Fayez G. Seif, M.D., StopColonCancerNow.com physician expert and Medical Director of Texas GI Endoscopy Center in Mesquite, Texas, specializes in gastroenterology and internal medicine and is dedicated to increasing the colonoscopy screening rate in the Dallas-Fort Worth area through education and quality care.
What is one issue that needs more attention in colon cancer prevention?
Dr. Seif: One issue that needs more attention is young-onset colon cancer. Family history can contribute to one’s risk for developing colon cancer. Lynch syndrome (or hereditary nonpolyposis colorectal cancer) is a genetic condition that increases the risks for many types of cancer, especially colon cancer. People with Lynch syndrome also have an increased risk of cancers of the stomach, small intestine, liver, gallbladder ducts, upper urinary tract, brain, ovaries, uterus, and skin. Colon polyps often develop earlier than they do in the general population.
It is extremely important that individuals with Lynch syndrome be screened early and often. It is also essential that these individuals communicate with their family members so their respective doctors can identify appropriate screening ages for each family member. It is my hope that, as we communicate more effectively, family physicians will refer these patients to our centers at a younger age. I remind my patients that 50 years of age is not the appropriate screening age for everyone; it is only for those who are at average risk for colon cancer. Knowing your risk and being aware of when you should have your first colonoscopy is the first step to colon cancer prevention.
Why is a colonoscopy the best colon screening?
Dr. Seif: The reason why a colonoscopy is the best colon screening is because colon cancer is preventable. Colon cancer begins as a polyp and polyps can grow and become dysplastic or malignant. We want to interrupt that process. Individuals usually develop polyps in their 50s, and that is why gastroenterologists screen men and women around 50 years of age. Unlike other cancers, we screen for the purpose of identifying precancerous lesions to prevent those lesions from developing into cancer later on.
Theoretically, if everyone chose to be screened at the appropriate time and intervals, we could actually eradicate colon cancer through prevention. We still have much to accomplish to achieve this goal because Americans fall prey to many “colon cancer myths.” One myth is that colon cancer is rare and is only a disease that affects the elderly. In actuality, the American Cancer Society estimates that there will be about 95,000 new cases of colon cancer diagnosed in 2016 and roughly 39,000 new cases of rectal cancer. Another myth is that colon cancer mostly affects men, but this is not true either. Colon cancer is the second leading cause of cancer death after lung cancer. The lifetime risk for a man developing colon cancer is about 1 in 21 and 1 in 23 for women. In fact, more women die from colon cancer than breast cancer.
Can you tell me about how colonoscopies have changed over the years?
Dr. Seif: Much has changed over the years regarding colonoscopies, especially in the preparation. The bowel prep continues to be one of the major reasons that individuals do not choose to have a colonoscopy. The Centers for Disease Control estimates that one in three American adults between the ages of 50 and 75 is not is not being tested for colon cancer as recommended. When surveyed, many men and women admit that their dread of the bowel preparation is a significant obstacle in wanting to schedule a colonoscopy.
In the past, the single-dose regimen for bowel preparation was the only prescribed method. The patient was required to consume a large volume of fluid the night before the procedure, and it often resulted in nausea and other undesirable side effects. The split-dose method is now almost universally accepted among gastroenterologists because it results in a better bowel cleansing. Now, patients can take the first dose of prep solution the night before the procedure, and the second dose on the morning of the procedure.
What we have found is that patient satisfaction improved dramatically with the split-dose method, but there are still some drawbacks. The bowel prep takes a long time. The prep solution is more palatable, but men and women still need to take two days off work for the prep day and the procedure day, which is a hassle at best and an impossibility at worst. Another downside is the clear liquid diet and fasting from solid foods. Being limited to a clear liquid diet is quite difficult for some people, and just one more reason that many eligible individuals choose not to be screened.
Can you share more about this low-residue diet that is gaining attention?
Dr. Seif: Recent research now shows that a low-residue diet is just as effective as a clear liquid diet for optimum visualization of the colon. Instead of patients only being allowed to have sodas, broth, popsicles, clear juices, tea, and black coffee, patients could eat foods like rice, white bread, pasta, or potatoes. There were six randomized studies, including a meta-analysis that found that a low-residue diet and a clear liquid diet produced the same results. This body of research is more than sufficient to prove that patients do not need to starve themselves and be uncomfortable in order to have a quality colonoscopy.
Do you prescribe the low-residue diet or the clear liquid diet?
Dr. Seif: I confidently prescribe a low-residue diet for my patients, and my adenoma detection rate (ADR) has remained consistent. There are many doctors who suggest a clear liquid diet and will continue to do so, but the low-residue diet is gaining wider acceptance.
Can you share one new advancement that is happening in the field of gastroenterology?
Dr. Seif: As I stated, one of the barriers to colon screening is the time-consuming nature of the colonoscopy prep. Many individuals simply cannot take time off from work for two days or do not want to have their lives interrupted. One way to solve this problem would be to have a way to clear the bowel more quickly and efficiently.
The FDA has recently approved an alternative to the traditional bowel prep: a high-water enema called HyGIeaCare to clear the bowel in a fraction of the time. It only takes about 20 minutes, and it is safe and effective. Basically, a patient is required to do very little to prepare for a colonoscopy. He or she would come into the center, have the enema procedure and immediately proceed to the screening colonoscopy. Currently, the enema is not covered by insurance, but this may change in the future. A survey showed 95 percent of HyGIeaCare patients would choose this method again for their next colonoscopy.
Dr. Seif completed his undergraduate studies and medical degree at Cairo University and School of Medicine, and completed his internship and residency at the New York Medical College and Westchester County Medical Center. He is a fellow of the American Gastroenterology Association. He’s also a member of the Texas Medical Association, the Dallas County Medical Society, the American College of Physicians, the American College of Gastroenterology, and the American Society for Gastrointestinal Endoscopy (ASGE). Over the course of his career, Dr. Seif has had numerous articles published on studies conducted in the field of gastroenterology.