Colon Cancer: What you Should Know

7 Questions with Gastroenterologist, Steven Itzkowitz, MD

Interview by Lara Trevino, AGNP-C, MSN

In the United States, colorectal (colon) cancer is the second most common cancer death amongst men and women combined. The American Cancer Society estimates there will be 150,000 new cases this year and more than 50,000 deaths. 

These numbers, as staggering as they are, can’t compare to our current situation with COVID-19. However even in the middle of a pandemic, once news spread of the death of 43-year old actor Chadwick Boseman due to colorectal cancer, many of us perked up to ask questions and learn more.

The stats have also been changing in recent years, with more people under 50 being diagnosed with colorectal cancer. In support of these trends, the US Preventive Services Task Force is updating their recommendation to initiate colorectal cancer screening at age 45. 

To dive deeper into symptoms, prevention and screenings, our primary care provider, Lara Trevino, AGNP-C, MSN interviewed Steven Itzkowitz, MD, gastroenterologist and Professor of Medicine and Oncological Sciences at the Icahn School of Medicine at Mount Sinai. This interview focuses on how to identify personal risk factors that contribute to colorectal cancer, preventive lifestyle changes, genetic testing, at-home stool sample testing, and how to select the best doctor for your colonoscopy. 

If you believe you may be at increased risk for colorectal cancer or are 45 or older, we encourage you to contact the Health Center to set up a time to speak with one of our providers about getting screened.

1. What are some early signs and symptoms of colon cancer?

Key takeaway: The top sign of colon cancer is no symptoms. Meaning, you could have colon cancer and have no symptoms. That is why preventive screening is so important. Do not wait for symptoms.

2. What medical conditions or lifestyle decisions put a person at greater risk for colon cancer?

Key takeaway: Colon cancer screening is suggested for anyone over 45 years of age – this is a recent change, down from 50 years old. Hear Dr. Itzkowitz discuss the difference between Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS) and how they can or cannot be a precursor for colon cancer. Lastly, hear him discuss the microbiome and how low fiber diets, processed meats and weight can play into the bacteria within our guts.

3. What degree of family history places a person at increased risk for colon cancer and therefore should seek an earlier screening?

Key takeaway: If a first degree relative (parent, sibling or child) had colon cancer before the age of 60, you should start your screenings 10 years earlier than the recommendations made for the general public.

4. What role does genetic blood testing play in determining colon cancer risk?

Key takeaway: There are certain genes that we know put people at extremely high risk of getting colon cancer. Lynch syndrome is one example. It is an inherited disorder that increases the risk of colon cancer and surprisingly, is more prevalent in the US population than BRCA mutations (breast cancer gene). Genetic testing, which is offered through the Health Center, can play an important role in detecting cancer early.

5. Do you recommend probiotics daily? Any brands that you recommend?

Key takeaway: We believe probiotics are helpful, but it is tough to measure the benefits. Probiotics are not considered a drug and therefore are not regulated by the FDA. When shopping for probiotics, look for ones with multiple strains.

6. Who is a candidate for a stool test vs a standard colonoscopy?

Key takeaway: Colonoscopies are the gold standard and only need to be repeated every 10 years. Alternatively, you can do a stool test which is less expensive and can be administered at home, such as FIT tests or Cologuard. These tests, however, need to be repeated more often: annually for FIT tests and every 3 years for Cologuard.

7. Should I ask my doctor about his/her adenoma detection rate (ADR)?

Key takeaway: The adenoma detection rate is a metric that is applied to screening colonoscopies – meaning the percentage in which a doctor finds an adenoma (polyp) during routine colonoscopy screenings (patients without symptoms or a family history of cancer). Studies show that if a doctor has a high adenoma detection rate, a patient is much less likely to go on to get colon cancer.

You should also be aware that men develop more polyps and at a younger age than women. So if you ask your doctor what their ADR is, their rate should be higher in men than in women. A target ADR is 25% overall; 20% in women and 30% in men.

For Health Center members interested in learning more about colon cancer screening options, please contact our Personal Health Navigators by chat through the member portal or by calling 646.819.5100.

About Steven H. Itzkowitz, MD

Steven H. Itzkowitz, M.D. is Professor of Medicine and Oncological Sciences, and Director of the GI Fellowship Program at the Icahn School of Medicine at Mount Sinai. He is past Chair of the Gastrointestinal Oncology Section of the American Gastroenterological Association, past President of the New York Gastroenterological Association, and immediate past Co-Chair of the New York Citywide Colon Cancer Control Coalition (C5). He is a recipient of a distinguished Jacobi Medallion from the Mount Sinai School of Medicine and a Gold Humanism Award.

Dr. Itzkowitz has served as a Study Section member for the National Cancer Institute, Veteran’s Affairs Merit Review Board, Crohn’s and Colitis Foundation of America, and US-Israel Binational Science Foundation, and as an editor of the International Journal of Colorectal Disease, and Gut and Liver, and associate editor of Inflammatory Bowel Diseases, Clinical Gastroenterology and Hepatology, and Gastric Cancer. He spearheaded efforts to secure NCI funding for the East Harlem Partnership for Cancer Awareness: a program based at Mount Sinai, designed to raise awareness in the East Harlem community regarding the risks and treatment for several common cancers including colon cancer.

Dr. Itzkowitz’s research interests are in the field of gastrointestinal cancer. His laboratory conducts research into the microbiome of patients with inflammatory bowel disease (IBD). Clinical studies have focused on detecting and preventing colon cancer in inflammatory bowel disease, reducing disparities in colon cancer screening, and developing new non-invasive stool DNA tests for colon cancer.

Sources:
https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html