It's a predictable rite of passage you, you turn 50 survive
lots of over-the-hill jokes and then the doctor hands your
prescription for a colonoscopy.
If you're anything like the more than twenty million adults in
this country your screening appointment is an unchecked box
on your to-do list.
According to the American Cancer Society
colorectal cancer is the third leading cause of cancer-related
deaths in men and women in the United States.
The good news is that colorectal cancer has a 90%
survival rate when detected in its early stages.
Today a comprehensive guide to
colorectal cancer screening options and an in-depth look at
an innovative screening option that might just motivate you to
get your rear end to the doctor.
I'm Ereka Vetrini, Access Health starts now.
[music.]
I'm pretty sure nobody likes to hear they
need to go in for colon cancer screening; however, for the
people who catch their colon cancer early the consensus is
that it's not so bad.
We begin with Dr. Perry Pickardt
Professor of Radiology from the University of Wisconsin School
of Medicine.
His work in abdominal imaging has resulted
in hundreds of scientific publications.
Colorectal cancer remains a major cancer killer.
Up to 140,000 new cases are diagnosed in the US per year, up
to 50,000 people die of this disease and the real shame of
that is it's a largely preventable disease.
I think there's a reluctance to come in
for a screening exam I think people feel healthy why should
they why should they bother but it should be clear that the vast
majority of colon cancers affect patients or at least
three-fourths without a family history and and those cancers
are lurking without symptoms for quite some time, often for many
years, to get screened as is absolutely vital because that
that's where we can intervene and either prevent a cancer or
cure an early cancer.
Access health caught up with Dr.
Cecilia Brewington a recognized expert in 3-dimensional medical
imaging at the University of Texas Southwestern Medical
Center in Dallas.
We know how colorectal cancer develops.
It starts out for the most part as
a benign growth called a polyp and 15 to 20 percent of us have
polyps.
If we remove the polyp you never get the cancer.
So our screening tests are built to
look for those polyps and then have them removed.
Not all polyps are created equal and
it's really driven by size, tiny polyps are are always benign and
they're like any benign looking mole on your skin for example we
would never remove every single mole on every patient you'd wait
until there's a feature that's concerning.
Maybe 1 in 1000 tiny polyps will grow to become a
large polyp, so time is on our side it takes maybe a decade or
more for these polyps to grow to a large size and cancer so we
don't need to be overly aggressive.
Now there are some of us who are going to be at
increased risk for polyps those are going to be patients who
might have a family history of polyps, if a first-degree
relative has a polyp then there's a higher likelihood that
you may also have a polyp and that means for you if they have
colorectal cancer you need to screen actually ten years
earlier then when your relative was diagnosed with colorectal
cancer.
We do see a difference in various ethnic groups in
terms of how often they get colorectal cancer,
African-Americans are the highest risk and specifically
the African-American male, they are the number one race and
gender to have colorectal cancer it means that we recommend they
screen earlier they should screen starting at age 45.
In 2016 the United States
Preventive service task force updated its colorectal cancer
screening guidelines adding some new choices aiming to get more
Americans screened.
The USPSTF looks at all screening tests and
decide if it is an appropriate test to be used across the
American population.
Well in June of 2016 they gave several
tests a grade A rating, that grade A rating means that this
should be a covered service that is offered to patients.
What that translates to is that your
private insurers must cover this test without out-of-pocket
expense.
The USPSTF recommendations break the
recommended tests into direct visualization tests versus the
stool based tests but I think it's important to note that the
American Cancer Society guidelines which came out years
earlier was the first to split these up but called those direct
visualization tests preventive tests or tests that can detect
polyps and cancer and went on to say that these are the preferred
tests because of that prevention benefit.
As Dr. Pickardt explained not all tests are
created equal, Dr. Brewington breaks down the options for us.
First and foremost there is the standard which is called a
colonoscopy that test involves taking a tube and inserting it
into the rectum and that tube has a scope and this allows us
to travel through the colon and see what's there.
There is only one other direct visualization
test and that's going to be your CT colonography, that test is a
less invasive test it involves taking pictures of your colon
when it's filled with air, we don't travel through the colon
with a tube, so that's what makes it less invasive.
There are other tests that also
received a grade A rating by the United States Preventive
Services Task Force that includes DNA testing.
DNA testing is a newer test that is
now available that you can do in the comfort of your own home.
Another test that you might want to consider is called a FIT
test, a FIT test is highly sensitive for detection of human
blood that occurs with colorectal cancer.
The stool based tests essentially try and
detect blood or abnormal cells that are sluffed off into the,
in the colon, they both suffer in the fact that they're
largely just cancer detection tests, so if that's your goal,
say an 85 year old patient where you really just want to know if
they have cancer or not, it might be an appropriate test,
for the 50 year old where prevention is really the greater
question, they fall short with that.
Up next we'll take a closer look at a non-invasive
alternative to colonoscopy.
Colorectal cancer isn't something someone in their 20s,
30s or even 40s generally thinks about, but young onset
colorectal cancer affecting anyone under the age of 50 is
sadly on the rise.
Young people in the prime of their lives are
being diagnosed more often, and at a later stage than any other
group.
March is National colorectal cancer awareness
month, to learn more about prevention and screening options
please contact the colorectal cancer Alliance at CC alliance
dot org [music]
[music] Welcome
back as we just learned the importance of screening to
prevent colorectal cancer can mean the difference between
early detection and a diagnosis that could come too late.
Joining me on the set today is Art Edmonds host of Military
Makeover on Lifetime, welcome Art!
I'm so glad you're here.
So great to be here Ereka I've been
waiting to work with you and waiting to talk with you for so
long and thank you for having me.
And I heard you've joined the screenings club!
Yes.
I actually had my first colonoscopy unfortunately a
little early because we have a history of colon cancer in my
family.
My mother-in-law had colon cancer so I'm aware of the
benefits of early detection, early screening and once my
doctor said you know this was something that I needed to do I
figured I might as well get on it.
So I hear there are there two options for preventive
screenings right?
Which one did you go for?
Well you know we live our lives on camera right
as TV hosts so of course I had to take a camera with me for
this event to document everything and I brought some
footage.
Well since I have no family history or other risk
factors for colon cancer my doctor said I have a choice I
can either do a standard colonoscopy which you know is
kind of yucky or a new non-invasive procedure called a
virtual colonoscopy.
So I'm doing a little bit of homework
here to help make my decision.
It says a colonoscopy is done as an outpatient procedure under
general anesthesia.
I didn't know I was gonna get a nap
during this whole thing.
Your doctor will use a flexible tube
to insert a tiny camera into your colon - that's not even my
best side, to look for polyps or other problems as the tube is
withdrawn!
Ouch!
The procedure takes about 20 to 30
minutes and there's a chance of perforation, bleeding, or
infection.
Yeah.
All right well let's talk about a virtual
colonoscopy, now it says here that the doctor does a CT scan
of your abdomen and pelvis to create 3-D images, wow that's
pretty cool and these images will show polyps and other
abnormalities inside your colon without actually putting a
camera in there - I like that idea.
Now there's less risk of tears, no sedation and the
patient can drive home by themselves afterwards, and the
procedure takes only about 15 minutes.
Think about all the fun things you can do in 15 minutes.
[music.]
Next up is the prep, it says the day before the test no
eating except for jello and clear liquids.
You'll need to drink your pre-screening
laxative and be prepared to spend a few hours near the
toilet.
So during the virtual colonoscopy the doctor slowly
fills your colon with carbon dioxide much like a balloon
right?
Just like this.
And again during a regular or standard
colonoscopy the doctor will take a flexible six foot long tube
and insert it all the way into your colon with a scope on the
end of it.
Yeah I think I've made my decision.
All right well today's the day, I've done my
prep I'm starving I can't wait to get this over with so I'll
see in 15 minutes.
[music.]
That was so easy all I'm feeling,
honestly is, just a little bit bloated from all the gas, but
guess what?
I guess I'll roll down the windows on the way
home.
You know what that didn't look so bad.
When I had my colonoscopy I had to stay close
to home the day before and the day after.
Well yeah prep work is never fun right?
And I'm such a chicken so it just seemed like
the right way to go but since I didn't have any other risk
factors or anything like that it was a perfect option for me
being minimally invasive.
But I have to ask you so with my
colonoscopy we had cameras on the inside, the imaging was on
the inside but this is a CT scan a cat scan right?
So the images come from the outside?
Exactly the board-certified radiologist
who happens to be a medical doctor too, a lot of people
don't realize that, they create 2-D and 3-D images of your
entire colon and your pelvis so they can see things from all
different angles.
Flip it around, spin it around.
They also, Ereka make a virtual
fly-through of your colon it's kind of like a video game for
radiologists.
That's crazy!
Yeah.
So as I mentioned I have a history of colon cancer in my
family so when I, after my first colonoscopy my doctors
recommended that I get another colonoscopy in three years
rather than ten years.
What did your doctor recommend after
that?
Well if you have no risk factors and everything's fine
it's like every five years but if they do find something you're
gonna come back sooner but the good news is they can track any
abnormalities or polyps and measure the size from screening
to screening.
And that's the important thing to get on a
screening program it's important to know that a colonoscopy it's
not a one-off thing.
Right.
You know it's something you have to
follow up with.
Well that's basically the takeaway from this
whole thing you know there's tests out there.
You know, choose the one that works for
you, and I always say the best test is the one that you're
actually going to do.
I'm so glad you came by to see us
today.
Well up next virtual colonoscopies raise the bar for
the patient experience.
[music]
[music] Welcome back
virtual colonoscopy is proving to be a front-runner in the
battle to prevent colon cancer, providing patients and doctors
with another powerful tool.
Dr. Pickardt is one of the early
pioneers and advocates of CT colonography and has published
countless studies on the effectiveness.
In fact he literally wrote the textbooks.
Before I came to the University of Wisconsin I was serving in
the Navy and and was the one of the principal investigators of a
multicenter Army Navy trial that was eventually published in the
New England Journal where we compared virtual to conventional
colonoscopy and this was back now almost 17 years ago and even
at that time we showed that VC was just as good slightly better
maybe at finding large polyps and cancers with the slightly
higher sensitivity.
It, it's a much more exact and precise way
to detect and measure polyps.
Colonoscopies, standard colonoscopy they really have a
hard time measuring things.
Now they can get tissue and biopsy
the lesion so it remains the therapeutic gold standard by
definition.
Virtually anyone is is an ideal candidate for VC
screening once they hit the right age.
We have the the totally healthy asymptomatic
screening population at one end and the the sick, frail or
anticoagulated patients and you know CTC is actually ideal for
for all of those patients.
[music]
[music] For women like
Lisa who has no family history of colon cancer virtual
colonoscopy was a welcomed solution for her.
When I was 50 my doctor told me that it was
time to have the dreaded colonoscopy and so then he
described to me an alternative experience, the virtual
colonoscopy that is available and I was very excited to be
able to take part in that.
It was really great for me because
I was working and I didn't want to take two days off work I
just wanted to take as little amount as possible and to feel
good the next day, and that part really appealed to me.
To be able to go on with your day and
not have any side-effects afterwards.
I didn't realize that it involved, it could see
other parts of your body and for me my mom had an aneurysm at an
early age I think she was 50 years old and had to have
surgery, so I always had in my back of my head that that could
happen to me, and that was something that was found during
my virtual colonoscopy that I didn't have that so that was a
bonus, as well as the osteoporosis check where that
came back with mine was normal and my aunt had that so that was
huge for me to find out those two things so I was really lucky
to get this additional information about my health.
So because virtual colonoscopy is
is a CT scan we see not only the colon but the other abdominal
contents including including the bones so we can actually provide
for osteoporosis screening in a way that's that's equivalent to
the DEXA or DXA scanning that that many women and some men are
undergoing separately.
In addition Medicare will cover an
ultrasound to look for abdominal aortic aneurysms, well there's
no need to do that when if you've had a virtual because it
screens for that as well.
So so it's a really it's a
three-in-one screening test but it actually goes beyond that and
detects cancers outside of the colon and actually screens for
other diseases as well.
Former professor Chuck completed his
first virtual colonoscopy almost thirteen years ago, doctors did
not find any polyps however what they found was life altering.
So I scheduled my virtual
colonoscopy a few days later after after being recommended by
my physician and then I got home my primary care physician called
and said well I've got some good news and some bad news.
The good news is there are no no signs of
any polyps or any sign of cancerous tissue in your colon
so your colon looks in very good health however while we were
while they were looking at this, the virtual colonoscopy also
imaged the rest of my abdomen and they discovered that there
were two aneurysms in each of my one in each of my iliac arteries
and the one iliac artery had distended to the to a six
centimeter about less than one inch in thickness and so I was
very significant and he recommended very strongly that I
talked to a cardiovascular surgeon very quickly.
So within about thirteen days of being
diagnosed with the aneurysms I was I was in the hospital
getting my aneurysms repaired.
One most one of the most common causes of unknown deaths to
people in their 50s and 60s turns out to be aneurysms that
we have no idea about so here I was harboring a silent killer
quite probably I would I would have died within a few months
had they not discovered the aneurysms.
It saved my life and I would not be here today if it
weren't for the discovery that the virtual colonoscopy made.
We might find especially in a 50
year old or older, that you have an aneurysm of your aorta and
out of those 11 percent of things that we find that might
be more significant only 3 percent of those were shown to
need additional workup.
So we've looked at why patients aren't
screening more.
It's not because the test isn't covered, if you
have insurance colorectal cancer screening is a covered service
that means it's covered without an out-of-pocket expense.
We do need to talk about Medicare
patients, specifically when we're discussing CT
colonography.
It is not covered for Medicare patients for
screening purposes.
Although the USPSTF vetted the tests and said
it's a great screening test, it should be offered as one of the
options.
A Medicare patient has to have a diagnostic CT
colonography, they are not qualified to have screening
colonography.
And why is that?
Why did CNS decide that in this patient population who tends to
have more risk factors for invasive tests that they would
not cover this as a service?
Because we've been talking to them extensively about this and
trying to get them to approve this.
We need to educate that there are options and we just
need to find the best option that matches with the patient.
I think we've shown beyond a
shadow of a doubt that this test saves lives it's as simple as
that.
There's no reason why this test shouldn't be alongside
colonoscopy as an option for for patients.
People are dying of a disease that's almost entirely
preventable and that's just unacceptable.
If you're in the recommended age group, having
questionable symptoms, or have a family history of colon cancer
do yourself a favor talk to your doctor and schedule a colorectal
cancer screening today and remember the best test for you
is the one that you will take.
For more information and to find screening centers near you visit
my CT colonography dot com and you can always find helpful
links and resources at the colorectal cancer alliance and
our web site access health Dot TV.
See you next time.
[music.]
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