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Screening for Colon Cancer: Know the Facts

Posted Aug 24 2008 1:49pm
DAVID R. MARKS, MD: Hi, and welcome to our webcast. I'm Dr. David Marks. Colon cancer is the second leading cause of cancer death in the US. But it doesn't have to be that way. Colon cancer is curable if it's caught early enough, and that's why routine screening is something everybody should know about.

Joining me to talk about the importance of screening are two experts. First is Dr. John Macdonald. He's an oncologist at St. Vincent's Comprehensive Cancer Center in New York City. Welcome.

JOHN MacDONALD, MD: Glad to be here, David.

DAVID R. MARKS, MD: Next to him is Dr. Mark Pochapin. He is a gastroenterologist at the Weill Cornell Medical College. Thanks for being here.

MARK POCHAPIN, MD: Thanks, David.

DAVID R. MARKS, MD: Why is screening so important?

JOHN MacDONALD, MD: Screening's important because you can detect colon cancer at a very early and curable stage. Or you can prevent it by removing a pre-malignant condition, a polyp.

DAVID R. MARKS, MD: What are the methods used to screen?

MARK POCHAPIN, MD: There basically are three currently accepted methods. There's a colonoscopy, which is a procedure done by a gastroenterologist or a trained person with an endoscope, which is a tube that goes in the large intestine while a patient is sedated, and can look around the colon for a tumor or cancer or a polyp that can be removed at the time of the procedure.

There's a sigmoidoscopy, which is like a small colonoscopy. It just looks at the very bottom of the colon. It's not as effective at looking at the entire colon, but at least it can be done very quickly.

And then there is a barium enema, which is not a procedure done by a gastroenterologist or an internist, but by a radiologist, where they take x-rays to look at the intestine. And finally, there's a new type of procedure called virtual colonoscopy, which in essence is a three-dimensional CAT scan, but still requires the same preparation as a colonoscopy.

DAVID R. MARKS, MD: There's also screening for blood that's commonly used.

MARK POCHAPIN, MD: That's right. Fecal occult blood testing is usually combined with any or all of these, where a doctor or a nurse looks for microscopic blood within the stool itself.

DAVID R. MARKS, MD: What information should a person know about before they go and get screening?

JOHN MacDONALD, MD: They should know whether they're a good candidate for the screening. That really depends on their personal history. Have they had a history of a polyp, have they had a history of rectal bleeding? Have they had some problem that would be directed at the colon?

And their family history. Do they have a history of colon cancer in the family? Do brothers, sisters, mothers, fathers have it? Is there colon cancer that occurs below the age of 50 in the family? Those are all important in deciding who should be screened and when.

DAVID R. MARKS, MD: And, again, what age should a person start worrying about this?

MARK POCHAPIN, MD: Definitely at age 50. Anybody 50 or above should at least be screened. Anybody with a family history of colon cancer or other type of cancers, like breast, ovarian, uterine, in younger family members, should start at age 40 or 10 years even before that person had the cancer in the family. And then look to make sure that there's no other type of family cancer histories that they would need to talk to their doctors about.

DAVID R. MARKS, MD: And they should talk to their primary care doctor or gastroenterologist to determine which is the best screening method?

MARK POCHAPIN, MD: Oh, yeah. Patients should take it under their own responsibility to learn their family history and bring it up with whoever primary care practitioner. Whether it's a doctor, a nurse, or even someone who's just taking care of them for any other reason.

DAVID R. MARKS, MD: Okay. Thank you both for being here. Thank you for joining our webcast. I'm Dr. David Marks. Goodbye.

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