The Impact of Colon Cancer

It is hard to overstate the impact of colon cancer with nearly 140,000 cases diagnosed and 50,000 people dying from colon cancer in the United States annually making it one of the most common cancers overall and one of the leading causes of death in the country. When it is caught early, the chances of survival are greatly increased and the complications of treatment are greatly decreased. Unfortunately, many people do not find out that they have colon cancer until it has spread making their prognosis worse as nearly 40% of the US population that is eligible for screening does not get screened.

Screening Methods

Screening typically begins at the age of 50 (some societies recommend starting at 45 in African Americans due to their higher risk of colorectal cancer). Screening can start earlier depending on a patient's family history or the presence of inflammatory bowel disease.

 

Once screening begins there are four primary methods:

  • FOBT/FIT (Fecal Occult Blood Test/Fecal Immunochemistry Test): Sending stool samples for analysis of microscopic blood or immune markers that could signal the presence of polyps or cancer

    • Done every year

  • DNA-based stool testing: Similar to FOBT/FIT, but also analyzes specific markers that are found in colon cancer.

    • Done every 3 years​

  • Flexible sigmoidoscopy + FIT: A combination of an endoscopic procedure (essentially a mini-colonoscopy) and one of the previously mentioned tests

    •  Flexible sigmoidoscopy every 10 years and FIT every year

  • Colonoscopy: A direct visualization of the entire colon

    • Every 10 years

 

If you decide to go with one of the non-invasive methods (FOBT/FIT), there should be an understanding that if it is positive you should undergo a colonoscopy to determine the significance of the finding. Before the FOBT/FIT, you should also avoid red meat and vitamin C for 2 days as well as  high-dose aspirin and anti-inflammatory medications for 7 days before the test to limit false-positives.

Colonoscopy

Colonoscopy is one of the most well-known screening tests out there, but is misunderstood by the public, who is usually unaware of what makes a good colonscopy.

 

The 2015 American Society of Gastrointestinal Endoscopy article "Quality indicators for colonscopy" outlines measures that a gastroenterologist should meet to decrease the likelihood that cancers or polyps that could turn into cancers are missed.

 

There are six metrics that are particularly important:

  • Appropriate Screening: Are colonoscopies being done on appropriate patients?

  • Bowel Preparation Quality: Is the patient's bowel preparation adequate for visualization of the colon to reduce the likelihood of missed polyps? This is an involved discussion, but this site provides excellent information.

  • Cecal Intubation: Was the the entire colon examined? The cecum is the end of the screening colonoscopy.

  • Withdrawal Time: How long did they spend looking for polyps? Doctors who take less than six minutes on withdrawal have lower adenoma (precancerous polyp) detection rates and higher rates of missed cancer.

  • Adenoma Detection Rate: How often does that doctor find polyps that were precancerous? Doctors with lower detection rates tend to have more missed cancers.

  • Appropriate Follow-Up: Was the patient advised on the appropriate follow-up based on their findings? This is another involved discussion (an excellent chart here), but if your doctor is bringing you back for a colonoscopy every 3 to 5 years and there are not any findings you should be asking questions.

Measuring these is a cumbersome process, but the four metrics that have established numeric targets are bowel preparation quality (≥85% are adequate; meaning that the screening interval doesn't need to be changed), cecal intubation (≥95% on screening colonoscopies), withdrawal time ≥ 6 minutes (100%), and adenoma detection rate (≥25% overall or ≥30% for male patients and ≥20% for female patients)

My Results

I have been tracking my results using these metric since I moved to the Palm Beach area as a way to ensure that I am doing the best job possible for my patients. Here is my data since August 1, 2015 on screening colonoscopies:

 

 

 

 

 

 

 

 

 

Dr. Reddy meets or exceeds all of the national benchmarks on colonoscopy.

Higher adenoma detection rates are an indicator of a quality colonoscopy and a lower risk of future colon cancers

Office Location
Disclaimer: This site is not a substitute for seeing a medical professional and should not be considered as direct medical advice.

Wellington

1397 Medical Park Blvd

Suite 380

Wellington, FL 33414

Palm Beach Gardens

3370 Burns Road

Suite 104

Palm Beach Gardens, FL 33410

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© 2016 by Naveen Reddy, PLLC