SARA LOMAX-REESE: Right now, we are going to zero in on colorectal cancer and this is kind of an Einstein spotlight and right now in the studio we have Dr. Donee Patterson, who is the family medical physician from Einstein Internal Medicine, and we also have in studio Dr. Richard Greenberg, who is the Chairman of Einstein's Colorectal Surgery. So, welcome to you both.
DONEE PATTERSON, MD: Thank you.
RICHARD GREENBERG, MD: Thank you.
LOMAX-REESE: Thank you. And Dr. Donee, why don't we start with you. The colorectal cancer incidents are much higher in the African American community.
LOMAX-REESE: Can you give us…first of all a lot of people say colon cancer, but I guess the broader category is colorectal, can you explain exactly what that broader definition is?
PATTERSON: Sure, so the colon is a lower part of our intestines and Dr.Greenberg can talk more on this later, but the rectum is the veryl ast part of our intestines; the part where the stool comes out. So we lump them together as colorectal to make it easier, but in medicine sometimes we do separate them out. But I do want to backtrack and say that March is colorectal Awareness Month and we wanted to talk to you about this because we always want to talk about things that we can do to improve the health of our community and colorectal cancer is one of the easiest detected cancers that we know of, yet, even though we know that,150,000 people a year are diagnosed with colon cancer and 50,000 people will die of colon cancer. So even though it is easily detectable, people are still being diagnosed with it. So we have to do something about it and we talk often that African Americans, they lead the charts in diabetes, they lead the charts in hypertension, well, it is not surprising that we lead the charts in colorectal cancer as well. We are more often diagnosed with colorectal cancer and we die of colorectal cancer more commonly than our white counterparts. So there are somethings that we can do and someone asked me today well why are you going to talk about colorectal cancer and I said I am excited to talk about colorectal cancer because it is something that we can make a difference in and so Dr. Greenberg and I are here today to tell people what they can do to make sure that they decrease their risk factors for colorectal cancer.
LOMAX-REESE: I just wonder if part of that high rate, the 150,000 people being diagnosed, has to do with people not having insurance or not having adequate insurance. I think as preventable as things can be and are, there is still this huge gap; there is this two tiered healthcare system that is very real so I think there are some systematic things that have to be addressed as well as kind of personal responsibility things as well. So we will turn to you Dr. Greenberg. You are our expert on colorectal cancer. It is very preventable as Dr. Donee just said. You are support to get screened at age 50, is that correct?
GREENBERG: Age 50 is the general screening recommendation; for the African American community, it is recommended to start at age 45.
LOMAX-REESE: For men and women?
GREENBERG: For men and women. That's right. Colorectal cancer affects both men and women just able equally and it is known that it affects African Americans at an earlier age and with worse prognosis. Why that is is probably multifactorial. Part of it may be as you said access to healthcare or lack thereof. It may have to do with diet; it may have to do with fears and that is something we also want to speak about today. There is a lot of fear associated with the word colorectal cancer; there is a lot of fear associated with just saying you need a colonoscopy. I can tell you how many eyebrows I see raised. A more important point to make is when wetalk about screening for colorectal cancer, colorectal cancer is preventable. If someone has a polyp, when a polyp is a precancerous growth in the colon and it is removed by colonoscopy that potentially prevents an individual from getting colon cancer. So not only is it one of the most treatable of all cancers, if it is identified early on, but it is actually preventable as well.
LOMAX-REESE: So Dr. Donee, you said this is new, this 45 year old threshold. When did that come into existence?
PATTERSON: It is relatively new.
GREENBERG: Around 2005, the American College of Gastroenterology recommended it based on a number of scientific studies.
PATTERSON: You know what, Sara, I did want to say you and I talk often about insurance issues and access to healthcare, but there are people that I see that have insurance and we can talk about ways to get colonoscopies without insurance, but there are people I see without insurance they are just afraid. They don't want to take theprep that you have to drink, a solution beforehand to clean out your bowel because in order to look and see if you have a polyp your bowel has to be cleaned out. They don't want to do the prep the day before, they are afraid, they are embarrassed, they don't want someone messing with their bottom parts and so I tell people all the time, it is a 20 to 25 minute test to make sure that you don't have colon cancer. You don't have to get the test for ten years so go ahead and get this 20-30 minute test that is preventable to make sure you don't have colon cancer. A lot of people say well I really don't want to do it; well I often tell my patients well I am pretty sure you don't want colon cancer either.
LOMAX-REESE: So you are saying once you get it you don't have to get it again for another 10 years?
LOMAX-REESE: And do you have to go to the hospital to have the colonoscopy or can it be done in a doctor's office?
GREENBERG: It can be done in a n umber of different facilities. It can be done in a hospital; it can be done in, not a physician's office,but perhaps in an endoscopy center. It is important to also know that people are asleep when they get their colonoscopies.
LOMAX-REESE: So you have to have anesthesia?
LOMAX-REESE: Well that's a whole other complication.
GREENBERG: No, it's not a complication.
LOMAX-REESE: More fear because anesthesia is one of those things that there is…you definitely have to get it right because you can have complications with the anesthesia.
GREENBERG: Well let me define the anesthesia. It is intravenous sedation. So there is no breathing tube, there are no agents to paralyze individuals, they are breathing on their own; they are just in a very deep sleep. Now, when I see people in my office just to discuss colonoscopy, the first thing I tell them is you are going to be asleep and they say ok, you can keep talking.
LOMAX-REESE: So is there any discomfort afterwards?
GREENBERG: There may be a little bit of gassiness from the procedure, but otherwise, no.
LOMAX-REESE: And how do you know immediately whether they found something or if there is something of concern or is there a week or two that you wait before you know something?
GREENBERG: Well colonoscopies are a direct view procedure. I'm actually looking through a tube which is connected to a camera chip; I am looking on a TV screen. So it is direct and immediate information so I can tell an individual right afterwards, I just looked at your whole colon, you are really well cleaned out,everything is fine, see you in five years or see you in ten years. If there is a polyp that is removed, I would tell an individual that a polyp was removed.
LOMAX-REESE: So you would tell them right then and there?
GREENBERG: Right then and there, at the same time.
LOMAX-REESE: How do you remove it?
GREENBERG: There is a little wire loop called a snare that goes right through the tube, the colonoscope, the polyp is encircled and an electric current is used to cauterize and divide the polyp from the bowel wall.
PATTERSON: So it's like it pinches the polyp off. The polyp is different sizes, but you can kind of picture it like a small almond and it may even be smaller and they literally pinch it off; it is not painful to the patient and you can say, I don't have colon cancer.
LOMAX-REESE: So you wouldn't have to analyze that polyp to see if it was cancerous or not at that moment?
GREENBERG: Well sure, if tissue is removed, it is sent to the lab and it is analyzed. And that is not an instantaneous occurrence. But I would tell an individual who had the colonoscopy I found a polyp, we sent it to the lab; it doesn't look bad, I will call you in a couple days and let you know.
LOMAX-REESE: So you are like stressed out for a couple of days.
GREENBERG: But again I think it is much better to know that it is out of your body then to worry about what's in me.
LOMAX-REESE: So what happens…ok, you pull out that polyp you send it to the lab it comes back positive, it comes back cancerous, then what happens?
GREENBERG: It depends on a number of factors; there's superficial cancer and it may be taking that polyp out cured an individual or if it's more involved they may need a work up including further evaluation,chest x-rays, scans, and potentially they may need a piece of their colon removed. For early stage colon cancer, which would be what a polyp with cancer is, the survival rate, meaning the five year period of time where people are alive, is well over 90%.
LOMAX-REESE: W eare talking today about colorectal cancer and we are joined in studio by Dr. Donee Paterson from Einstein and Dr. Richard Greenberg, who is the Chairman of Einstein Colorectal Surgery. I am going to open the phones, if you have a question or comment about colorectal cancer, give us a call,215-634-8065, toll free 866-361-0900. Now there are risk factors for colon cancer in addition to age and ethnicity but things like inflammatory bowel disease, Crohn's disease, colitis, things like that, so if you have those kinds of illnesses or challenges, what is the risk factor, the additional risk factor for colorectal cancer? Dr. Donee?
PATTERSON: There are definitely some disorders that increase your risk of getting colon cancer. So if someone has ulcerative colitis,depending on how bad it is and where it is and how extensive the symptoms, they may have to be screened more often. Ulcerative colitis has an increased risk of cancer so those people don't goten years before they are screened again. They get screened more often and you talk to your doctor about how often that happens. Dr. Greenberg and I wanted to make sure that we got out the message today that colon cancer, yes it most often happens in people that are 50 or older, but that it definitely happens in people who are younger so the National Cancer Institute reported that about 25,000 people a year under the age of 50 still get colon cancer and so if you have any symptoms, we can't leave here today without at least talking about some of the symptoms, so if you have blood in your stools, black tarry stools, a change in your bowel habits, not just one brief day of constipation but if you are starting to be constipated, meaning your stools are hard and you have to strain to get them out and if you have unexplained weight loss or unexplained fatigue, if you have unexplained anemia, these are the things that you definitely want to bring to your doctor's attention. Maybe four months ago, in one month I had three people under the age of 40 come with colorectal cancer, so it happens and people need to make sure that they know the symptom sand yes you do have to look. People say I don't want to look, but yes, you do have to look because no one is in the bathroom with you, you have to look, you have to tell our doctor and you have to be an advocate for yourself.
LOMAX-REESE: So let me ask you, Dr. Greenberg, some of the digestive problems we talked about, colitis and Crohn's disease and things like that, but I know that digestive problems like indigestion and constipation and things like that are one of the most common health issues that people try to medicate themselves for with over the counter stuff, so we do as a culture have massive digestive issues going on. I am wondering , what are some of the things from a dietary standpoint…we at the station are on this plant based initiative right now up until Easter and we think it's kind of the preferred preventative dietary approach, but what do you think as someone who works right there in the colon?
GREENBERG: I am a big believer in moderation. I think when people go to extremes, one way or the other, it doesn't always put us in the best state of health. We know there are some dietary factors which are associated with increased risk of colorectal cancer and those are diets high in red meat, high in animal fat, foods which are cooked at high temperature, processed foods like deli lunch meats, excessive amounts of alcohol and tobacco are all associated with it. Now that doesn't mean one can't enjoy a cheesesteak, but probably not three meals a day, seven days a week. So again, its moderation and listening to your body.
LOMAX-REESE: We are going to go to the phones; if you have a question or comment,gives us a call give us a call, 215-634-8065, toll free 866-361-0900. We got George from Germantown. Welcome to the program George.
George: Good afternoon.
LOMAX-REESE: Good afternoon.
George: I don't want to scare anybody but I wanted to tell you of a horror story that happened with me and I am sure hospitals are more efficient now in guarding against this and the doctors may know where I am going. Within a day or two after having a colorectal exam back in the 80's, I came down with hepatitis and I just want to be assured that you folks are aware of that issue and I was just unlucky enough to go to a place that wasn't at the top of their game.
LOMAX-REESE: Dr. Donee, do you want to go….
PATTERSON: There are a lot of things about that. A day or two, you don't even detect HIV or hepatitis viruses like that within a day or two. So it might mean that the person had it before and for whatever reason their immune system was low and then the procedure possibly brought it out but we are not putting anything …. All the equipment is sterile; we are not putting any blood products into you. Hepatitis and HIV, they are sexually transmitted disease that you get through the passing of fluids and so we are not putting any body fluids into you, like a blood transfusion. It's a clean colonoscope so that we have to test and retest and retest and make sure it is autoclaved and totally clean so we are not actually putting blood products or body fluids into you so I think there may be some discrepancy and yes, that was in the 80's and it's 2012, so things are totally different as far as sterilization and everything. It's unfortunate that happened to you but I hope you are ok now.
LOMAX-REESE: So there is always another question when we talk about colorectal cancer which is colon hydrotherapy or colonics and whether that is an important therapeutic thing that women and men should incorporate into their health regimes to prevent colorectal cancer. What do you say Dr. Greenberg?
GREENBERG: I would say that our bodies are miracles of nature and they function at an extraordinarily amazing level on their own. Part of that is eliminating waste, so if we listen to our bodies,we eat reasonably well, it is not usually necessary to add other measures, such as hydrotherapy or laxatives on a regular basis. If things are done every once in a while, there probably is not any harm to it, if an appropriately skilled individual or licenses individual does it but it is not something which should be done with any frequency.
LOMAX-REESE: Ok. We are going to go to Tim from South Philly; welcome to the program Tim.
Tim: Yeah hi, I got a question regarding the fluid you have to take before you…to clean yourself out. Is there a choice of fluids or is it all the same?
LOMAX-REESE: Dr. Greenberg?
GREENBERG: That's a great question. There are different choices of fluids and one of the things that concerns people is how much they have to drink. So there are different preparations which reduce the amount of fluids that needs to be taken in; some of them are very salty so individuals who have heart problems or diabetes or other conditions may not be able to take them but that is something to ask the doctor who is going to be doing the procedure.
LOMAX-REESE: Thanks for your call Tim. We've got Mr. Andrews from Overbrook; welcome to the program.
Andrews: Good morning, how are you?
Andrews: Now the question I have has to do with one of my children and actually both of my children in a way. The thing is that 20 some years ago my son or my wife had this called black strep virus and mostly black women gets it so the hospital did not take a test for this black strep virus and so my son had that when he came out the birth canal, right, so the only thing that would stop that is penicillin while they are coming out the birth canal so 11 years later I had a daughter, she was born. We asked the doctor to check for that and she said ok, she tested it and she had it done,my daughter is great.
LOMAX-REESE: Now does this have to do with colorectal cancer?
Andrews: Well actually in a way it does.
LOMAX-REESE: We are trying to keep the conversation focused on colorectal cancer today and we are running out of time, so if you could zero in on your question that would be great.
Andrews: Ok, the thing is if people are tested for this black step virus, a lot of children will not have disability problems and things like that and so being blacks are the number one that has this thing, I think doctors or something should have it permanent that everyone have it and my daughter, same thing.
LOMAX-REESE: In the interest of time, Mr. Andrews, I am going to throw this to Dr. Donee and see if she can respond.
PATTERSON: I believe what you are talking about is MRSA, which is MRSA and it's methicillin resistant staph aureus and we do test for that and I don't know how old your daughters are but it is something that is commonly tested in hospitals now but that is a different area of the body, so that is the vaginal birth canal and we are talking about colorectal, but it is very important and it is tested now to make sure that when children come through the birth canal that they are not infected, so that is something that is commonly done.
LOMAX-REESE: Alright, thanks for your call Mr. Andrews. I don't think we have time for any more calls. We are talking today about olorectal cancer and we have in studio Dr. Richard Greenberg and he is the Chairman of Einstein Colorectal Surgery and Dr. Donee Patterson who is a family physician with Einstein Internal Medicine so we definitely have to have take aways. What are the final thoughts, the take aways that people really need to incorporate into their lives relating to colorectal cancer? Do you want to go Dr. Greenberg?
GREENBERG: Sure, thank you. Number one, screening saves lives; don't be afraid; if you have symptoms, listen to your body and talk to your physician. We don't wait until something happens to take action. It is very important; colorectal cancer is preventable and it is very curable when it is found early. African Americans should get screened at the age of 45 unless they have other risk factors, such as a family history and if a parent has had colorectal cancer, these screenings starts ten years before the year that parent developed colorectal cancer.
LOMAX-REESE: I just can't believe I am in that age category where I am having these kinds of screenings, but go ahead, I'm on it. Go ahead Dr. Donee.
PATTERSON: I want people to stop saying I have to die of something because this is not something you have to die of. You can get a very simple, 20 minute test to make sure that you don't die of this form of cancer. Stop smoking, eat healthier, eat more plants and nuts and beans and if you need us we are at 1-800-EINSTEIN. If you need a GI doctor or if you need colorectal doctor, Dr. Greenberg who is here in the office today, his number is 215-457-4444 and if you want free health tips you can follow me on Twitter @DrDonee.
LOMAX-REESE: So next week or the next time, in two weeks, what are we going to be covering Dr. Donee?
PATTERSON: In two weeks we are going to be talking about the ENON Men's Health Fair where we have talked about before. We are screening 1000 men free for most of the medical…we are not doing colonoscopies,but we are doing almost everything else. Free men's health fair on march 24 and we are going to tell you more about it.