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Colon Cancer Screenings: Latest Advances and Ways to Prepare
Jennifer Nayor, MD, discusses the prevalence of colon cancer, why screening is so important, and tips for helping patients prepare for colonoscopy.
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Learn more about Jennifer Nayor, MD
Jennifer Nayor, MD
Jennifer Nayor, MD is a Gastroenterologist, Emerson Hospital.Learn more about Jennifer Nayor, MD
Transcription:
Bill Klaproth (Host): Colon cancer is a disease that should rarely happen. Why? Because early detection is so good you can easily detect the cancer in advance. So let’s talk about colon cancer screenings and the latest advances and ways to prepare for a colonoscopy with Dr. Jennifer Nayor, a gastroenterologist at Emerson Hospital. This is Healthworks Here, the podcast from Emerson Hospital. I'm Bill Klaproth. Dr. Nayor, is colon cancer common and who gets it?
Jennifer Nayor, MD (Guest): Thanks so much for having me. So colon cancer is very common. Colon cancer is the third leading cause of new cancers in men and women. There are about 145,000 people who are going to be diagnosed with colon cancer in 2019. Colon cancer can effect men, can effect women, can effect anyone. We think about colon cancer effecting later in life. So we usually think of it as something that happens to people over the age of 50, but there's newer data that suggests that the rates of colon cancer are rising particularly in young people. So when people are having symptoms such as rectal bleeding, change in bowel habits, it’s a good time to talk to your doctor and figure out if you need to be screened.
Host: Well, I didn’t know that. The third leading cause of new cancer. That’s pretty alarming. So we know that there is effective screening and the colonoscopy is the gold standard in screening, but are there other effective ways to test for colon cancer?
Dr. Nayor: There are other effective ways. So colonoscopy is the gold standard test because it’s both the diagnostic and therapeutic. What I mean by that is that colonoscopy can look at the colon to identify polyps. It can also remove polyps and potentially even early colon cancers at the time of the tests. So that’s why it’s the gold standard. But there are alternatives to a colonoscopy. The main alternatives that we think about—So one is a virtual colonoscopy. That’s where people take a bowel preparation to clean out the colon and then undergo a CAT scan to look at the contours of the colon and identify polyps. The main drawbacks to doing a virtual colonoscopy, you still have to do a colonoscopy preparation. So in my mind, if you're going to do the preparation you might as well go through with a colonoscopy and get the polyps removed anyway. The CAT scan, also one of the downsides to that is that there is a small amount of radiation with a CAT scan as opposed to a colonoscopy where we’re just looking inside with a camera. So there's no radiation with that test.
The other kind of options that you have aside from a virtual colonoscopy are these new stool based tests. So there are two major options for stool based testing for colon cancer screening. One is called a FIT test or a fecal immunochemical test. That test is looking for human globulins. It’s looking for human blood in the colon in a stool sample. There used to be a test called a hemoccult that we used to do for colon cancer screenings. The downsides to that was if you ate a big juicy hamburger the day before, the blood in the hamburger could be something that was detected in the person’s stool whereas this test is specifically looking for human blood in the tool. The FIT test is a good option for colon cancer screening, especially if people really don’t want to go through with a colonoscopy.
The other alternative for stool based testing is something called a FIT DNA test, which is marketed as Cologuard is the name. A Cologuard test is the FIT test—that fecal immunochemical test—but it adds in DNA markers of colon cancer. So it’s really specifically looking for colon cancer in a stool sample. Both of those stool tests, you have a kit that you bring home. Then you send in a sample of stool and then they're able to analyze that for colon cancer.
Host: Well, I know people like those home options. Are there any other new ways to test for colon cancer?
Dr. Nayor: The stool based testing are the two kind of newest ways to test for colon cancer. The other thing that I should mention about both of those tests is that if they're positive, you're still winding up with a colonoscopy. So they're good tests as a general screening test for the population, but in a lot of ways it doesn’t negate the need for colonoscopies in certain people.
Host: Right. So I heard that you can swallow a pill with a camera in it that looks at your gut instead of a colonoscopy. Is that true?
Dr. Nayor: So there is a pill camera that has been approved by the FDA. It has very limited approval. So it’s not really a good colon cancer screening test. The FDA specifically has approved this pill camera for imaging of the beginning or proximal part of the colon in patients who have had an incomplete colonoscopy. For some reason we couldn’t get all the way to the beginning of the colon in colonoscopy. Or in patients who are not a candidate for colonoscopy but need a look at the colon in some other way. The FDA has not approved these pill cameras for average risk colon cancer screening. So it’s not a great option for that.
Host: Right. So earlier you mentioned that seems like the instance of colon cancer is happening with younger people now. We always thought it was an older person’s disease. When should people begin colon cancer screening then?
Dr. Nayor: So we used to say that colon cancer screenings should begin at the age of 50. In 2018, the American Cancer Society came out with guidelines that recommended starting average risk colon cancer screening at the age of 45. There are other groups. So the U.S. Preventative Task Force Services, the U.S. Multi-society Task Force—So two other groups have not changed their recommendation about starting at the age of 50, but the American Cancer Society is recommending starting at the age of 45 because we are finding more colon cancer in young people.
Host: So hopefully we’ve persuaded people to go and get a colonoscopy. So the big day has come. What are some of your best tips for helping a patient through a colonoscopy? The preparations and then the screening itself.
Dr. Nayor: So the worst part about a colonoscopy is doing the prep. Patients really don’t like it. It’s usually kind of a big jug of salty liquid. We now have some newer preparations that are a little tastier, a little bit more palatable. I would say the number one recommendation I have for patients when going through a colonoscopy prep is follow the instructions. So there's a lot of steps that patients have to do in order to get their colon clean to have a good exam. Having a clean colon is essential for a colonoscopy to be a good test. The last thing we want is someone to come in having done a preparation maybe not following the instructions completely—or even sometimes they follow the instructions and the prep isn’t great. Then we have to say sorry. The colonoscopy can't be done, or we didn’t get a good enough look and people have to come back. So following the instructions is an essential part of the test. Every center has different recommendations in terms of diet, but typically I recommend patients stay on a clear liquid diet—so nothing solid to eat and the liquids you drink are only things you can see through. So that would be like chicken broth or juice, coffee with no milk. So a clear liquid diet for the entire day before and that really helps the cleansing process.
Host: I get so frustrated with people when they say, “I don’t want to get a colonoscopy because of the prep.” I mean really, would you rather get cancer? Seriously? I've had a colonoscopy. It’s really not that bad. Actually, it’s very easy. So I find it very frustrating when people continually put off getting a colonoscopy because of the prep.
Dr. Nayor: 100%. I think getting through the prep can be challenging for people, but it’s a one time thing. If we don’t find a polyp in someone who’s average risk and doesn’t have a family history of colon cancer, that means you're then good for 10 years until you need your next colonoscopy. So it’s good to get one really good exam and then you don’t need another one for quite some time.
Host: And it’s great peace of mind knowing. It’s very easy. You go through it. It’s quicker than you think it’s going to be. The doctor comes in and says, “Hey, everything looks good. See you in 10.” Then you know and you have that peace of mind. Just go get the colonoscopy. So Dr. Nayor, let me ask you this. Why did you become a gastroenterologist?
Dr. Nayor: So I love the field of gastroenterology. When I was in my medical training, I was interested in doing internal medicine. So I wanted to see patients in the office, get to interact with people, get to know about them, and then treat them with medications in order to help them feel better. What's great about gastroenterology is that it combines that office space practice with a procedural field where we can really change the course of a disease. With colonoscopy, we can take out a polyp and prevent someone from getting colon cancer down the line. For me, that’s incredibly rewarding and why I chose gastroenterology.
Host: Yeah. So you’ve got an impressive background. Can you quickly share that with us?
Dr. Nayor: So I'm a clinical gastroenterologist. I see patients in the office. I trained at Hopkins for my internal medicine and then I was at Brigham and Women’s for my fellowship. I've really enjoyed working with patients. I've done a lot with improving the quality of care that we deliver with patients. At Brigham and Women’s Hospital, I worked on a program that sent automated reminders about colonoscopy preps to patients. That really improved patients tolerating their colonoscopy preps, getting through the preps, and also making sure they arrive for their procedures.
Host: So last question. What is it that you most love about your work?
Dr. Nayor: I love getting to know patients. I think that getting to be a doctor is incredibly rewarding because you meet new people every day. You can tailor what you're doing for them based on what’s going on with their lives. That’s an incredibly rewarding part of my job.
Host: Well, that’s easy to see. Dr. Nayor, thank you for your time today. This has really been informative.
Dr. Nayor: Thank you so much for having me.
Host: That’s Dr. Jennifer Nayor. Call 978-287-3835. That's 978-287-3835 or visit emersondocs.org to make an appointment with Dr. Nayor or schedule a screening. If you like what you’ve heard, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Healthworks Here from Emerson Hospital. Thanks for listening.
Bill Klaproth (Host): Colon cancer is a disease that should rarely happen. Why? Because early detection is so good you can easily detect the cancer in advance. So let’s talk about colon cancer screenings and the latest advances and ways to prepare for a colonoscopy with Dr. Jennifer Nayor, a gastroenterologist at Emerson Hospital. This is Healthworks Here, the podcast from Emerson Hospital. I'm Bill Klaproth. Dr. Nayor, is colon cancer common and who gets it?
Jennifer Nayor, MD (Guest): Thanks so much for having me. So colon cancer is very common. Colon cancer is the third leading cause of new cancers in men and women. There are about 145,000 people who are going to be diagnosed with colon cancer in 2019. Colon cancer can effect men, can effect women, can effect anyone. We think about colon cancer effecting later in life. So we usually think of it as something that happens to people over the age of 50, but there's newer data that suggests that the rates of colon cancer are rising particularly in young people. So when people are having symptoms such as rectal bleeding, change in bowel habits, it’s a good time to talk to your doctor and figure out if you need to be screened.
Host: Well, I didn’t know that. The third leading cause of new cancer. That’s pretty alarming. So we know that there is effective screening and the colonoscopy is the gold standard in screening, but are there other effective ways to test for colon cancer?
Dr. Nayor: There are other effective ways. So colonoscopy is the gold standard test because it’s both the diagnostic and therapeutic. What I mean by that is that colonoscopy can look at the colon to identify polyps. It can also remove polyps and potentially even early colon cancers at the time of the tests. So that’s why it’s the gold standard. But there are alternatives to a colonoscopy. The main alternatives that we think about—So one is a virtual colonoscopy. That’s where people take a bowel preparation to clean out the colon and then undergo a CAT scan to look at the contours of the colon and identify polyps. The main drawbacks to doing a virtual colonoscopy, you still have to do a colonoscopy preparation. So in my mind, if you're going to do the preparation you might as well go through with a colonoscopy and get the polyps removed anyway. The CAT scan, also one of the downsides to that is that there is a small amount of radiation with a CAT scan as opposed to a colonoscopy where we’re just looking inside with a camera. So there's no radiation with that test.
The other kind of options that you have aside from a virtual colonoscopy are these new stool based tests. So there are two major options for stool based testing for colon cancer screening. One is called a FIT test or a fecal immunochemical test. That test is looking for human globulins. It’s looking for human blood in the colon in a stool sample. There used to be a test called a hemoccult that we used to do for colon cancer screenings. The downsides to that was if you ate a big juicy hamburger the day before, the blood in the hamburger could be something that was detected in the person’s stool whereas this test is specifically looking for human blood in the tool. The FIT test is a good option for colon cancer screening, especially if people really don’t want to go through with a colonoscopy.
The other alternative for stool based testing is something called a FIT DNA test, which is marketed as Cologuard is the name. A Cologuard test is the FIT test—that fecal immunochemical test—but it adds in DNA markers of colon cancer. So it’s really specifically looking for colon cancer in a stool sample. Both of those stool tests, you have a kit that you bring home. Then you send in a sample of stool and then they're able to analyze that for colon cancer.
Host: Well, I know people like those home options. Are there any other new ways to test for colon cancer?
Dr. Nayor: The stool based testing are the two kind of newest ways to test for colon cancer. The other thing that I should mention about both of those tests is that if they're positive, you're still winding up with a colonoscopy. So they're good tests as a general screening test for the population, but in a lot of ways it doesn’t negate the need for colonoscopies in certain people.
Host: Right. So I heard that you can swallow a pill with a camera in it that looks at your gut instead of a colonoscopy. Is that true?
Dr. Nayor: So there is a pill camera that has been approved by the FDA. It has very limited approval. So it’s not really a good colon cancer screening test. The FDA specifically has approved this pill camera for imaging of the beginning or proximal part of the colon in patients who have had an incomplete colonoscopy. For some reason we couldn’t get all the way to the beginning of the colon in colonoscopy. Or in patients who are not a candidate for colonoscopy but need a look at the colon in some other way. The FDA has not approved these pill cameras for average risk colon cancer screening. So it’s not a great option for that.
Host: Right. So earlier you mentioned that seems like the instance of colon cancer is happening with younger people now. We always thought it was an older person’s disease. When should people begin colon cancer screening then?
Dr. Nayor: So we used to say that colon cancer screenings should begin at the age of 50. In 2018, the American Cancer Society came out with guidelines that recommended starting average risk colon cancer screening at the age of 45. There are other groups. So the U.S. Preventative Task Force Services, the U.S. Multi-society Task Force—So two other groups have not changed their recommendation about starting at the age of 50, but the American Cancer Society is recommending starting at the age of 45 because we are finding more colon cancer in young people.
Host: So hopefully we’ve persuaded people to go and get a colonoscopy. So the big day has come. What are some of your best tips for helping a patient through a colonoscopy? The preparations and then the screening itself.
Dr. Nayor: So the worst part about a colonoscopy is doing the prep. Patients really don’t like it. It’s usually kind of a big jug of salty liquid. We now have some newer preparations that are a little tastier, a little bit more palatable. I would say the number one recommendation I have for patients when going through a colonoscopy prep is follow the instructions. So there's a lot of steps that patients have to do in order to get their colon clean to have a good exam. Having a clean colon is essential for a colonoscopy to be a good test. The last thing we want is someone to come in having done a preparation maybe not following the instructions completely—or even sometimes they follow the instructions and the prep isn’t great. Then we have to say sorry. The colonoscopy can't be done, or we didn’t get a good enough look and people have to come back. So following the instructions is an essential part of the test. Every center has different recommendations in terms of diet, but typically I recommend patients stay on a clear liquid diet—so nothing solid to eat and the liquids you drink are only things you can see through. So that would be like chicken broth or juice, coffee with no milk. So a clear liquid diet for the entire day before and that really helps the cleansing process.
Host: I get so frustrated with people when they say, “I don’t want to get a colonoscopy because of the prep.” I mean really, would you rather get cancer? Seriously? I've had a colonoscopy. It’s really not that bad. Actually, it’s very easy. So I find it very frustrating when people continually put off getting a colonoscopy because of the prep.
Dr. Nayor: 100%. I think getting through the prep can be challenging for people, but it’s a one time thing. If we don’t find a polyp in someone who’s average risk and doesn’t have a family history of colon cancer, that means you're then good for 10 years until you need your next colonoscopy. So it’s good to get one really good exam and then you don’t need another one for quite some time.
Host: And it’s great peace of mind knowing. It’s very easy. You go through it. It’s quicker than you think it’s going to be. The doctor comes in and says, “Hey, everything looks good. See you in 10.” Then you know and you have that peace of mind. Just go get the colonoscopy. So Dr. Nayor, let me ask you this. Why did you become a gastroenterologist?
Dr. Nayor: So I love the field of gastroenterology. When I was in my medical training, I was interested in doing internal medicine. So I wanted to see patients in the office, get to interact with people, get to know about them, and then treat them with medications in order to help them feel better. What's great about gastroenterology is that it combines that office space practice with a procedural field where we can really change the course of a disease. With colonoscopy, we can take out a polyp and prevent someone from getting colon cancer down the line. For me, that’s incredibly rewarding and why I chose gastroenterology.
Host: Yeah. So you’ve got an impressive background. Can you quickly share that with us?
Dr. Nayor: So I'm a clinical gastroenterologist. I see patients in the office. I trained at Hopkins for my internal medicine and then I was at Brigham and Women’s for my fellowship. I've really enjoyed working with patients. I've done a lot with improving the quality of care that we deliver with patients. At Brigham and Women’s Hospital, I worked on a program that sent automated reminders about colonoscopy preps to patients. That really improved patients tolerating their colonoscopy preps, getting through the preps, and also making sure they arrive for their procedures.
Host: So last question. What is it that you most love about your work?
Dr. Nayor: I love getting to know patients. I think that getting to be a doctor is incredibly rewarding because you meet new people every day. You can tailor what you're doing for them based on what’s going on with their lives. That’s an incredibly rewarding part of my job.
Host: Well, that’s easy to see. Dr. Nayor, thank you for your time today. This has really been informative.
Dr. Nayor: Thank you so much for having me.
Host: That’s Dr. Jennifer Nayor. Call 978-287-3835. That's 978-287-3835 or visit emersondocs.org to make an appointment with Dr. Nayor or schedule a screening. If you like what you’ve heard, please share it on your social channels and be sure to check out the full podcast library for topics of interest to you. This is Healthworks Here from Emerson Hospital. Thanks for listening.