According to the U.S. Preventive Services Task Force, colorectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States.
Colonoscopies remain the most powerful weapon in the prevention, early detection and treatment of colon cancer.
John M. Dalena, M.D., Summit Medical Group Gastroenterologist, discusses current screening guidelines and the benefits of this important preventive health test.
Selected Podcast
Importance of Colorectal Cancer Screening/Colonoscopies
Featured Speaker:
In addition to his position at Summit Medical Group, Dr. Dalena is Director of Endoscopy at Morristown Surgical Center and Chairman in the Department of Gastroenterology at Morristown Medical Center in Morristown, New Jersey. He is an attending physician in the Department of Internal Medicine at Morristown Medical Center, Florham Park Endoscopy Center, Hanover Endoscopy Center, and Morristown Surgical Center. Dr. Dalena has practiced privately with Atlantic Gastroenterology in Cedar Knolls, Florham Park, Morristown, and Whippany, New Jersey.
He is a member of the American Medical Association, Medical Society of New Jersey, Morris County Medical Society, American College of Gastroenterology, and Alpha Omega Alpha Honor Medical Society. He is Past Chairman and a member of the Crohns and Colitis Foundation Medical Advisory Committee - New Jersey Chapter.
Dr. Dalena has earned the Morristown Medical Center Physician of the Year Award. He also earned the University of Medicine and Dentistry Fellowship Research First Prize Award and American College of Physicians - New Jersey Chapter Laureate Award for Outstanding Achievement in Medicine. He has been featured multiple times in New Jersey Monthly and Castle Connolly "Top Doctors" and "Top Doctors in the New York Metro Area" listings. Dr. Dalena is one of few physicians nationwide to earn Castle Connolly "Top Doctor" listings for more than 10 consecutive years. His "Top Doctors" listings are reprinted in Inside Jersey and US News and World Report.
When he is not working with his patients, Dr. Dalena is an avid runner and cyclist. He has completed many duathlons, triathlons, and marathons. A life-long resident of Morris County, Dr. Dalena lives in Madison with his wife and 3 children.
John Dalena, MD
John M. Dalena, MD, specializes in conditions and diseases of the esophagus, stomach, small intestine, large intestine, liver, gall bladder, and pancreas. Dr. Dalena also provides a wide range of gastrointestinal services, including cancer screening, nutritional support, therapeutic endoscopy, and colonoscopy.In addition to his position at Summit Medical Group, Dr. Dalena is Director of Endoscopy at Morristown Surgical Center and Chairman in the Department of Gastroenterology at Morristown Medical Center in Morristown, New Jersey. He is an attending physician in the Department of Internal Medicine at Morristown Medical Center, Florham Park Endoscopy Center, Hanover Endoscopy Center, and Morristown Surgical Center. Dr. Dalena has practiced privately with Atlantic Gastroenterology in Cedar Knolls, Florham Park, Morristown, and Whippany, New Jersey.
He is a member of the American Medical Association, Medical Society of New Jersey, Morris County Medical Society, American College of Gastroenterology, and Alpha Omega Alpha Honor Medical Society. He is Past Chairman and a member of the Crohns and Colitis Foundation Medical Advisory Committee - New Jersey Chapter.
Dr. Dalena has earned the Morristown Medical Center Physician of the Year Award. He also earned the University of Medicine and Dentistry Fellowship Research First Prize Award and American College of Physicians - New Jersey Chapter Laureate Award for Outstanding Achievement in Medicine. He has been featured multiple times in New Jersey Monthly and Castle Connolly "Top Doctors" and "Top Doctors in the New York Metro Area" listings. Dr. Dalena is one of few physicians nationwide to earn Castle Connolly "Top Doctor" listings for more than 10 consecutive years. His "Top Doctors" listings are reprinted in Inside Jersey and US News and World Report.
When he is not working with his patients, Dr. Dalena is an avid runner and cyclist. He has completed many duathlons, triathlons, and marathons. A life-long resident of Morris County, Dr. Dalena lives in Madison with his wife and 3 children.
Transcription:
Importance of Colorectal Cancer Screening/Colonoscopies
Melanie Cole (Host): According to the US Preventative Services Task Force, colorectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States. Colonoscopies remain the most powerful weapon in the prevention, early detection, and treatment of colon cancer. My guest today is Dr. John Dalena. He is a gastroenterologist with Summit Medical Group. Welcome to the show, Dr. Dalena. Tell us a little bit about colonoscopies. People get afraid. They don’t want to have them. They put them off for the longest time. When should you have your first colonoscopy? And give us some of the screening guidelines out there.
Dr. John Dalena (Guest): Sure. Thank you for having me, first of all. I’m happy to be part of this program. To answer your question, the average risk patient, in other words—no family history, no other medical conditions such as inflammatory valve disease—would begin screening at 50. However, if you’re an African American, the guide is 45 years old.
Melanie: You are supposed to get yours if you’re the average American at 50 years old. This is an initial one or baseline. How often after that do you get them?
Dr. Dalena: Another great question, Melanie. Thank you. The assumption would be if your first exam is normal, then your next one is in 10 years, unless, of course, your life expectancy is less than 10 years, then it would not be repeated.
Melanie: Tell us about colonoscopy itself. We hear that you want a clean colon. You want to be able to go in there and see the walls, the lining, and get everything kind of pictured very well and clear. Tell us about the prep because that’s what most people are afraid of, Dr. Dalena.
Dr. Dalena: That is so true. If there could be a colonoscopy done without a prep, there would be much, much more of a compliance issue than there is now. Right now, the vast majority of people are still not getting screened. The roadblock is the preparation. It’s a day of a liquid diet prior to the procedure, clear liquid diet—lots of ginger ale, apple juice, Gatorade, et cetera. Then the evening prior, there’s a laxative. There’s various kinds. But the idea is to get things flowing. Then the morning prior to the procedure, at least in our practice up here in New Jersey, we give a second dose. About five hours prior that is the icing on the cake when it comes to really getting that colon to its place where you can see millimeter size polyps. That’s important because if you’re going to tell that patient that they’re good for 10 years, you better really see completely. Otherwise, you’re running into missed lesions and then a long interval between your next colonoscopy, and that can lead to trouble. An important aspect to this, the most important aspect of this discussion about colonoscopy is the preparation. It needs to be as good as possible.
Melanie: Does it have to be a gallon of liquid? Because that’s really what makes people nauseous. Tell us about a few of the preps that are out there now.
Dr. Dalena: The evolution of the preps is very interesting. Twenty-five years ago, when I started, it was unequivocally the large gallon of salty tasting fluid that caused a lot of discomfort. It was not pleasant. Since then, there have been many attempts at creating preps that were lower volume. The balance is not only are we trying a low-volume prep, but we want one that is effective and of course safe. We can have tremendous imbalances in the electrolytes of the patients because we’re doing colonoscopies on people with kidney disease, heart disease, who can’t withstand wide fluctuations in their electrolytes. It’s a complicated process, and the number one question I get is why can’t this be made more palatable and a smaller volume. There’s a lot of great minds working on it, and the evolution is smaller volume and still effective but yet safe for those people who need to have a delicate range for their electrolytes remaining.
Melanie: Now we’re on to the procedure itself, which is really a piece of cake. People must say to you every day, “When are you going to start?” and meanwhile then you say, “I’m done.”
Dr. Dalena: I give credit to the anesthesiologist for that statement because it is the medication that they’re administering that makes the patient say that exact sentence that I do indeed hear over and over again. The sedation is such that the patient doesn’t feel the scope going in, coming out. There’s no after-effects from the anesthetic. There’s no hangover type feeling of headache or nausea. The patient usually says it’s the best sleep they’ve ever had. Meanwhile, I’ve gone in there and removed polyps or diagnosed colitis or diverticulosis or whatever other condition there may be, all while the patient is having their best sleep ever. So I give credit to the anesthesiologist for that.
Melanie: Now, you give us these pretty little pictures when we’re done, and you show us these wonderful—really amazing, actually—color pictures of the insides of our colon. Tell us about polyps. If you had to remove them, should we be worried that now we are a higher risk for colon cancer?
Dr. Dalena: Again, Melanie, it’s a hundred percent correct. The complicated part of the discussion is that there’s different types of polyps. There’s not just benign and malignant. Within the benign category, there’s subtypes. Your next colonoscopy will be determined by the subtype of polyp that you have and also the size of that polyp. If a polyp is large, you’re most likely going to come back in three years, regardless of the type of benign polyp it is. If the polyp is small and it’s a certain type, you may indeed still come back in three years. However, I would say the majority of patients who have a one solitary small polyp removed need to return in five years. There are polyps that are large. The large and flat polyp, that could require a follow-up in three months to make sure that it was entirely removed. There’s lots of variation, but in general, you can plan on coming back in anywhere from three to five years.
Melanie: Then, what is our worry about those polyps? You’re going to tell us what you found and you’re going to do a biopsy of them, then tell us, what, a few days later what it is you found?
Dr. Dalena: Sure. The happening custom with my patients is I let them leave the suite knowing that I’m not worried. “Okay, Melanie, I removed a small polyp. In my experience, it looks entirely benign. I expect you won’t need to return for three to five years. However, I will call you in one week or less and we will solidify that interval when you need to return. However, in the meantime, please do not worry. It looks totally fine.” Until then, the polyp gets analyzed. There’s a pathology report reviewed and for that small adenoma, you’re coming back in five years.
Melanie: Now, wrap it up for us, Dr. Dalena. This is one of the best preventive tools for colorectal cancer that we have. Give your best advice for people that are scared, considering that colonoscopy, and why they should come and see you at Summit Medical Group for their colonoscopy.
Dr. Dalena: Well, colon cancer is one of those conditions where the earlier you catch it, the more likely you are to live. Early detection is key. Colonoscopy and colon cancer are the poster children for early detection. I think that the message is yes, there is an aggravating part to it, but the benefit of having something detected early is far outweighing any misery you may suffer the day prior.
Melanie: Thank you so much, Dr. Dalena. For more information on colonoscopies with Summit Medical Group, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. Go get your colonoscopy. It’s really a piece of cake and something that you will really appreciate that you did. You’re listening to SMG Radio. This is Melanie Cole. Thanks so much for listening and have a great day.
Importance of Colorectal Cancer Screening/Colonoscopies
Melanie Cole (Host): According to the US Preventative Services Task Force, colorectal cancer is the third most common type of cancer and the second leading cause of cancer death in the United States. Colonoscopies remain the most powerful weapon in the prevention, early detection, and treatment of colon cancer. My guest today is Dr. John Dalena. He is a gastroenterologist with Summit Medical Group. Welcome to the show, Dr. Dalena. Tell us a little bit about colonoscopies. People get afraid. They don’t want to have them. They put them off for the longest time. When should you have your first colonoscopy? And give us some of the screening guidelines out there.
Dr. John Dalena (Guest): Sure. Thank you for having me, first of all. I’m happy to be part of this program. To answer your question, the average risk patient, in other words—no family history, no other medical conditions such as inflammatory valve disease—would begin screening at 50. However, if you’re an African American, the guide is 45 years old.
Melanie: You are supposed to get yours if you’re the average American at 50 years old. This is an initial one or baseline. How often after that do you get them?
Dr. Dalena: Another great question, Melanie. Thank you. The assumption would be if your first exam is normal, then your next one is in 10 years, unless, of course, your life expectancy is less than 10 years, then it would not be repeated.
Melanie: Tell us about colonoscopy itself. We hear that you want a clean colon. You want to be able to go in there and see the walls, the lining, and get everything kind of pictured very well and clear. Tell us about the prep because that’s what most people are afraid of, Dr. Dalena.
Dr. Dalena: That is so true. If there could be a colonoscopy done without a prep, there would be much, much more of a compliance issue than there is now. Right now, the vast majority of people are still not getting screened. The roadblock is the preparation. It’s a day of a liquid diet prior to the procedure, clear liquid diet—lots of ginger ale, apple juice, Gatorade, et cetera. Then the evening prior, there’s a laxative. There’s various kinds. But the idea is to get things flowing. Then the morning prior to the procedure, at least in our practice up here in New Jersey, we give a second dose. About five hours prior that is the icing on the cake when it comes to really getting that colon to its place where you can see millimeter size polyps. That’s important because if you’re going to tell that patient that they’re good for 10 years, you better really see completely. Otherwise, you’re running into missed lesions and then a long interval between your next colonoscopy, and that can lead to trouble. An important aspect to this, the most important aspect of this discussion about colonoscopy is the preparation. It needs to be as good as possible.
Melanie: Does it have to be a gallon of liquid? Because that’s really what makes people nauseous. Tell us about a few of the preps that are out there now.
Dr. Dalena: The evolution of the preps is very interesting. Twenty-five years ago, when I started, it was unequivocally the large gallon of salty tasting fluid that caused a lot of discomfort. It was not pleasant. Since then, there have been many attempts at creating preps that were lower volume. The balance is not only are we trying a low-volume prep, but we want one that is effective and of course safe. We can have tremendous imbalances in the electrolytes of the patients because we’re doing colonoscopies on people with kidney disease, heart disease, who can’t withstand wide fluctuations in their electrolytes. It’s a complicated process, and the number one question I get is why can’t this be made more palatable and a smaller volume. There’s a lot of great minds working on it, and the evolution is smaller volume and still effective but yet safe for those people who need to have a delicate range for their electrolytes remaining.
Melanie: Now we’re on to the procedure itself, which is really a piece of cake. People must say to you every day, “When are you going to start?” and meanwhile then you say, “I’m done.”
Dr. Dalena: I give credit to the anesthesiologist for that statement because it is the medication that they’re administering that makes the patient say that exact sentence that I do indeed hear over and over again. The sedation is such that the patient doesn’t feel the scope going in, coming out. There’s no after-effects from the anesthetic. There’s no hangover type feeling of headache or nausea. The patient usually says it’s the best sleep they’ve ever had. Meanwhile, I’ve gone in there and removed polyps or diagnosed colitis or diverticulosis or whatever other condition there may be, all while the patient is having their best sleep ever. So I give credit to the anesthesiologist for that.
Melanie: Now, you give us these pretty little pictures when we’re done, and you show us these wonderful—really amazing, actually—color pictures of the insides of our colon. Tell us about polyps. If you had to remove them, should we be worried that now we are a higher risk for colon cancer?
Dr. Dalena: Again, Melanie, it’s a hundred percent correct. The complicated part of the discussion is that there’s different types of polyps. There’s not just benign and malignant. Within the benign category, there’s subtypes. Your next colonoscopy will be determined by the subtype of polyp that you have and also the size of that polyp. If a polyp is large, you’re most likely going to come back in three years, regardless of the type of benign polyp it is. If the polyp is small and it’s a certain type, you may indeed still come back in three years. However, I would say the majority of patients who have a one solitary small polyp removed need to return in five years. There are polyps that are large. The large and flat polyp, that could require a follow-up in three months to make sure that it was entirely removed. There’s lots of variation, but in general, you can plan on coming back in anywhere from three to five years.
Melanie: Then, what is our worry about those polyps? You’re going to tell us what you found and you’re going to do a biopsy of them, then tell us, what, a few days later what it is you found?
Dr. Dalena: Sure. The happening custom with my patients is I let them leave the suite knowing that I’m not worried. “Okay, Melanie, I removed a small polyp. In my experience, it looks entirely benign. I expect you won’t need to return for three to five years. However, I will call you in one week or less and we will solidify that interval when you need to return. However, in the meantime, please do not worry. It looks totally fine.” Until then, the polyp gets analyzed. There’s a pathology report reviewed and for that small adenoma, you’re coming back in five years.
Melanie: Now, wrap it up for us, Dr. Dalena. This is one of the best preventive tools for colorectal cancer that we have. Give your best advice for people that are scared, considering that colonoscopy, and why they should come and see you at Summit Medical Group for their colonoscopy.
Dr. Dalena: Well, colon cancer is one of those conditions where the earlier you catch it, the more likely you are to live. Early detection is key. Colonoscopy and colon cancer are the poster children for early detection. I think that the message is yes, there is an aggravating part to it, but the benefit of having something detected early is far outweighing any misery you may suffer the day prior.
Melanie: Thank you so much, Dr. Dalena. For more information on colonoscopies with Summit Medical Group, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. Go get your colonoscopy. It’s really a piece of cake and something that you will really appreciate that you did. You’re listening to SMG Radio. This is Melanie Cole. Thanks so much for listening and have a great day.