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 Jennifer Arnouville, D.O., a geriatric medicine physician at USMD, a health system based in Irving, TX.
Be Seen, Get Screened: Can you tell us a bit about your professional experience, including anything specific in regard to colon cancer screening?
My practice focus is geriatric medicine, which is the care of older adults. My patients are those most likely to be afflicted with conditions such as colon cancer. Older adults may also be the most likely group to benefit from preventative screening to detect colon cancer early in its course.
BSGS: Does working with the elderly present any specific challenges in regard to colon cancer screening?
Older adults must be carefully screened to determine if colon cancer screening is appropriate in light of their other chronic conditions. Most older adults should continue to undergo colon cancer screening at least until age 75, but some patients who are more frail or chronically ill may not be appropriate for continued screening.
BSGS: Do you find that elderly patients you work with are more receptive to your screening recommendations?
I do find that most of my patients are very receptive to the preventative screening that I recommend. This is because they know that I follow evidence-based recommendations regarding preventative screening in older adults.
BSGS: The Center for Disease Control and Prevention recommends that “the decision to be screened [for colon cancer] after age 75 should be made on an individual basis.” What types of things do you look for in patients age 75 or older to determine whether or not it is appropriate for them to be screened?
Patients with a history of precancerous polyp or previous cancerous may be appropriate for ongoing colon cancer screening. Patient with "alarm symptoms", such as rectal bleeding, unexplained anemia or weight loss, or abdominal pain of unclear cause may be appropriate for colon cancer screening.
Patients who may not be appropriate for continued colon cancer screening include patients without any concerning symptoms or history, and patients with limited life expectancy due to chronic illness or who are exceptionally high risk for sedation.
BSGS: What recommendations do you have for elderly people in order to improve colorectal health?
Healthy colorectal practices include healthy diet with plenty of fruits and vegetables, good hydration practices, regular exercise, and maintaining a regular bowel regimen. It is not necessary to have a bowel movement everyday; in fact, forcing a bowel movement can have negative health consequences.
The important thing is that a person remain a regular pattern, and avoid self-medicating with laxatives and antidiarrheals as much as possible. Seek medical care early when help is needed.
BSGS: What about cancer prevention? What things can people do to help prevent cancer as they age?
Avoid practices which are known to be related to excessive cancer risk, particularly tobacco use in any form, including prolonged second-hand exposure. Avoid excessive or regular alcohol use, which is also known to be associated with increased risk for certain cancers.
Have regular preventative exams with a primary care physician and have appropriate health screening tests, which studies have proven beneficial in catching cancer at its earliest or precursor stages.
BSGS: Do you have anything else to share with Be Seen, Get Screened?
Colonoscopy remains the single best test for colon cancer screening. Many patients are hoping for a "virtual" test which will be equivalent. There is no test currently available which can detect, and often treat, precancerous or early cancerous lesions of the colon as effectively and definitely as a colonoscopy.