Just saying the words “colorectal cancer screening” can provoke a kind of instinctive reaction in some people. Sphincter muscles involuntarily tighten while a queasy, nauseous feeling begins to build in the stomach.
Still, because of increased colorectal cancer screening nationwide over the past 10 years, it appears this is one front in the “war on cancer” where people are winning and cancer is losing. The American Cancer Society says the rate of colorectal cancer in adults over 50 has dropped an impressive 30 percent in the past decade.
Despite that decline, colorectal cancer remains the third most common kind of cancer in both men and women, not counting skin cancer, and it is still the second leading cause of cancer death in this country. The National Cancer Institute at the National Institutes of Health estimates that in 2014 there were 96,830 new cases of colon cancer and 40,000 new cases of rectal cancer which, it projects, will lead to more than 50,000 deaths.
Despite this success, there are now of charges floating around the internet declaring that physicians are over-screening for this disease. Gastroenterologist Dr. Bruce Grossman strongly disagrees. After all, he points out, “Only about 40 percent of the adult population in this country has been screened.”
Grossman, who has been a physician for 26 years, just moved to Vero Beach and began practicing at Indian River Medical Center earlier this month.
Besides being highly familiar with diseases of the colon and colorectal cancer screening, his area of expertise includes more vital organs and covers more bodily functions than just about any other medical specialty. The esophagus, the stomach, the small and large intestines, the liver, the pancreas, the gallbladder and the bile ducts are all under the purview of the gastroenterologist. From irritable bowel syndrome to cancer, Grossman has seen and treated it all from the Palm Beach area to Colorado’s Rocky Mountains and now back again in Vero.
A colonoscopy, as most people know, is an outpatient procedure during which the inside of the large intestine is examined by inserting a thin, flexible tube about four feet long into the rectum to look for lesions, polyps or other signs of cancerous or pre-cancerous growths. That tube is called a colonoscope or endoscope and thanks to modern miniaturization, it literally sheds light on what’s usually a very dark subject. It also has a camera and can accommodate small cutting tools. Pictures from the camera, illuminated by the light, are relayed to the physician on a high-definition monitor and if the doctor so chooses, he or she can take tissue samples for a biopsy or even remove polyps or abnormalities by using the scope’s tiny cutting tools.
The colonoscopy was originally used to evaluate gastrointestinal symptoms including rectal and intestinal bleeding, abdominal pain, pelvic pain or changes in bowel movements, but today most colonoscopies are performed on individuals with no symptoms at all as a way to check for cancerous or pre-cancerous polyps. The Centers for Disease Control recommends screening colonoscopies for everyone 50 years of age and older as a preventive measure.
Opinions, according to Grossman, vary widely on how frequently people should undergo a colonoscopy but he points to family history as perhaps the largest single factor in determining risk. “If a first line relative has or had colon cancer,” Grossman explains, or a history of inflammatory bowel disease such as ulcerative colitis or Crohn’s disease, it would probably be prudent to undergo the procedure more frequently than if there’s no history of such problems in the family.
Once every 10 years from age 50 onward is sometimes given as the norm but under certain circumstances Grossman says, it might be better to plan on every three to five years. He adds that after age 75 or so, colonoscopies may not be necessary at all.
Grossman claims the prep for colonoscopies has gotten far easier on patients than it was just a few years ago. To have a successful colonoscopy, the patient’s bowels must be completely empty so the doctor can clearly view the inside of the colon. The old and sometimes downright draconian pre-procedure instructions used to include strict dietary changes stretching out several days in advance of the procedure and drinking a prep solution that, quite frankly, made most people extremely nauseous. Grossman says the newer protocols are a big improvement though he admits it would be nice if that liquid prep solution could be made “even more palatable.” He also gives a nod to advances in anesthesiology saying current sedatives, when needed, have “revolutionized” the patient’s experience.
All that is good news in the fight against colorectal cancer but sometimes cancer moves the goalposts on us in the middle of the game.
While colorectal cancer screening has been almost exclusively aimed at the over 50 crowd for years, Grossman reports a potentially disturbing trend he witnessed back in Colorado.
“I was seeing pre-cancerous polyps,” he explained, “in 30 and 40 year olds.” Whether there were (or are) environmental factors unique to that area or whether that represents a change in the evolution of this disease is, as yet, unknown. The naturally curious Grossman, who went to medical school at the Far Eastern University of Medicine in the Philippines, in part because he “wanted to travel through Asia,” before moving on to serve both his internship and residency at the prestigious Mt. Sinai hospital in New York City, will likely put that curiosity to work looking for answers.
Dr. Bruce M. Grossman has joined doctors Eberhart, MacKay and Zerega at IRMC’s gastroenterology practice at 11th Circle, Suite 101 in Vero Beach. 772-299-3511.
