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. Anna Toker, a Colorectal Surgeon at USMD in Arlington, Texas.
BSGS: Can you tell us a little bit about your professional experience (especially in regard to colon cancer)?
Dr. Toker: I am a board-certified colorectal surgeon and an fellow of the American Society of Colon and Rectal Surgeons. I have been in practice in the Dallas area for more than 10 years now.
My practice focuses on the screening and prevention of colon cancer and the minimally invasive Robotic Laparoscopic approach to surgery for the treatment of colon and rectal cancer as well as a variety of benign colorectal diseases.
I have been fortunate enough to be elected by my physician peers to D Magazine list of Best Doctors four times now. It is a real honor and privilege to care for their patients.
BSGS: How much of your work is devoted to treating colon cancer?
Dr. Toker: Approximately 40% of my time is dedicated to cancer screening and another 30% is dedicated to the treatment and cure of colorectal cancer
BSGS: Besides screening, what do you recommend to patients in order to lower their cancer risk?
Dr. Toker: Colon cancer is the second leading cause of cancer death in this country and the No. 1 thing people can do to prevent colon cancer is to be compliant with screening colonoscopies and the removal of pre-cancerous polyps when found.
There are ways to screen for colon cancer that cannot prevent cancer. These methods include Barium enema, virtual colonography, fecal occult blood screening, but none of these tests allow for the removal of pre-cancerous polyps, which is why they are not currently considered the gold standard for cancer screening and prevention.
Other good health habits such as quitting smoking, living an active lifestyle, and eating a balanced diet high in fiber may help prevent cancer, but nothing has been shown as effective as routine screening colonoscopies for the prevention of cancer.
BSGS: How do you educate patients about colon cancer risk factors and the importance of being screened?
- Patients are often referred to me by their primary care doctors for screening and in those patients we discuss that colon cancers come from colon polyps which are precancerous growths of the colon. 30% of the population has these polyps and 0.5% of patients will develop a cancer.
- Of the 60,000 people per year that die from colon cancer, 40,000 are over the age of 50 and waited until they had a symptom to be evaluated with a colonoscopy (those symptoms include bowel habit changes, rectal bleeding, abdominal or rectal pain, and unexpected weight loss. Probably the most common symptom people complain about prior to their diagnosis of cancer is a worsening of "hemorrhoids") Our goal then is to screen everyone over the age of 50 before they get symptoms in order to potentially save 40,000 lives per year.
- One colonoscopy doesn’t protect you for life. It can take between 5-10 years for a normal colon to develop a polyp and that polyp become cancer, so regular intervals of 5 years for high risk patients and 10 years for average risk patients are used to screen for cancer. (A high risk patient is someone with a family history of gastrointestinal cancers or uterine cancer, personal history of breast, GI, or uterine cancers, personal history of colon polyps, and personal history of inflammatory bowel disease.) In patients with multiple family members with colon or uterine cancer including a first degree relative and someone in the family who was under 50 when diagnosed with cancer, I suggest genetic testing to help guide management. Patient with a known genetic defect may choose to have pre-emptive surgery in order to prevent colon cancer.
- If you have a long standing complaint of bowel habit changes, rectal bleeding or discomfort regardless of your age, you should be evaluated for colon cancer as the incidence for cancer in people under 50 seems to be rising.
- The new health care law does consider colonoscopy a screening test, however, only allows for one test every 10 years in normal risk patients and one every 5 years in high risk patients. It is critical that patients perform a good bowel prep before the procedure to facilitate a complete and thorough exam. Failure to do so will not only lead to false confidence if nothing is found, it will also lead to repeat exams in attempt to get a better view which increases the cost to both the patient and society as a whole. No one wants to do the bowel prep, but it is absolutely critical the patient is completely clean for the exam. Furthermore, as a doctor, it is not fun to dig through an unprepped colon. So, I have this information written down, I explain it and the prescribed prep has the same information written down. Then I smile and ask people to help a sister out, do the prep!
BSGS: You've practiced in the South your entire career. Are there any unique benefits or challenges that come with practicing medicine in the South?
Dr. Toker: I was born in Texas and raised in South Louisiana which gives me the typical down to earth southern charm New Orleans girls are known for. I will admit there are some men in the South that are hesitant to discuss their bowel habits or rectal problems with a woman.
It is normally not the gentlemanly thing to do. However, I try to ensure the male patients that there is nothing new they are telling me and I remind them that I have the smallest finger in town, so they need not worry. Women on the other hand prefer a female doctor, so most of my patients are women.
I am also a mom, so my approach to the hurting patient is rather motherly, which is another personality characteristic patients seem to respond well to.
From a health perspective, Texans tend to be meat and potato people and will drink tea and coffee over water, so from a dietary stand point I spend a lot of time discussing ways to work more water and fiber into patients diets.
BSGS: What makes USMD's colorectal healthcare stand out?
Dr. Toker: From a cancer perspective the best aspect of USMD as a health care system is that the medical oncologists and I are in close proximity and coordinate daily in the care of patients. We employ world class health care in a timely fashion and as cost effective as we can.
The end result is a coordinated team approach to each patients care for the best outcome possible.
BSGS: Do you have anything else you'd like to share with us today?
Dr. Toker: USMD is growing daily and we are now starting a gastroenterology department, which will further improve the integrated team approach that we are able to offer patients. In our system, ideally, patients will undergo screening tests for colon cancer.
Those who are found to have a problem will first be evaluated by colorectal surgery and oncology then they will undergo a minimally invasive procedure in order to return to a normal productive life. We really like to work one-on-one with our patients when it comes to treatment.