Colon Cancer Screening: An Ea... Video Transcript

Participants

John S. Macdonald MD, David R. Marks MD, Shari Midoneck MD, Mark Pochapin MD

Summary

Have you been told you should be screened for colorectal cancer but avoided it out of embarrassment or fear? It's a common reaction, but a dangerous one. Join our panel as they describe the various procedures for colon cancer screening, discuss who should get screened and explain why early detection can make a difference between life and death.

Webcast Transcript

DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. Colon cancer is the second leading cause of cancer death in the US. But you often don't get symptoms until the cancer has spread. That's why routine screening is so important.

Here to talk about colon cancer screening and who should get it, are two experts. First is Dr. John Macdonald. He's an oncologist at St. Vincent's Comprehensive Cancer Center in New York City. Next to him is Dr. Mark Pochapin. He is a gastroenterologist at the Weill Cornell Medical College. Welcome.

Why is screening so important?

JOHN MacDONALD, MD: Obviously, with any cancer, it has to start somewhere. It starts in a relatively localized fashion. And if you detect and treat the disease when it's localized, you essentially can cure any cancer. If you wait until the disease has disseminated, has metastasized, it becomes very difficult to cure patients. So screening, with the detection of early, curable disease, is a very important aspect of all cancer, and it's a very important aspect of colon cancer, which is a really common disease in the United States.

DAVID R. MARKS, MD: What are the different ways people go about screening?

MARK POCHAPIN, MD: There are a lot of different ways. They're all not equivalent, though. The most effective and most comprehensive would be a colonoscopy, which is a procedure where a tube is put in the intestine, looks around the entire colon. That's also the most invasive, and it's done with sedation, so a patient is relatively sleepy or asleep.

Then there's a sigmoidoscopy, which is a much smaller version of that, where it's just the bottom of the colon that they're looking at. That's usually combined with fecal occult blood testing, which is the little card that doctors or nurses use to see if there's any occult or microscopic blood in the stool.

And then there's a barium enema, which is a radiographic or an x-ray test. And finally, there's a new kid on the block known as virtual colonoscopy, which is really a fancy three-dimensional CAT scan, which still requires the same preparation as colonoscopy, but it's an indirect or an x-ray measurement of the internal view of the colon.

DAVID R. MARKS, MD: How is a person supposed to choose which one of these screening methods is right for them?

JOHN MacDONALD, MD: With good advice. Obviously the patient can't really choose which is the appropriate method for them. Many people feel, nowadays, that if a patient can tolerate a colonoscopy, which most people can, that that's the best approach because, for several reasons. One is that, if you do a colonoscopy and you find that the colon is entirely normal, no polyps, no abnormalities, that has been shown to very substantially decrease the risk of death from colon cancer in the next 7-10 years. So it's a very good screening test.

And two is, if you find an abnormality with colonoscopy, the colonoscopist, the gastroenterologist can do something. Can remove a biopsy, if it's a tumor. Can actually remove a polyp in toto. So it's a useful procedure, both diagnostically and therapeutically.

DAVID R. MARKS, MD: Of course, a lot of insurance companies won't pay for routine screening colonoscopies.

MARK POCHAPIN, MD: That's true. It's a real problem. Actually, Medicare now is just recently in the process of trying to approve, or actually may have approved a bill to look specifically at patients for screening colonoscopy over the age of 50. I think they may have just approved one.