The Truth About Colon Cancer Screening The Green Smoothie Challenge By David E. Stein, MD
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By Christina Sciarretta
s a practicing colorectal surgeon, March is very March,exciting it feels likebecause I am – not pullingwinter myself outends of and a pit of formally spring healthit and way Colon too beginscrappy – but because is National Cancermonths Awareness Month.dark, On February many of cold, damp 29, 2000, President William Jefferson weather, and if you live here at Clinton signed a Presidential Proclamation the shore, you know that with the designating March to be the month where weather we have had, this year is no we think about everyone’s colons. Those different! I don’t know about you, interested can insert commentary here.but it feels to me it hasawareness been raining The goal waslike to create about for 87 years. colorectal cancerI cannot screening,understand since at the time people less thanlive 25%inofyear-round people underwent how rain, proper screening every year. Why do in we like Seattle or London. We, here care? Colorectal cancer is the second Atlantic County, are beach people. most common cause of cancer death in We don’t thrive in gloom and darkthe United States and is the third most ness. Wecancer comeintomen lifeand in sun, sand, common women with and salty air. As such,cases I always find approximately 145,600 diagnosed every year. The incidence, defined as the myself needing a total recharge occurrence of new cases diagnosed in March. That recharge comes inina given year,ofisaslightly higher than the form giant cup fullin ofmen green women. For Ashkenazi Jews, there is an awesomeness and good vibes. increased risk of developing colorectal I use over the month of March to replencancer the general population. This is ish body with vita-of duemy to adepleted genetic mutation foundthe in 6% Ashkenazis. For people with this mutation, the risk of developing colorectal cancer is two times greater than those who do not have the mutation. Screening, for cancers before they begin to cause symptoms, has been shown to decrease the incidence of cancer when implemented in a population. In fact, the incidence of colorectal cancer has been decreasing as more and more people get screened for this preventable cancer. Effective screening is the product of three critical factors: accuracy, compliance, and access. Compliance rates are still suboptimal; approximately 65% of Americans report being screened at least once on survey questionnaires, but the participation rates may be lower based on actual record reviews. Fewer still are compliant with the screening frequencies recommended in guidelines. Finally, access (geographic or otherwise) is a barrier to many people. Since early cancers rarely cause symptoms, testing to detect something becomes critically important. So now that we understand why we need to screen for colorectal cancer, who needs to be screened? The American Cancer Society recommends routine colorectal cancer screening for anyone who turns 45 years of age. In years past it was age 50, but the incidence of colorectal cancer in younger patients has been increasing, so the age
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to begin screening was reduced in 2018. There are specific guidelines for individuals at higher risk for cancer, but this article will focus on average risk adults. Depending on the choice of screening test, the interval between these tests varies. Screening should continue for healthy individuals through the age of 85. For those over 85, screening is not required. It is important to re-emphasize that these guidelines are for healthy, asymptomatic adults who do not have any family history of cancer. If you have any symptoms, such as change in bowel function or blood in the stool, please tell your physician. Now that we know why we screen and who needs screening, what screening test should you choose? There are three main categories of tests: stool-based tests (gross, but no prep required), imaging tests (radiology and prep required) and endoscopic tests (invasive and prep required). I will briefly highlight what I believeand are nutrients the most effective within mins that it istests missing, each of these categories. due to the over-abundance of carbs Stool based tests include Fecal and sugar and lack of anything green Immunohistochemical Tests (FIT) and or healthy… anyone else? Come Multi-Target Stool DNA Tests (Cologuard on, Enter theantibodies Green from somebody! Exact Sciences). FIT uses to detect microscopic amounts of human blood in the stool. A single stool sample is probed several times with a sampling stick, placed into a tube and sent to a laboratory where it is tested for blood. It should be done every year. It detects about 80% of colon cancers which is why we do this every year. Cologuard analyzes the stool for altered DNA found in common cancers. A whole stool is deposited into a bucket mounted to a toilet seat, which gets sealed and sent to a central laboratory by a prearranged mail courier service. This test detects 92% of cancers and is done every three years. If either test is positive, one needs to get a colonoscopy to confirm the source of the blood or abnormal DNA. The major advantages for stool-based testing are that it requires no prep, can be done at home, is cheap and noninvasive. Cat Scan (CT) Colonography, often called Virtual Colonoscopy is also an acceptable screening test for colorectal cancer. For this test, the colon needs to be cleaned with bowel prep. The day before the procedure you drink clear liquids only, then take the bowel cleanse medication the evening before. The way the procedure works is a technician inserts a small tube trans-anally and distends the colon with air. Then the CT scan is performed. This test detects 90% of cancers but does have a higher incidence of false positives. It is ideal for someone who cannot have or doesn’t want a colonoscopy
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as no sedation is required. It needs to be repeated every five years and does deliver a radiation dose. Similar to the stool tests, a positive test will require the person to undergo a colonoscopy. MRI (magnetic resonance imaging) colonoscopy which has higher resolution and no radiation is not yet mainstream. Colonoscopy is still the gold standard for colorectal cancer screening. In addition to having a high cancer detection rate of up to 93%, it also allows endoscopists to actually remove precancerous growths called polyps – essentially preventing the polyp from growing into cancer. Similar to Virtual Colonoscopy, you need to drink clear liquids the day prior and do a bowel cleanse so the endoscopist can see the inside wall of the colon. Colonoscopy is also usually performed under sedation which means you need someone to accompany you. That being said, I have had patients who refuse sedation and do the procedure awake – it is an option – even if not desirable by 99% of Smoothie. I have found that blending the population. It is repeated every years. nutrient-rich leafy greens with10 other Although this is the best test, because it
is invasive and uses anesthesia it also has the most risk. Injury tolike the me, colonyou can know occur If you’re a parent in just under 1 out of a thousand scopes. that healthy eating is just about last Anesthesia also carries a small but real risk. on the to-do list for most of the year, Since colonoscopy is both diagnostic and so it’s important for us to takecancer time therapeutic, the benefits of finding to stop and polyps reset.outweigh If you go and removing thetoo risk.long So, what should you do? Let’s it, without proper nutrition, it willface creep drinking copious amounts of fluid that back up in awful ways, like chronic can make you nauseous and will give you disease, illness, aches and pains, diarrhea may not be your idea of fun, but low energy, moodiness, etc. I’d like it beats dying of colon cancer. In general, I to encourage you all to(and joinitour com-I recommend colonoscopy is what munity, takeat charge of then yourfollowing health, had) starting age 45 and up 10-year intervals. someone really andat consider takingIf the challenge does not want a colonoscopy, then yourself or with your family or team!I recommend stool DNA test (Of course,the asCologuard with anything healthevery three years. The most important take related, it is always important to dishome message is that it does not matter cuss the benefits and risks with your how you get screened for colorectal cancer; havegettoscreened. do peace, itphysician.) matters thatAll youyou actually love, and good vibes, my friends! David E. Stein, MD, serves as the Regional Chief of makes Surgerya green for MedStar Health’s What smoothie? Baltimore region and Chair of Surgery for Leafy greens of your choice spinFranklin Square Medical Center. He is boarded ach, kale, collards, swiss chard, etc in both General and Colon and Rectal Surgery.
Other veggies of choice: carrot, veggies, fruit, and liquid (yogurt, coconut water, almond milk, etc.) bring cucumber, beets, etc MIKVEH Fruit of your choice (I almost almy body and mind back to life.ISRAEL It is ASSOCIATION use ANNUAL bananas and one or more a total rejuvenation! For YOU 31 days, I waysTHE INVITES TO ATTEND of the following: pineapple, mango, commit to consuming a homemade PURIM CELEBRATION green smoothie every single day. By berries, cherries, papaya, avocado, apple,9,etc the end of the month,MONDAY, I almost don’t MARCH 2020 Liquid of your choice: yogurt, cocoeven recognize myself. My skin is radiant, my hair is shinier, my energy nut milk, almond milk, ice, water, etc Extras: chia seed, flax seed, protein level is sky-high, my mental clarity is improved, my sleep is deep, my wake powder, hemp seed, cacao powder, is easy, I’m usually a bit more trim, I etc Here are just a few of the benefits begin to crave healthier foods, and I feel unbelievably freaking awesome. of green smoothies: • Increased energy I decided that I just couldn’t keep this • Improved digestion magic to myself, so I created The Sci• Improved mental clarity and arretta Collection’s Green Smoothie focus Challenge! • Supports overall health I can’t lie, it is a bit scary to see • Improved mood how much change happens, just • Glowy skin from nourishing my body properly.
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