Are you over 45 and hesitant about scheduling a colonoscopy? Did you know there are now several types of screenings that you should discuss with your primary care provider? In recognition of Colorectal Cancer Awareness Month, Matthew A. Grossman, MD, a gastroenterologist and interventional endoscopist with Atlantic Health System, joins a Community Conversation to discuss the importance of getting a colon screening and explains the latest technology to support this important procedure.
What kind of health care does a gastroenterologist and interventional endoscopist practice?
A gastroenterologist is a specialist with expertise in disorders and diseases of the digestive system. Dr. Grossman explained that all gastroenterologists perform basic and routine endoscopies where a long, flexible tube with a tiny camera looks down the mouth into the esophagus, stomach, small intestine, and the colon. Interventional endoscopies go deeper, beyond the walls of the gastrointestinal tract, to detect and treat early-stage cancers. Endoscopic ultrasounds can also examine the liver and pancreas.
How has technology advanced the field of gastroenterology?
Dr. Grossman was enthusiastic about the use of technology to detect and treat diseases of the gastrointestinal tract. “Nothing is off limits for interventional GI. It's a very exciting field, a lot of high-tech instruments and a lot of fun technology to work with. I love it. The tech is what keeps me waking up every morning, coming in excited. You never know what's around the corner. The latest advancements in endoscopy would blow you away.”
How important is early screening and detection of colorectal cancer?
“I cannot tell you how important it is for you and your loved ones to undergo screening,” said Dr. Grossman. Early detection, treatment and removal of a pre-cancerous polyp increases a person’s survival rate upwards to 90%. By contrast, if cancer presents itself in the later stages, survival is “actually quite dismal” according to Dr. Grossman. Guidelines for screening have changed in recent years. In the past, many people received their first colonoscopy at age 50, whereas the new benchmark is 45. The younger a person is, the more likely cancer can be detected sooner.
Is a colonoscopy the only screening option?
Colonoscopy is the gold standard because the screening is both diagnostic and therapeutic. If a polyp is found during a colonoscopy, it is removed during the procedure. But Dr. Grossman acknowledged that not everyone wishes to undergo a colonoscopy because the preparation to clean out the intestine can be uncomfortable and time consuming. There are other screening options that don't require preparation, including fecal immunochemical testing that checks for blood in the stool and Cologuard® , which is a genetic test. Often, these two screenings are performed together.
How often should a person get screened for colon cancer?
Dr. Grossman recommends getting a screening colonoscopy every 10 years. If the screening shows no polyps, you wouldn't repeat a screening colonoscopy for another 10 years. A combined Cologuard and fecal immunochemical test should be performed every three years. If a fecal immunochemical test is performed without Cologuard, it should be done annually. There is also the option for flexible sigmoidoscopy, which requires an enema prep, and is performed every 5 to 10 years. This screening is usually for patients who don't have access to full colonoscopies in certain parts of the country.
How does family history impact the screening process?
Dr. Grossman explained that a family history of colon cancer can increase the possibility of developing the condition yourself. It is therefore important to screen early. He suggested that if you have a close relative who has had colon cancer or advanced polyps, whatever age they were detected, you begin your screening 10 years prior to that age. For instance, if your father had polyps at age 47, you would begin screening for the condition at age 37.
What is the recovery time after a colonoscopy?
“I often tell my patients that getting a colonoscopy is now like going to the spa,” said Dr. Grossman, “it's very relaxing because you receive sedation prior to the procedure. The procedure itself is painless and you should not fear any discomfort during the procedure…recovery is really a matter of minutes.” Dr. Grossman explained that new techniques have made the screening far more comfortable than in the past. Instead of air, carbon dioxide is used to inflate the bowel, which allows the patient to absorb it into their bloodstream and exhale it without bloating. If a polyp is removed, most patients do not experience discomfort because there are no nerve fibers in the colon to cause pain.
Why have colon cancer rates increased, particularly in younger people?
Although there is an increase in cancer rates among younger people, Dr. Grossman said there is no definitive answer as to why. He mentioned trends that might contribute to the increase, including diets high in carbohydrates, and more sedentary lifestyles spent indoors. He reiterated the benefit of early screening, especially if you have symptoms of gastrointestinal disease such as black colored stool, blood in the stool, unexplained weight loss, a feeling of fullness without eating much and/or changes in your bowel functions. He added, “We don't screen people below 45 years old, but colon cancer can occur younger than that…You need to speak up when you're having symptoms. It's not in your head, you're not imagining it. We want you to take these seriously and voice it because this is the only way we're going to catch colon cancer in young people.”
How far has screening colonoscopy technology progressed?
Dr. Grossman said the cutting edge of colon cancer screening is the use of artificial intelligence to enhance the conclusions drawn by the endoscopist. The AI could potentially increase detection rates and help to lower mortality rates. Additionally, fiber optic scopes that produced grainy images have been replaced by 4K images that allow doctors to see the tiniest textural changes in the colon. Flat polyps that were difficult to detect are now rendered in high definition. According to Dr. Grossman, these factors have made colonoscopy 100% accurate in detecting colon cancer.
How reliable are other screening methods?
The combination of fecal immunochemical testing with Cologuard genetic testing is approximately 90% accurate for detecting cancer. Cologuard advertises itself as being more than 85% accurate for detecting advanced polyps. Dr. Grossman said that while there are trade-offs in terms of detection rates when patients choose non-invasive testing over colonoscopy, non-invasive methods are repeated more frequently to offset the lower percentage rates.
How often are polyps discovered during a colonoscopy?
Atlantic Health System is committed to providing quality metrics and the physicians who perform screenings adhere to high performance standards. Dr. Grossman said the colon is thoroughly examined “behind every fold and every crevice of this organ.” About 25% of those who exhibited no previous symptoms have polyps. He reiterated that risk factors, including family history, as well as smoking cigarettes and drinking heavily, are contributing causes for colon cancer. And yet polyps are also found in patients with no known risk factors as well. “I've done many a colonoscopy on a nun, and they can have polyps just the same as the rest of us, as blessed as they are.”
What preparation is needed before a colonoscopy?
Dr. Grossman said that despite its reputation for discomfort, the preparation for a colonoscopy is not as bad as people imagine. Previously, patients had to drink a gallon of clear liquid over the course of a few hours that tasted like pickle juice. Today, the preparation has changed. The new method is called a “split prep” which allows patients to do half the preparation the evening before the procedure and half the morning of the procedure.
Patients no longer have to drink the unpleasant-tasting liquid and instead drink a smaller amount of fluid mixed with water to dilute the taste. Some patients may be required to take a laxative. Other patients may be able to prep by taking tablets diluted with water. Regardless of the method, Dr. Grossman urged patients to endure the preparation as best they can. “Quite honestly, in the name of the prevention of colon cancer, I encourage our patients to endure the prep. You just have to do it. It's a rite of passage in this lifetime. Let's do it for the sake of our own health.”
Be Proactive About Colon Health
Are you over 45 and hesitant about scheduling a colonoscopy? Did you know there are now several types of screenings that you should discuss with your primary care provider? Your primary care physician can discuss the importance of getting a screening and the latest technology to support this important procedure.