March is National Colorectal Cancer Awareness Month. And if you’re reading this column, it’s likely that you or someone you know has been affected by the disease, which is the nation’s second-leading cause of cancer-related deaths.
Locally, Suffolk County officials estimate that around 260 people die each year from the illness, which is largely treatable when detected in its early stages.
Despite this, the National Colorectal Roundtable reports that fewer than 70 percent of New York State residents age 50 and older undergo regular colonoscopies, an outpatient procedure that screens for cancer-causing polyps. That’s why Suffolk County Health Commissioner James Tomarken recently pledged to increase that figure to 80 percent by 2018.
“Colorectal cancer screening has been proven to save lives,” said Dr. Tomarken, who signed the pledge with Peconic Bay Medical Center officials in Riverhead last Monday. “We call on residents of Suffolk County to raise their awareness of colorectal cancer and take preventive steps to safeguard their health and that of their loved ones from this disease.”
Dr. Dhiren Mehta, a Riverhead gastroenterologist affiliated with ELIH, said the availability of colonoscopy screening makes colorectal cancer 100 percent preventable. But according to Dr. Brett Ruffo, director of colorectal surgical services at PBMC, there are several reasons people avoid getting them.
“They fear the procedure or the diagnosis, they don’t believe they are at risk or don’t think they can afford it,” he said.
Ask anyone who’s had a colonoscopy what to expect and they’ll probably tell you the procedure itself, which is generally administered under “conscious” sedation or general anesthesia, is painless. It’s the bowel preparation, which entails fasting for a number of hours and consuming enough powdered laxative to completely empty your bowels, that can present a challenge.
“We’re dealing with 30 feet of intestines,” said Dr. Eyad Ali, senior attending gastroenterologist at PBMC. “It needs a lot of preparation.”
The preparation has, however, evolved over the years. In the past, Dr. Ali said, patients were asked to consume a chalk-like prescription-only laxative called GoLYTELY. Today, many doctors tell patients they can use over-the-counter products like Miralax, which are flavorless and grit-free.
If undergoing a colonoscopy still frightens you, or if you’re at risk with general anesthesia, alternative tests exist that can provide a good starting point.
Last year, I wrote about Cologuard, the first non-invasive DNA screening test, approved in 2014 by the U.S. Food and Drug Administration. According to the FDA, the test uses stool samples to detect potentially troublesome red blood cells and DNA mutations that may indicate the presence of cancer. Patients with positive test results are advised to undergo a colonoscopy.
In addition to Cologuard, patients can opt for either a virtual or capsule colonoscopy. Both require the dreaded bowel preparation but are far less invasive than a traditional colonoscopy.
During a virtual colonoscopy, a CAT scan creates three-dimensional images of a patient’s colon.
“There’s no anesthesia involved and it literally takes about 30 seconds to do the imaging,” said Dr. Ali. “The disadvantage is not all insurance carriers cover it; it can miss small polyps; and, because it’s a CAT scan, you’re being exposed to radiation.”
Patients who undergo capsule colonoscopies swallow a small pill containing a camera capable of taking 30,000 pictures of the large intestine.
“There’s no anesthesia and no radiation,” said Dr. Ali. “The camera transmits its pictures wirelessly and the pill takes about 10 hours to pass.”
Like virtual colonoscopies, capsule colonoscopies aren’t covered by all insurance companies and can sometimes miss polyps. Rarely, said Dr. Ali, the capsule may even get stuck in the colon.
Ultimately, whether you opt for a traditional colonoscopy or one of the aforementioned alternatives isn’t as important as the fact that you get screened. Doing so just may save your life.
“Anything that gives patients more options to increase that screening rate is always good,” Dr. Ali said.
Caption: From left to right, Dr. Brett Ruffo, Dr. Mark Coronel, Dr. George Ruggiero and Dr. James Tomarken show the community what it’s like to walk through a 10-foot tall inflatable colon at Peconic Bay Medical Center. (Credit: PBMC)
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