the small bowel was connected to the transverse colon. The tumor was officially classified as "Duke's B," meaning it was within the muscularis layer and confined to the bowel wall.  Exploration of other abdominal structures found no spread of the cancer.

Still, controversy arose over whether the colonoscopy should have been performed earlier. The White House insisted that the procedure had long been planned, but was postponed because of the president's official duties, including Soviet negotiations and defense issues including "Star Wars."

After the operation, the surgeon remarked about the 74-year-old president: "This man has the insides of a 40-year-old." The surgeon predicted that Reagan would need less than six to eight weeks in the hospital. In fact, Reagan left the hospital in less than two weeks.

As for the American people, the reaction was a high demand for colon cancer screening, physicians across the country reported.

Reagan recovered sufficiently to travel to Switzerland for the Nov. 19, 1985, Geneva summit with Soviet leader Mikhail Gorbachev, one of the four meetings the men would lead.

Eighteen months after the colon surgery, Reagan's follow-up colonoscopy detected four more polyps, which were removed on Jan. 4, 1987. None was malignant. Later that year, he made his famous visit to the Berlin Wall, where he declared: "Mr. Gorbachev, tear down this wall!"

In November 1989, the wall was indeed torn down, and the Cold War was declared over the following month, just as Reagan's presidency was ending.

As is the case with a growing number of cancer patients, Reagan survived his cancer, only to fall to another illness. President Ronald Reagan died of pneumonia, a complication of Alzheimer's disease, on June 5, 2004, at his California home.

Allan B. Schwartz, M.D., is a professor of medicine in the Division of Nephrology & Hypertension at Drexel University College of Medicine.