Be Seen, Get Screened's Physician Spotlight Q&A series highlights the work of health care professionals on the front line in the fight against colon cancer. In our latest Q&A, we talked to Dr. Louis Barfield, Chair of the Colorectal Cancer Multidisciplinary Care Team at Mary Bird Perkins – Our Lady of the Lake Cancer Center.
Be Seen, Get Screened: Can you tell us a bit about your professional experience, specifically in regards to colon cancer and colon cancer screening?
As a colon and rectal surgeon, cancer of the colon and rectum is one of the primary disease processes I treat. I perform surgical procedures that can potentially offer my patients a cure, particularly if the cancer is diagnosed in its early stages. That is why screening and early detection is so vital.
For the average individual, a colonoscopy should be performed at age 50 and every 10 years thereafter. Those with a family history of colon cancer or colon polyps should be screened earlier and at more frequent intervals.
Ninety-five percent of colorectal cancers arise from colorectal polyps over an extended period of time. If polyps are removed and the patient continues with screenings at the recommended intervals, colon cancer should be averted. There are alternative options for patients who refuse colonoscopy.
BSGS: What is your role as a colorectal surgeon and chairperson of the Cancer Center’s colorectal cancer multidisciplinary care team?
As a colon and rectal surgeon, I treat colon and rectal cancer and associated disease processes by providing endoscopic as well as open and minimally invasive surgical approaches.
I have been privileged to serve as chair of the Cancer Center’s Colorectal Cancer Multidisciplinary Care (MDC) team since 2008. This team is comprised of surgeons, medical and radiation oncologists, radiologists, pathologists, gastroenterologists, patient navigators, nurses and allied health professionals all working together to provide state-of-the-art colorectal cancer care.
We have worked over the years to assure we are providing the best possible colorectal cancer treatment while using a multidisciplinary approach.BSGS: Louisiana has one of the highest colon cancer incidence rates in the United States. Why do you think this is the case?
Compared to the rest of the country, Louisiana has rather low colorectal cancer screening rates. While there has been improvement over the last several years, we still lag behind. With proper screening, many of these cancers would have been prevented or diagnosed at an earlier stage.BSGS: What are some of the major challenges to colorectal cancer screening in Louisiana?
Poverty and the lack of health insurance coverage for many in our state make it difficult for some. Nevertheless, there are screening opportunities for the uninsured through the LSU system and through free screening events offered throughout the state.
The need for more education about early detection and proper screening is undeniable. There are many who could easily afford to have appropriate screening performed but choose not to.BSGS: Among your patients who have undergone colon resection to remove cancer, what is the most common sited reason for avoidance of colorectal cancer screening?
Many discuss their concerns about the required bowel preparation prior to a colonoscopy or the fear of having the procedure performed.BSGS: How do you address common objections to colon cancer screening?
There are now much better bowel prep options than in the past. Preps now require drinking much less volume and are easier to tolerate. Sedation for the procedure is much improved as well.
I tell them because of my family history of colon cancer I have had three colonoscopies myself. The process for me each time was fairly easy.BSGS: What is the impact of colorectal cancer screening on surgical outcomes in resections to remove colon or rectal cancer?
Colorectal screening is the key. With screening, polyps can be removed and often colorectal cancer can be avoided. Also with proper screening, cancer can often be found at an earlier stage, which makes cancer resections easier to perform and can result in a much better prognosis and greater chance of cure.BSGS: How big of a problem is colon cancer screening avoidance from a surgical perspective?
Avoidance of colon cancer screening is a big problem. Quite often we see patients who have colon cancer diagnosed at age 60-ish at their first colonoscopy. It is likely that at age 50, the recommended screening age, the cancer would have been just a polyp that would have been removed thus avoiding the future cancer.
Also, avoidance of proper screening often leads to more advanced cancers ultimately being diagnosed. These more advanced cancer often require a more difficult operation and are associated with a poorer prognosis.