Importance of Colonoscopies
From the Show: SolutionHealth
Summary:
Air Date: 5/15/23
Duration: 10 Minutes
Dr. Haider Rahman discusses the importance of getting a routine colonoscopy.
Transcription:
Scott Webb: Colon cancer is one of the leading causes of cancer deaths in America, but it doesn't have to be. If we know our risk factors and heed our doctor's advice to be screened, most of us will likely not develop colon or rectal cancers. And joining me today to emphasize these points is Dr. Haider Rahman. He's a gastroenterologist with Solution Health.
Host: This is your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Dr. Rahman, thanks so much for your time today. We're going to talk about colonoscopies, and we tend to do that this time of year, encouraging folks to get their colonoscopies and explaining to them why they're so important, why they're the gold standard and so on. So, all that in mind, let's talk about that. Why is getting a colonoscopy so important?
Dr. Haider Rahman: Getting a colonoscopy is probably the easiest thing that you can do to prevent colon cancer. Colon cancer is, as of now, the second leading cause of cancer-related deaths in the US. We have about 52,000 people dying from this disease every year. And when you think about it, it's people you know, it's your parents, it's family members, it's friends, siblings. So having something so simple as a colonoscopy to prevent that, we like to promote it and let people know about it.
Host: Yeah, we definitely do. And maybe just take us through the process a little bit. Is this usually something that patients request because they realize they're in the age range? And we're going to get to that too, that the guidelines have changed a little bit. Is it usually coming from the patients or the doctors say, "Hey, listen, you're 45. And this is the time when people get colonoscopies"? How does that usually work?
Guest: Yeah, it's usually a combination. Patients, when they are with their PCP, often if they meet the age requirement for a colonoscopy, which at this time is 45 years old, they'll mention to the patient that they need to get it done. And after that's confirmed, they go ahead and put an order in and a referral, and they get them set up in our office to have the procedure done. Of course, if somebody has family history of significant colon disease, including colon cancer or if they're having symptoms themselves, they can always bring this up to their PCP and they can have that done at a sooner age as well.
Host: Yeah. So, let's talk about the guidelines. You know, it used to be like 50 was kind of like the magic age, right? You got to be 50 and, you know, it's time for your colonoscopy. Now, it's 45, I believe. And maybe you can just talk about the importance of knowing our family history and being aware of our own risk factors and so on. We think about who should get a colonoscopy when and how often.
Guest: In the recent last few years, the guidelines, the multitask force has decided that 45 is a more acceptable age for colon cancer screening. And I think that's in part due to the high incidence of disease. As far as family history, those that have a first-degree relative with colon cancer, we actually recommend them have the screening performed at age 40 or 10 years less than the age of diagnosis of the family member, whichever one comes first.
Host: Yeah. It could be a little tricky sometimes, and knowing our family history, sort of documenting our family history, but certainly as best we can and knowing our own personal history and risk factors and so on. And I know there's been some research lately sort of implying that maybe colonoscopies are not as effective as maybe professionals like yourself think they are or believe they are or know them to be. Maybe you can discuss that a little bit. Is that accurate? Where does that come from and is that a myth that should be dispelled here?
Dr. Haider Rahman: I'm glad you brought that up. this study was pretty controversial. It was known as the Nordic trial and it was a tenure study involving three countries, Poland, Norway, and Sweden. And the goal was to test the effectiveness of a colorectal cancer screening program in a community that didn't have this prior to the study.
Guest: And so, their conclusions from this in regards to 10-year death from colon cancer showed that there was no benefit. But when you take a closer look at the study itself, there are a lot of inherent flaws. The study actually based itself on how many people they invited for colon cancer screening. And in that sense, only 42% of those that they asked to have a colonoscopy responded. But when they compared the effectiveness amongst the population, they included everybody, so even the people that did not opt for colonoscopy, which would be about 60%. So, it's not really reflective of the effectiveness of colonoscopy as it is showing that this screening program is not very effective.
There also some other inherent flaws in the study. Some red flags that were raised about the detection rate of polyps in the people who were doing the procedure. Polyps are outgrowths of the colon and those are the things that actually turn into colon cancer. So usually, we like to have a detection rate of about 25%. It's accepted over here in the US. And about a third of the people performing the study there didn't meet that standard, so that does raise a question of whether there was some technique involved or if perhaps that patient population itself is just not prone to colon cancer as we are in the US.
Host: Yeah. I think that you and I can agree and most medical professionals, at least here in the US, believe that colonoscopies really are the gold standard and let's talk about that, maybe because they serve more than one purpose, right? They're both like-- what's the right way to put it? Diagnostic and therapeutic. They're really unique in a way, right?
Guest: That's the thing. We have plenty of screening modalities for different types of diseases. People get breast cancer screening. People who have a smoking history get low-dose CT scans to detect lung cancer. This test is great because, in addition to finding the problem, if it's a polyp or a cancer, in the cases of polyps, you can prevent it, you can eliminate it, you get rid of it.
Host: Yeah. It's really amazing. And let's talk about the actual procedure, right? The colonoscopy and the prep. And I know when people hear the prep, those of us who have had a colonoscopy, we think, "Yeah, that was my least favorite part." But it has gotten better, it has improved. And the actual process, other than really needing a ride to and from. You get a great nap out of the deal, you know? So, maybe just take us through the process of getting a colonoscopy.
Guest: Sure. Yeah. So, the prep involves basically being on a clear liquid diet for the day before, and that includes things like jellos, broth soups. We like to avoid anything red because it can look like blood. Then, the night before we have you take a solution that's basically a laxative and just helps you clean out your stool. That's the worst part because people have varying types of preps that they're prescribed. Sometimes it can be a bit of liquid to down, but that is agreeably the worst part of the procedure. The procedure itself, once you show up, it's a breeze in the park. It's basically a nice nap.
Host: Yeah. That was my experience and I think most people, it's one of the best naps you'll ever have, you know, right? You need a ride there and a ride home. But it's not a lot of work required on the part of the patient, which is really nice. And it's always good to get the word out and educate folks. And I think we've done that here today. And as we wrap up here, doc, would be your main takeaways when we think about colonoscopies? The importance, the efficacy, all of that good stuff, tie it all up for us. What do you want folks to most know about colonoscopies?
Guest: The main thing is that this is such an easily preventable disease. I think understanding the number of people that are diagnosed, again, about 50,000 a year deaths from colon cancer. And having such a simple procedure that can both help catch early disease as well as prevent, in most cases, if it's available, it's out there, it's something that should get done.
Host: Yeah. It is the gold standard for a reason, despite some research, you know, suggesting otherwise. Those of us here in the US and all of our medical professionals really believe it is the gold standard. It's diagnostic, it's therapeutic, it's easy, it's a nice nap, every good reason for all of us to get our colonoscopies. So doctor, thanks so much for your time today. You stay well.
Guest: Thank you. Thanks so much for having me, Scott. Take care.
Host: And for more information, go to snhhealth.org/gastroenterology.
And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Stay well, and we'll talk again next time.
Scott Webb: Colon cancer is one of the leading causes of cancer deaths in America, but it doesn't have to be. If we know our risk factors and heed our doctor's advice to be screened, most of us will likely not develop colon or rectal cancers. And joining me today to emphasize these points is Dr. Haider Rahman. He's a gastroenterologist with Solution Health.
Host: This is your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Dr. Rahman, thanks so much for your time today. We're going to talk about colonoscopies, and we tend to do that this time of year, encouraging folks to get their colonoscopies and explaining to them why they're so important, why they're the gold standard and so on. So, all that in mind, let's talk about that. Why is getting a colonoscopy so important?
Dr. Haider Rahman: Getting a colonoscopy is probably the easiest thing that you can do to prevent colon cancer. Colon cancer is, as of now, the second leading cause of cancer-related deaths in the US. We have about 52,000 people dying from this disease every year. And when you think about it, it's people you know, it's your parents, it's family members, it's friends, siblings. So having something so simple as a colonoscopy to prevent that, we like to promote it and let people know about it.
Host: Yeah, we definitely do. And maybe just take us through the process a little bit. Is this usually something that patients request because they realize they're in the age range? And we're going to get to that too, that the guidelines have changed a little bit. Is it usually coming from the patients or the doctors say, "Hey, listen, you're 45. And this is the time when people get colonoscopies"? How does that usually work?
Guest: Yeah, it's usually a combination. Patients, when they are with their PCP, often if they meet the age requirement for a colonoscopy, which at this time is 45 years old, they'll mention to the patient that they need to get it done. And after that's confirmed, they go ahead and put an order in and a referral, and they get them set up in our office to have the procedure done. Of course, if somebody has family history of significant colon disease, including colon cancer or if they're having symptoms themselves, they can always bring this up to their PCP and they can have that done at a sooner age as well.
Host: Yeah. So, let's talk about the guidelines. You know, it used to be like 50 was kind of like the magic age, right? You got to be 50 and, you know, it's time for your colonoscopy. Now, it's 45, I believe. And maybe you can just talk about the importance of knowing our family history and being aware of our own risk factors and so on. We think about who should get a colonoscopy when and how often.
Guest: In the recent last few years, the guidelines, the multitask force has decided that 45 is a more acceptable age for colon cancer screening. And I think that's in part due to the high incidence of disease. As far as family history, those that have a first-degree relative with colon cancer, we actually recommend them have the screening performed at age 40 or 10 years less than the age of diagnosis of the family member, whichever one comes first.
Host: Yeah. It could be a little tricky sometimes, and knowing our family history, sort of documenting our family history, but certainly as best we can and knowing our own personal history and risk factors and so on. And I know there's been some research lately sort of implying that maybe colonoscopies are not as effective as maybe professionals like yourself think they are or believe they are or know them to be. Maybe you can discuss that a little bit. Is that accurate? Where does that come from and is that a myth that should be dispelled here?
Dr. Haider Rahman: I'm glad you brought that up. this study was pretty controversial. It was known as the Nordic trial and it was a tenure study involving three countries, Poland, Norway, and Sweden. And the goal was to test the effectiveness of a colorectal cancer screening program in a community that didn't have this prior to the study.
Guest: And so, their conclusions from this in regards to 10-year death from colon cancer showed that there was no benefit. But when you take a closer look at the study itself, there are a lot of inherent flaws. The study actually based itself on how many people they invited for colon cancer screening. And in that sense, only 42% of those that they asked to have a colonoscopy responded. But when they compared the effectiveness amongst the population, they included everybody, so even the people that did not opt for colonoscopy, which would be about 60%. So, it's not really reflective of the effectiveness of colonoscopy as it is showing that this screening program is not very effective.
There also some other inherent flaws in the study. Some red flags that were raised about the detection rate of polyps in the people who were doing the procedure. Polyps are outgrowths of the colon and those are the things that actually turn into colon cancer. So usually, we like to have a detection rate of about 25%. It's accepted over here in the US. And about a third of the people performing the study there didn't meet that standard, so that does raise a question of whether there was some technique involved or if perhaps that patient population itself is just not prone to colon cancer as we are in the US.
Host: Yeah. I think that you and I can agree and most medical professionals, at least here in the US, believe that colonoscopies really are the gold standard and let's talk about that, maybe because they serve more than one purpose, right? They're both like-- what's the right way to put it? Diagnostic and therapeutic. They're really unique in a way, right?
Guest: That's the thing. We have plenty of screening modalities for different types of diseases. People get breast cancer screening. People who have a smoking history get low-dose CT scans to detect lung cancer. This test is great because, in addition to finding the problem, if it's a polyp or a cancer, in the cases of polyps, you can prevent it, you can eliminate it, you get rid of it.
Host: Yeah. It's really amazing. And let's talk about the actual procedure, right? The colonoscopy and the prep. And I know when people hear the prep, those of us who have had a colonoscopy, we think, "Yeah, that was my least favorite part." But it has gotten better, it has improved. And the actual process, other than really needing a ride to and from. You get a great nap out of the deal, you know? So, maybe just take us through the process of getting a colonoscopy.
Guest: Sure. Yeah. So, the prep involves basically being on a clear liquid diet for the day before, and that includes things like jellos, broth soups. We like to avoid anything red because it can look like blood. Then, the night before we have you take a solution that's basically a laxative and just helps you clean out your stool. That's the worst part because people have varying types of preps that they're prescribed. Sometimes it can be a bit of liquid to down, but that is agreeably the worst part of the procedure. The procedure itself, once you show up, it's a breeze in the park. It's basically a nice nap.
Host: Yeah. That was my experience and I think most people, it's one of the best naps you'll ever have, you know, right? You need a ride there and a ride home. But it's not a lot of work required on the part of the patient, which is really nice. And it's always good to get the word out and educate folks. And I think we've done that here today. And as we wrap up here, doc, would be your main takeaways when we think about colonoscopies? The importance, the efficacy, all of that good stuff, tie it all up for us. What do you want folks to most know about colonoscopies?
Guest: The main thing is that this is such an easily preventable disease. I think understanding the number of people that are diagnosed, again, about 50,000 a year deaths from colon cancer. And having such a simple procedure that can both help catch early disease as well as prevent, in most cases, if it's available, it's out there, it's something that should get done.
Host: Yeah. It is the gold standard for a reason, despite some research, you know, suggesting otherwise. Those of us here in the US and all of our medical professionals really believe it is the gold standard. It's diagnostic, it's therapeutic, it's easy, it's a nice nap, every good reason for all of us to get our colonoscopies. So doctor, thanks so much for your time today. You stay well.
Guest: Thank you. Thanks so much for having me, Scott. Take care.
Host: And for more information, go to snhhealth.org/gastroenterology.
And if you enjoyed this podcast, please be sure to tell a friend and share on social media. This is Your Wellness Solution, the podcast by Elliot Health System and Southern New Hampshire Health, members of Solution Health. I'm Scott Webb. Stay well, and we'll talk again next time.