Colon Cancer Screening
Tomislav Dragovich, MD, is the Medical Oncology, Hematology Section Chief at Banner MD Anderson Cancer Center.
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Banner Health: Colon Cancer Screening - Full Transcription
Audio: Music over opening titles and introduction.
Text: Banner MD Anderson Cancer Center presents
Text: Colon Cancer Screening Recommendations
Tomislav Dragovich, M.D., Ph.D.
Banner MD Anderson Cancer Center
Text: Andrew Schorr
Founder and Host, Patient Power
Author, The Web-Savvy Patient
Image: Andrew Schorr on- and off-camera
Audio: “Hello. I’m Andrew Schorr from Patient Power. This program is sponsored by Banner MD Anderson Cancer Center. I want to talk to you about colon cancer, colorectal cancer it’s often called. You know, most of the time it is preventable. And to help us understand what can be done to prevent it, our guest is Dr. Tom Dragovich. He is the Medical Oncology, Hematology Section Chief at Banner MD Anderson Cancer Center. Doctor, thank you so much for being with us. ”
Text: Tomislav Dragovich, M.D., Ph.D.
Medical Oncology and Hematology Section Chief
Banner MD Anderson Cancer Center
Images: Dr. Dragovich and Andrew Schorr on camera as each speak.
Dr. Dragovich Audio: “Andrew, you’re welcome. It’s a pleasure to share some information with you about his important topic. As you brought it up, colorectal cancer is a very preventable disease and curable disease when detected early. The impact of colon cancer in the United States is huge. One in twenty Americans will develop colorectal cancer during their lifetime and it’s about a hundred forty thousand cases diagnosed each year of which about fifty thousand die from colon cancer. So it’s a huge impact in this country, in this population.”
Andrew Schorr Audio: “When I think about colon cancer, it’s very personal to me because my mother died of it. It was diagnosed late and had spread to her liver and that led to her demise. On the other hand, my father would have colonoscopy, and I know we’ll talk about that, and he would have precancerous polyps snipped out and he never developed the disease. So, Doctor, help us understand how we can prevent colorectal cancer.”
Dr. Dragovich Audio: “Yes. And I’m probably the person who can speak for that because I do see, unfortunately, patients that come with an advanced disease, quite often nonresectable and incurable. An example of your father is certainly a great personal example. As I said, it touches a lot of families in this country. I think this is perfect timing for this discussion. There’ve been two important studies that came out in the last two months, international studies, that really, really confirm the notion that we knew all along for many years: that screening for colon cancer saves lives. You know, there was always that sense we’ve saving lives but really there were no studies that absolutely proved that. Now there are studies that prove that.
To your point on when to start, who has a higher risk, it gets a little more complicated. I think the first recommendation is that you should talk to your physician about screening for colon cancer. And also they should be alerted to the family history, take a good family history, because that effects how frequently and how intensely you will need to be screened in order to save that life.
New United States guidelines, United States Preventive Task Force, advocates starting colorectal cancer screening at the age of 50 for the general population. And for those individuals who have a strong family history, who are considered high risk or have family history of early onset colon cancer, 10 years before the first diagnosis in the youngest family member or starting at the age of 40. Again, these are very general guidelines. I think it’s very important that you discuss with the physician the family history and risk factors that may influence how early and how often you get screened.”
Andrew Schorr Audio: “The thing about my family, just a little more, I recall that my grandfather also had colorectal cancer. So help us understand the modalities that are used when we talk about screening.”
Dr. Dragovich Audio: “Well, Andrew, any screening diagnostic test is better than no screening. I really want that to be clear because we know that there are different options and sometimes, then, depends on the patient’s age, other risks factors, co-morbidities and so on. But that doesn’t mean that you should not be screened. You know, your physician should certainly advise you in what is the optimum way of screening for you. I would say that the golden standard is colonoscopy because, in addition to actually surveying the colon for presence of malignancies, also allows a physician, gastroenterologist, to remove any precancerous lesions, such as a colon polyp. The study that I just referred to, which looked at a large number of patients in the U.S. that had a propensity to develop polyps in the colon, show that those patients who had regular colonoscopies, when the polyps were removed, actually had about a 50% reduction in risk of dying of colon cancer as opposed to the general population. So I think this is certainly bringing up the importance of screening and colonoscopy.
Now, it may be that a colonoscopy could be something that might be difficult in certain patients, in certain populations, in certain regions—the access to physicians with expertise—but, in that case, I think stool testing for blood and what’s called flexible sigmoidoscopy, which is really a partial colonoscopy and requires no full bowel preparation, could be considered as effective screening methods.”
Andrew Schorr Audio: “Now anyone who’s had a colonoscopy, including myself, wonder about the preparation for it. Has that gotten any easier?”
Dr. Dragovich Audio: “Well, I have to tell you, the preparation is what most patients are really fearful of. Although, after you talk to many of my patients, they say, “You know, really, it wasn’t a big deal at all.” It’s a quite quick and simple procedure. There are some improvements in that setting. There are certainly different options in terms of preparing patients for a colonoscopy and bowel cleaning techniques. And I think those options are offered to patients. It depends sometimes on their individual preference or the physician’s preference.
There is a lot of hype about what is called a virtual colonoscopy or a CT colonography, which is a new technology that employs, not an endoscope, but a CT scan. However, that does not remove the need for bowel preparation. I think patients need to be aware of that. But it could be used in some cases where a colonoscopy may be difficult to do when patients are older, in which case, again, if there’s any suspicious lesion, they will have to have a full colonoscopy or sigmoidoscopy after that.
Where the improvements will come, I think in the near future, is there are a series of tests. They’re looking at DNA, the genes in the stool sample, with the idea of identifying those that are indicative of the present colon cancer, precancerous lesions, such as polyps. I think those will be probably a new generation of tests that will obviously not require bowel preparation and cleaning and will be used as a large spectrum screening test, and could be followed with a colonoscopy in those selected cases.”
Andrew Schorr Audio: “So it seems the bottom line is, with proper colon cancer screening, it can be life saving, certainly with colonoscopy.”
Dr. Dragovich Audio: “It is life saving and I think it is still a golden standard when it comes to the screening technology.”
Andrew Schorr Audio: “I know from my own experience with colonoscopy, if they find something, they can snip it out and you come back at some interval, maybe five years. But it’s not a big deal when you think of how life saving it can be.”
Dr. Dragovich Audio: “That’s right. That’s absolutely right. The need for a follow up exam is based on the original risk assessment and the findings on an initial baseline colonoscopy. And I also think another thing that you will be hearing more of in the next, hopefully, few years is there will be some other options in terms of reducing the risks of colon cancer by chemo preventive treatments. There have been a lot of attempts and they are on-going trials with different medications. They’re usually nontoxic and orderly available to see if we can actually further decrease the risk of colon cancer, especially in high risk populations in people that have had hereditary non-polyposis, lynch syndrome or familial polyposis or just have a very strong family history.”
Andrew Schorr Audio: “All this information is so good to know, basically, that with the proper screening and in the vast majority of cases, colorectal cancer can be prevented. Thank you so much, Dr. Tom Dragovich, Section Chief for Medical Oncology and Hematology at Banner MD Anderson Cancer Center.”
Dr. Dragovich Audio: “Thank you, Andrew. And, just again, a last word is: this is a very important mission to raise awareness about colorectal screening. Unfortunately, despite all of the availability, it’s only about 60% of the U.S. eligible populations that gets screened for colon cancer today.”
Image: Andrew Schorr addresses camera
Audio: Closing music over conclusion and titles.
Andrew Schorr Audio: “Put this on your list. You heard the recommendations. Have the proper screening. It can be lifesaving. Thanks for joining us. I’m Andrew Schorr from Patient Power. Remember, knowledge can be the best medicine of all.’”
Text: Banner MD Anderson Cancer Center presents
Text: Banner MD Anderson Cancer Center
Making Cancer History
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