A Call to Return to Regular Screening

A CALL TO RETURN TO REGULAR SCREENINGS

The pandemic interrupted many health screenings—with serious consequences. A colorectal surgeon at CBMC explains why it’s imperative to get back on schedule for these tests and preventive screenings.

The COVID-19 pandemic has upended many aspects of our lives, including normal health care. In the past two years, many people have cancelled important elective procedures, which has led to a substantial decline in cancer screening, according to the American Cancer Society (ACS).

“We’re seeing a lot of bad things resulting from COVID not allowing us to find things early,” when cancer is most easily and successfully treated, says Mark Gilder, M.D., a colorectal surgeon affiliated with Cooperman Barnabas Medical Center (CBMC) and a member of the RWJBarnabas Health Medical Group. “We lost a lot of ground with prevention. We were doing a pretty good job, but now we have to kind of reinvent the wheel a bit, and get back to prevention.”

Gilder notes that, in his specialty, screening guidelines have changed recently. In the past, regular screening for colorectal cancer typically started at age 50 for those at average risk for the disease. Now, most health organizations, like the American Cancer Society, the American Society of Colon and Rectal Surgeons and the Centers for Disease Control and Prevention, put the starting age at 45 for average-risk individuals. (See risk categories at right.)

Early detection can make a world of difference. Take the case of Gang (he prefers to use one name), a 39-year-old who started having abdominal pain and irregular bowel movements. Three different gastrointestinal specialists misdiagnosed him with diverticulitis and treated him with antibiotics. When Gang’s symptoms persisted, he was referred to Dr. Gilder, who suspected an abnormal growth and recommended that Gang get a colonoscopy. The procedure confirmed he had an obstructive mass, and a biopsy found that it was cancerous. Six days later, on November 16, 2021, Dr. Gilder performed surgery to remove the tumor.

Post-surgery, Dr. Gilder and Gang’s oncologist, Michael Scoppetuolo, M.D., medical director of The Cancer Center at CBMC, determined that Gang did not need any further treatments, but will be evaluated regularly for any changes. Gang, a marathon runner who’s in “very good shape,” Dr. Gilder says, quickly regained his strength and, just six weeks later, was back to his normal running routine and training for his seventh marathon in Philadelphia this November—just one year since surgery. Now cancerfree, Gang says it’s important to “listen to your body. You know yourself better than anyone else. If you have a problem, take action.” At 39, Gang was not a candidate for regular screening; had he been, the test may have caught his disease in its earliest stages before it became cancerous. There are several options for testing, according to the ACS, including stool-based tests, DNA testing and imaging tests. But the gold standard is colonoscopy, a minimally invasive procedure that allows the surgeon to see inside the colon and rectum and remove any growths, called polyps, to test for signs that they could become cancerous. Mark Gilder, M.D. Dr. Gilder adds that some insurance companies have not been quick to update their coverage to meet the new 45-and-older recommendations, and initially may not cover the expenses of the screening. “This is a situation where, clearly, lives are saved, but unfortunately some insurance companies are delaying this. It’s very frustrating for all of us [in his field],” he says. If a patient’s insurance initially denies coverage, his team can try to authorize it on a case-by-case basis. Dr. Gilder’s final word is to take the screening guidelines seriously. The preparations needed are much easier and more flexible to accommodate one’s work requirements, the sedation required is minimal, there is no pain and the recovery is quick. Most importantly, screening saves lives. To learn more about colorectal cancer treatment or to make an appointment, go to 973.322.0250 or rwjbh.org/colonscreening. CBMC, together with Rutgers Cancer Institute of New Jersey, is the state’s only NCI-designated Comprehensive Cancer Center.

ACS GUIDELINES

The American Cancer Society recommends that people at average risk of colorectal cancer start regular screening at age 45. People who are in good health and with a life expectancy of more than 10 years should continue regular colorectal cancer screening through the age of 75.

For people ages 76 through 85, the decision to be screened should be based on a person’s preferences, life expectancy, overall health and prior screening history. People over the age of 85 should no longer get colorectal cancer screening.

For screening, people are considered to be at average risk if they do not have: • A personal history of colorectal cancer or certain types of polyps. • A family history of colorectal cancer. • A personal history of inflammatory bowel disease (ulcerative colitis or Crohn’s disease). • A confirmed or suspected hereditary colorectal cancer syndrome, such as familial adenomatous polyposis (FAP) or Lynch syndrome (hereditary nonpolyposis colon cancer or HNPCC). • A personal history of getting radiation to the abdomen (belly) or pelvic area to treat a prior cancer.

Those at higher risk may need to begin screening earlier. Talk to your doctor to assess your risk and screening schedule.