By age 50, people are at average risk and should be screened for colorectal cancer. Every year, more than 130,000 people learn they have colorectal cancer, and many of them are men, yet men seem more hesitant to get the screening than women.
Some people who get colorectal cancer have no known risk for it. Screening allows doctors to identify and remove abnormalities that can lead to cancer. It also allows us to identify cancer in its early stages when it has the best possibility of responding to treatment.
Raymond P. Kenny, MD, gastroenterologist at Summit Medical Group, is here to discuss the importance of getting a colon and rectal cancer screening for men, and how their loved ones can encourage them to get this very important screening.
Colon Cancer Screening: Getting Your Men To Get The Screening
Featured Speaker:
An innovator in endoscopic procedures and pioneer in the early use of endoscopic ultrasound (EUS), Dr. Kenny is the first gastroenterologist in New Jersey to perform endoscopic ultrasound, treat bile duct stones with laser lithotripsy, and place expandable stents to relieve obstruction of an esophageal tumor. He is the coauthor of articles and abstracts that are published in prestigious, peer-reviewed scientific journals, including Hepatology, Journal of Laparoendoscopic Surgery, and Gastroenterology. He has been Co-investigator for research projects on hepatitis C.
Learn more about Raymond P. Kenny, MD
Raymond P. Kenny, MD
Raymond P. Kenny, MD, FACP, FACG, specializes in in liver disease, including chronic hepatitis C and B, autoimmune hepatitis, cirrhosis, and fatty liver. Dr. Kenny's expertise includes colon cancer screening, fine-needle aspiration of pancreatic cysts and cancers, radiofrequency ablation for Barrett's esophagus, endoscopic evaluation and treatment of Barrett's endoscopic ultrasonography (EUS), pneumatic dilation for achalasia, stenting for cancers of the bile duct and pancreas, transduodenal cholangioscopy, and endoscopic retrograde removal of gallstones.An innovator in endoscopic procedures and pioneer in the early use of endoscopic ultrasound (EUS), Dr. Kenny is the first gastroenterologist in New Jersey to perform endoscopic ultrasound, treat bile duct stones with laser lithotripsy, and place expandable stents to relieve obstruction of an esophageal tumor. He is the coauthor of articles and abstracts that are published in prestigious, peer-reviewed scientific journals, including Hepatology, Journal of Laparoendoscopic Surgery, and Gastroenterology. He has been Co-investigator for research projects on hepatitis C.
Learn more about Raymond P. Kenny, MD
Transcription:
Colon Cancer Screening: Getting Your Men To Get The Screening
Melanie Cole (Host): Every year more than 130,000 people learn they have colorectal cancer and many of them are men yet men seem more hesitant to get the screening than women. My guest today is Dr. Raymond Kenny. He is a gastroenterologist at Summit Medical Group. Welcome to the show, Dr. Kenny. I would like to first start to talk about why men seem more hesitant to even go to the doctor or a urologist or a gastroenterologist than women.
Dr. Raymond Kenny (Guest): I think one might look at that from the opposite perspective. Women are quite used to screening for malignancies. They’re quite used to getting PAP smears for cervical cancer and doing annual mammography for breast cancer. At a very early age, they’re used to going for this routine. Men have not been indoctrinated into that. So, really, their screenings and things start at age 50 so they’re not as accustomed to it. For example, for breast cancer and cervical PAP smears the compliance rate in women is about 80% of women who should be screened are following the rules. That is not the case with men.
Melanie: Wow. So, if we want to get our men in to get this very important preventive screening, what do you recommend to say to the guy to get him into see you so that he can get his colonoscopy? Then we’ll talk about colonoscopy itself.
Dr. Kenny: The first thing you have to realize is education, then you try to break this down relatively simply as 1-2-3. Maybe we could do those in reverse order using the number 3. Colon cancer is the 3rd most common lethal cancer in the United States. Most people don’t realize that. If you ask the average person about cancer and name the cancer, lung will be at the top of the list and then, maybe, breast and prostate. They are on the Mt. Rushmore of cancers, if you will, because they are the four most common. But colon cancer is actually the third most common. People don’t realize that it affects perhaps around one in twenty Americans. It’s much more common then they think. Actually, if you take it from that Mt. Rushmore, first there is the George Washington, if you will, would be lung cancer. It’s very common and very lethal in its attack rate but right behind that is colon cancer in lethality. The second most common lethal cancer in the United States. The way you have to look at that is the gender specific cancers of prostate and breast cancer only affect half the population, so their death rates drop back so that colon cancer is the number two cancer killer. So, there’s our number two. Number one is this is the most preventable cancer. You can prevent yourself from even having the cancer. How is that? It’s because colon cancer starts out as a benign wart-like polyp on the inner lining of the colon. When we go in there and harvest these – take these out – you will not get colon cancer after that’s been removed, perhaps as high as 60-70% of the time. In fact, the incidence, the occurrence of colon cancer has been declining since the 90’s just because of that effect of screening people, finding things early, removing polyps. You’re preventing a colon cancer from happening in the future. One in six of those polyps will grow up to become a cancer. If you remove them they don’t get to grow up. In a sense, you get the test not the disease. If you arm a person with that knowledge, they have a safe and effective test that will not only detect cancer early – early cancer detection – but number 2, and most importantly, the take home message is, it prevents cancer from happening. If you sit down and explain these numbers to a patient, an intelligent person will do the right thing.
Melanie: That’s what you just said, an intelligent person, so men – you say education is so important but to them all they hear is camera, prep. They think it’s going to be a lot – and as someone who’s had a bunch of colonoscopies, I can tell you how easy it is. Usually the person wakes up and says “When are you going to start?” Right? So, speak about that prep a little and how easy this test really is.
Dr. Kenny: We’re, obviously, aware of this, we confront this on a daily basis and we’ve tried to make everything easy about it. For instance, the cost of the procedure. We’ve now got legislators to actually include this test for Americans to be cost free. If you have insurance, most insurance companies will give you the benefit of doing this for free. So, it’s for free – number one. It’s going to save your life – number two. Number three – the inconvenience of the prep – we’ve worked on that. The prep that we particularly use is a modified use of Gatorade. I drink G2 when I go to the gym. This is the same substance you’re going to drink for this prep that I have. It’s not onerous. It’s just that 24-hours before the examination drinking Gatorade. So, the palatability of the prep has changed. The prep is vitally important so we’re not going to compromise on the quality but we’ve taken it down to where people tolerate the preps and we’re even looking at allowing people to eat a little bit more in that first 24 hours. We are very cognizant of what the complaints are but the benefits clearly outweigh all of that. Yes we have listened. We’ve made it easier. The palatability is easier. The test itself – we really don’t even worry about that conversation anymore because of the kind of sedation that we have now. It’s just like you said – you go to sleep you have no idea that you had the test you wake up and it’s not infrequent people say, “When are they going to start?” Because you’re sedated and out for the procedure. The comfort issue is not a problem with the test itself now. The prep questions have been answered in large part by making these kinder, gentler preps and the discomfort with the procedure has really been answered by the different types of anesthetic or sedation that we give now as compared to say five or ten years ago.
Melanie: See, women, we don’t mind taking this test because we lose a pound or two for a day. So, we’re happy about that. We’re on a liquid diet and then we get rid of everything. It’s a nice cleanse. Then we get on the scale and jump up and down for a few times. Men don’t look at all those kinds of humorous things. We can make it humorous; however, it’s a really serious cancer and this is such a preventive procedure. What else do you want men to know or women who love them about getting in to see a G.I. guy? As you say they’re free now. They’re part of a well visit. What else do you want women to know to get their men into see you?
Dr. Kenny: What I want the women to know, too, is that they should come in, too. The screening rates for colon cancer are below those – women are getting their mammograms and they’re getting their PAP smears at a rate of 80-90%, but they’re about 67% on getting screened for colon cancer. Even though they’re doing a good job with those things, it still should be higher than that. There’s a goal now of getting 80% of people screened by 2018. If they go first, they’ll see what I’m saying here is true and they will have not a horrible experience with this. Then, they go first and then they’ll be able to bring in their loved ones. It’s not uncommon that that is what happens. You get the woman first and then the husband will then come in after he sees it’s not so horrible.
Melanie: That’s great advice. I love that. What about after if polyps are found? That’s what a lot of people men and women are afraid to get it because they’re afraid of what’s found afterwards. Are some polyps worse than others?
Dr. Kenny: Certainly. You have a range of polyps. You have to think of it as a stage. I frequently say there are four steps between the formation of that polyp and cancer. Through that journey, there are a number of mutations that these polyps accrue before they become cancer and before they invade. There are some polyps that are what we consider are pretty close to innocuous – the hyperplasic polyps. There are other polyps that are most commonly called “adenomatous polyps” and perhaps one in six of those over an extended time period – 5 to 8 years – would develop into a cancer. Then, there’s the serrated adenoma which is flat legion which has a slightly different biology and they’re more serious. But, there are some innocuous polyps but the ones that we’re looking for are the adenomatous polyps and the serrated adenomas. If you have them there, you want them out.
Melanie: That’s the whole point is that you take them out and then they’re gone. Do they grow back over time? How often if somebody has polyps do you want them to come back for a colonoscopy?
Dr. Kenny: It depends on multiple factors. You basically have to stratify your interval of follow up proportional to the patient’s risk of getting another polyp. First of all, like you said to begin with, are you sure you got every part of the tissue there? You want to be sure that you have complete removal of the polyp. There are certain criteria that we have where we’re certain about it and other ones where it is a little more questionable. If there is some question, the interval of time is shorter. The garden variety situation where we’re sure we got all of the polyps out and they’re not a great number and they’re not a great size and they’re not advanced – the short answer to your question is you’d follow up in five years. But, some of these other criteria you might want to do it in a shorter interval if you had some concerns.
Melanie: In just the last few minutes, Dr. Kenny, and what a great guest you are, please give your best advice for people and getting their colonoscopy – not just men but, as you said, women, too, and how important this preventive screening is and why they should come to Summit Medical Group for their care.
Dr. Kenny: The reason that they should do this colonoscopy is because it’s the gold standard. It’s the best test. It’s the test I’ve had on myself, the test I’ve had on our family. We practice what we preach. If for some reason you couldn’t get them to do it, there are other tests that are available – fecal occult blood testing, for example. The best test is the test that’s done. If you couldn’t get this, get something done. That’s one of the take home points that I wanted to have. The gold standard test, the colonoscopy, it does matter who’s doing the procedure. That brought you to this situation with the Summit Medical Group. Convenience. You’ve asked about how we do it. We’ve even gotten to the point we’re doing this test by direct access now. What that means is a healthy 50-year-old can contact our office and if they’re otherwise healthy, we can do it directly without even coming into the office for an office visit beforehand. Availability--we’ve made a commitment to this. We’ve actually started to do these on Saturdays. So, it’s easy access for people because we believe in this. The legislature has manned up by paying for this, making it cost free to the patient in that circumstance. The reason that you do this is there are ample studies that it really does make a difference who’s doing your colonoscopy. There were studies in Canada that if you had your colonoscopy done by a primary care physician, which is sometimes done in Canada, you’re 40% more likely to have a cancer develop in the interval than you were if you had it done by a gastroenterologist. Among gastroenterologists – not all gastroenterologists are created equal. We track quality perimeters. How good is your colonoscopy rate? We have an adenoma detection rate. How often on a patient if you’re doing a screening colon do you find an adenoma or a polyp? The industry standards may say that it’s 25% in males and 15% in females but in our practice here, we’re running 50% and also sometimes we have 60%. The reason we get that is we insist on good preps and the people that are doing the test have a commitment to this. In my office here we have five Ivy League trained gastroenterologists – Harvard, Penn, Cornell and I’m the last guy from Yale. It sounds geeky but we spend a lot of time just talking about preps and all these things to maximize that adenoma detection rate. Why do we do that? Because if we maximize the adenoma detection rate, the chance that person will develop a cancer in the time between their next recommended colonoscopy and the one you’ve done is shown to be markedly decreased. The higher the adenoma detection rate, the lower the interval cancer rate. It’s a very important thing. If you’re concentrating on quality, those are the things that you do. You want to have an endoscopist who concentrates on quality.
Melanie: Wow. What great information and so beautifully put. Thank you so much, Dr. Kenny, for being with us today. You’re listening to SMG Radio and for more information you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.
Colon Cancer Screening: Getting Your Men To Get The Screening
Melanie Cole (Host): Every year more than 130,000 people learn they have colorectal cancer and many of them are men yet men seem more hesitant to get the screening than women. My guest today is Dr. Raymond Kenny. He is a gastroenterologist at Summit Medical Group. Welcome to the show, Dr. Kenny. I would like to first start to talk about why men seem more hesitant to even go to the doctor or a urologist or a gastroenterologist than women.
Dr. Raymond Kenny (Guest): I think one might look at that from the opposite perspective. Women are quite used to screening for malignancies. They’re quite used to getting PAP smears for cervical cancer and doing annual mammography for breast cancer. At a very early age, they’re used to going for this routine. Men have not been indoctrinated into that. So, really, their screenings and things start at age 50 so they’re not as accustomed to it. For example, for breast cancer and cervical PAP smears the compliance rate in women is about 80% of women who should be screened are following the rules. That is not the case with men.
Melanie: Wow. So, if we want to get our men in to get this very important preventive screening, what do you recommend to say to the guy to get him into see you so that he can get his colonoscopy? Then we’ll talk about colonoscopy itself.
Dr. Kenny: The first thing you have to realize is education, then you try to break this down relatively simply as 1-2-3. Maybe we could do those in reverse order using the number 3. Colon cancer is the 3rd most common lethal cancer in the United States. Most people don’t realize that. If you ask the average person about cancer and name the cancer, lung will be at the top of the list and then, maybe, breast and prostate. They are on the Mt. Rushmore of cancers, if you will, because they are the four most common. But colon cancer is actually the third most common. People don’t realize that it affects perhaps around one in twenty Americans. It’s much more common then they think. Actually, if you take it from that Mt. Rushmore, first there is the George Washington, if you will, would be lung cancer. It’s very common and very lethal in its attack rate but right behind that is colon cancer in lethality. The second most common lethal cancer in the United States. The way you have to look at that is the gender specific cancers of prostate and breast cancer only affect half the population, so their death rates drop back so that colon cancer is the number two cancer killer. So, there’s our number two. Number one is this is the most preventable cancer. You can prevent yourself from even having the cancer. How is that? It’s because colon cancer starts out as a benign wart-like polyp on the inner lining of the colon. When we go in there and harvest these – take these out – you will not get colon cancer after that’s been removed, perhaps as high as 60-70% of the time. In fact, the incidence, the occurrence of colon cancer has been declining since the 90’s just because of that effect of screening people, finding things early, removing polyps. You’re preventing a colon cancer from happening in the future. One in six of those polyps will grow up to become a cancer. If you remove them they don’t get to grow up. In a sense, you get the test not the disease. If you arm a person with that knowledge, they have a safe and effective test that will not only detect cancer early – early cancer detection – but number 2, and most importantly, the take home message is, it prevents cancer from happening. If you sit down and explain these numbers to a patient, an intelligent person will do the right thing.
Melanie: That’s what you just said, an intelligent person, so men – you say education is so important but to them all they hear is camera, prep. They think it’s going to be a lot – and as someone who’s had a bunch of colonoscopies, I can tell you how easy it is. Usually the person wakes up and says “When are you going to start?” Right? So, speak about that prep a little and how easy this test really is.
Dr. Kenny: We’re, obviously, aware of this, we confront this on a daily basis and we’ve tried to make everything easy about it. For instance, the cost of the procedure. We’ve now got legislators to actually include this test for Americans to be cost free. If you have insurance, most insurance companies will give you the benefit of doing this for free. So, it’s for free – number one. It’s going to save your life – number two. Number three – the inconvenience of the prep – we’ve worked on that. The prep that we particularly use is a modified use of Gatorade. I drink G2 when I go to the gym. This is the same substance you’re going to drink for this prep that I have. It’s not onerous. It’s just that 24-hours before the examination drinking Gatorade. So, the palatability of the prep has changed. The prep is vitally important so we’re not going to compromise on the quality but we’ve taken it down to where people tolerate the preps and we’re even looking at allowing people to eat a little bit more in that first 24 hours. We are very cognizant of what the complaints are but the benefits clearly outweigh all of that. Yes we have listened. We’ve made it easier. The palatability is easier. The test itself – we really don’t even worry about that conversation anymore because of the kind of sedation that we have now. It’s just like you said – you go to sleep you have no idea that you had the test you wake up and it’s not infrequent people say, “When are they going to start?” Because you’re sedated and out for the procedure. The comfort issue is not a problem with the test itself now. The prep questions have been answered in large part by making these kinder, gentler preps and the discomfort with the procedure has really been answered by the different types of anesthetic or sedation that we give now as compared to say five or ten years ago.
Melanie: See, women, we don’t mind taking this test because we lose a pound or two for a day. So, we’re happy about that. We’re on a liquid diet and then we get rid of everything. It’s a nice cleanse. Then we get on the scale and jump up and down for a few times. Men don’t look at all those kinds of humorous things. We can make it humorous; however, it’s a really serious cancer and this is such a preventive procedure. What else do you want men to know or women who love them about getting in to see a G.I. guy? As you say they’re free now. They’re part of a well visit. What else do you want women to know to get their men into see you?
Dr. Kenny: What I want the women to know, too, is that they should come in, too. The screening rates for colon cancer are below those – women are getting their mammograms and they’re getting their PAP smears at a rate of 80-90%, but they’re about 67% on getting screened for colon cancer. Even though they’re doing a good job with those things, it still should be higher than that. There’s a goal now of getting 80% of people screened by 2018. If they go first, they’ll see what I’m saying here is true and they will have not a horrible experience with this. Then, they go first and then they’ll be able to bring in their loved ones. It’s not uncommon that that is what happens. You get the woman first and then the husband will then come in after he sees it’s not so horrible.
Melanie: That’s great advice. I love that. What about after if polyps are found? That’s what a lot of people men and women are afraid to get it because they’re afraid of what’s found afterwards. Are some polyps worse than others?
Dr. Kenny: Certainly. You have a range of polyps. You have to think of it as a stage. I frequently say there are four steps between the formation of that polyp and cancer. Through that journey, there are a number of mutations that these polyps accrue before they become cancer and before they invade. There are some polyps that are what we consider are pretty close to innocuous – the hyperplasic polyps. There are other polyps that are most commonly called “adenomatous polyps” and perhaps one in six of those over an extended time period – 5 to 8 years – would develop into a cancer. Then, there’s the serrated adenoma which is flat legion which has a slightly different biology and they’re more serious. But, there are some innocuous polyps but the ones that we’re looking for are the adenomatous polyps and the serrated adenomas. If you have them there, you want them out.
Melanie: That’s the whole point is that you take them out and then they’re gone. Do they grow back over time? How often if somebody has polyps do you want them to come back for a colonoscopy?
Dr. Kenny: It depends on multiple factors. You basically have to stratify your interval of follow up proportional to the patient’s risk of getting another polyp. First of all, like you said to begin with, are you sure you got every part of the tissue there? You want to be sure that you have complete removal of the polyp. There are certain criteria that we have where we’re certain about it and other ones where it is a little more questionable. If there is some question, the interval of time is shorter. The garden variety situation where we’re sure we got all of the polyps out and they’re not a great number and they’re not a great size and they’re not advanced – the short answer to your question is you’d follow up in five years. But, some of these other criteria you might want to do it in a shorter interval if you had some concerns.
Melanie: In just the last few minutes, Dr. Kenny, and what a great guest you are, please give your best advice for people and getting their colonoscopy – not just men but, as you said, women, too, and how important this preventive screening is and why they should come to Summit Medical Group for their care.
Dr. Kenny: The reason that they should do this colonoscopy is because it’s the gold standard. It’s the best test. It’s the test I’ve had on myself, the test I’ve had on our family. We practice what we preach. If for some reason you couldn’t get them to do it, there are other tests that are available – fecal occult blood testing, for example. The best test is the test that’s done. If you couldn’t get this, get something done. That’s one of the take home points that I wanted to have. The gold standard test, the colonoscopy, it does matter who’s doing the procedure. That brought you to this situation with the Summit Medical Group. Convenience. You’ve asked about how we do it. We’ve even gotten to the point we’re doing this test by direct access now. What that means is a healthy 50-year-old can contact our office and if they’re otherwise healthy, we can do it directly without even coming into the office for an office visit beforehand. Availability--we’ve made a commitment to this. We’ve actually started to do these on Saturdays. So, it’s easy access for people because we believe in this. The legislature has manned up by paying for this, making it cost free to the patient in that circumstance. The reason that you do this is there are ample studies that it really does make a difference who’s doing your colonoscopy. There were studies in Canada that if you had your colonoscopy done by a primary care physician, which is sometimes done in Canada, you’re 40% more likely to have a cancer develop in the interval than you were if you had it done by a gastroenterologist. Among gastroenterologists – not all gastroenterologists are created equal. We track quality perimeters. How good is your colonoscopy rate? We have an adenoma detection rate. How often on a patient if you’re doing a screening colon do you find an adenoma or a polyp? The industry standards may say that it’s 25% in males and 15% in females but in our practice here, we’re running 50% and also sometimes we have 60%. The reason we get that is we insist on good preps and the people that are doing the test have a commitment to this. In my office here we have five Ivy League trained gastroenterologists – Harvard, Penn, Cornell and I’m the last guy from Yale. It sounds geeky but we spend a lot of time just talking about preps and all these things to maximize that adenoma detection rate. Why do we do that? Because if we maximize the adenoma detection rate, the chance that person will develop a cancer in the time between their next recommended colonoscopy and the one you’ve done is shown to be markedly decreased. The higher the adenoma detection rate, the lower the interval cancer rate. It’s a very important thing. If you’re concentrating on quality, those are the things that you do. You want to have an endoscopist who concentrates on quality.
Melanie: Wow. What great information and so beautifully put. Thank you so much, Dr. Kenny, for being with us today. You’re listening to SMG Radio and for more information you can go to SummitMedicalGroup.com. That’s SummitMedicalGroup.com. This is Melanie Cole. Thanks so much for listening.