As we honor colorectal cancer awareness month, what do you feel is the most important message to share with our patients?
I think the most important message to share is that patients should seek out screening for colorectal cancer, beginning at age 45, but also speak to their primary care physician in advance of that if they're having abnormal bleeding, change in their bowel habits, or other unusual symptoms such as weight loss, night sweats, etc. Ideally this screening would be in the form of a colonoscopy, because colonoscopies identify polyps which can be removed before they ever even have the chance to become cancer. Less invasive screening methods are unable to diagnose polyps.
How do you collaborate with the Center for Gastrointestinal Cancers team at Smilow Cancer Hospital to care for patients diagnosed with colorectal cancer? What locations do you practice at?
I operate out of the York Street campus at Yale New Haven Hospital. I see patients in our outpatient clinic which is physically attached to the hospital complex and perform all operations at York Street.
I am the co-chair of the lower GI tumor board, which meets every Monday afternoon to discuss all new patients with colorectal cancer across the Yale system. Participating in that tumor board are GI oncologists from across the Yale system, radiation oncologists, pathologists, and surgical oncologists. Occasionally our interventional radiology colleagues will also participate. Thus, all new patients can be assured that their case has been reviewed from all angles by a team with specific expertise in their cancer.
How can we work together as healthcare professionals, and as community members, to encourage colorectal cancer screening?
I think as healthcare professionals, we need to ask patients a thorough colorectal cancer family history, and then actively refer them for colonoscopy based upon the latest guidelines. I document this in my notes, and follow up with patients at their next visit to make sure it has happened.
Do home colon cancer screenings offer acceptable alternatives to colonoscopies?
A colonoscopy, by definition is both diagnostic and therapeutic. This means that cancers and precancerous lesions cannot only be seen, but they are either biopsied or fully removed at the time of colonoscopy. This offers the best success in colon cancer prevention and screening.
For patients who do not wish to proceed with a full colonoscopy, or the bowel prep which proceeds it, there are at home screening methods. These testing methods can identify cancers by abnormal cells, DNA, or blood in the stool, however they do not identify the location, can miss small lesions, and still require that the patient have a colonoscopy to identify and biopsy/remove any lesion which caused the test to be positive. More importantly, they are not useful for detecting polyps which are the precursors to cancer. Therefore, they offer little utility in the prevention of cancer.