Be Seen, Get Screened: Tell us a bit about your professional experience, specifically in regard to colon cancer and colon cancer screening.
I have a family history of adenomatous polyps and premature colon cancer - so I personally follow the guidelines of colon screening every five years. I have seen beloved patients struggling with widely metastatic colon cancer that could have been prevented with appropriate screening.
Two very dear friends of mine—one a larger-than-life outdoorsman and the other one of the finest doctors I have had the honor of working with—both died of metastatic colon cancer after courageous battles with surgery and aggressive chemotherapy. They both have left a void in this world - to me a needless loss.
BSGS: You have over 30 years of practice experience. How have attitudes toward screening changed in that time period?
EVERYTHING has changed in screening. In my early career, routine screening was not even covered, now it is a standard. Unfortunately, people still have the attitude "it ain't broke so don't fix it" without understanding the nature of occult cancers.
Unlike pancreatic cancer, colon cancer is a cancer that we have a gold standard of screening, the colonoscopy, which is effective and safe. The anesthesia has become MUCH safer and better tolerated. Innovations such as Cologuard stool DNA testing can potentially give other options of screening.
BSGS: You’ve also practiced medicine in a lot of different places. Have you seen any significant differences in screening attitudes from place to place?
Geographic differences include, access to health care both from a socioeconmic stand point to geographic challenges—it's certainly difficult to perform colonoscopy on someone who lives in the "bush" of Alaska (interior many times without roads - only fly in) or all the way out into the Aleutians-Dutch Harbor.
BSGS: What are some common objections to colon cancer screening? How do you address them?
Most commonly it’s the prep, which has at least been reduced by 1/2 the volume. Fear of anesthesia is another objection. I reassure the patient that it has become much safer and better tolerated.
BSGS: Besides screening, what do you recommend to patients to improve colorectal health?
INCREASE FIBER—we are seeing diverticulitis now in 20 year olds due to poor dietary habits. Eat a diet that is low in fat and rich in whole grains, fruits and vegetables
BSGS: What about cancer prevention? What kinds of things would you recommend for lowering cancer risk?
Stop smoking, eat more fresh fruits and vegetables, and less processed foods and meats.
BSGS: Is there anything else you’d like to share with Be Seen, Get Screened?
Summation: there are so many occult cancers, such as pancreatic cancer, that we do not have routine screenings against. Colon cancer is a cancer that we have a proven safe screening that is more accurate than mammography in diagnosing cancer and, with the removal of adenomatous and villous polyps, is also preventive.
Colon cancer has a high rate of cure if found early, but that cure rate falls off dramatically if distant metastasis. Why hesitate, get screened!