During a recent PW Podcast episode, we spoke with Lisa Mathew, MD, a gastroenterologist at South Denver Gastroenterology in Colorado. Following is a summary of that interview:
What do patients and physicians need to know about preventing colorectal cancer?
There’s a long timeline from polyp to the development of colorectal cancer, and certainly to the development of metastatic colorectal cancer. So, there’s a window of opportunity in which we can intervene, remove precancerous lesions, and prevent colon cancer. Unfortunately, colon cancer is notoriously asymptomatic, so we commonly see patients present without symptoms. Patients should know it’s detected on screening examinations, and that some people do present with symptoms; the most common is bleeding or, sometimes, a change in bowel habits, but typically that’s fairly late into the disease course. The window of opportunity to intervene, prevent and, really help our patients is before the cancer develops, and colonoscopy is considered the gold standard in screening.
For patients who are afraid of colonoscopy, I recommend they first talk to someone who’s had the procedure and ask them about their experience, because I think there’s a lot of fear based on the perception that it’s going to be uncomfortable. Talking to someone who’s had the procedure helps patients understand that it’s done with sedation and that the worst part is the prep the day before, which is unfortunately unavoidable. But, patients should know that it’s just 1 day of their life and if the test is normal and they don’t have a family history, their next colonoscopy wouldn’t be for 10 years.
That said, we always present stool-based screening tests to patients as an option. However, if you’re discussing proceeding with colon cancer screening, it’s very important for patients to know that if the stool testing is positive, the next step would be colonoscopy, so it’s nearly impossible to have a conversation about complete colon cancer screening without discussing how colonoscopy fits into that. That said, if a patient is resistant to colonoscopy for any reason, stool-based testing is certainly an option. Patients should be told that most insurers do not consider colonoscopy following a positive fecal test to be a screening colonoscopy and so they could potentially be charged a quite different amount to go through a similar exam. They should also know that fecal immunochemical testing is annual, versus every 10 years following a negative colonoscopy.
When a patient asks about colonoscopy versus fecal testing, I ask them if they want to find a cancer or prevent a cancer. I tell them colonoscopy is the most effective way to find cancer and the only test that we can do to prevent cancer. They should know it is the most sensitive tool in finding polyps. It finds about 95% of large polyps, compared with 42% for Cologuard and 30% for fecal immunochemical testing. If they want the most effective test in finding cancer, finding polyps, and actually preventing cancer, which is to remove the polyp, then colonoscopy is the simple choice.