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The Colonoscopy: A Historical Timeline

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As we approach the end of this year’s Colorectal Cancer Awareness Month, let’s take a closer look at something near and dear to our hearts: the colonoscopy. 

As the only screening test that detects and prevents cancer, the best test for finding precancerous polyps, and the only test recommended for people with risk factors such as personal history of polyps or cancer, the colonoscopy is truly a life-saving resource. Over 15 million colonoscopies are performed across the United States each year, reducing the widespread risk of colorectal cancer death by over 60%.

However, despite the colonoscopy’s widespread use and unequivocal standard of effectiveness, it is actually a fairly new methodology, one that took decades to be widely-known and well-established. While variations of the colonoscopy were first conceptualized throughout the 1960s, it wasn’t until the last few decades that the standards of quality which govern the colonoscopy as we know it came to be.

Follow along for a deep-dive into our favorite colorectal cancer screening test. 

1960s-70s: The Early Years

Up until the mid-1960s, the closest thing to a colonoscopy was an endoscopic procedure using a rigid sigmoidoscope. This device had very limited movement, reach, and was unable to actually remove polyps. 

In 1969, colleagues Dr. William Wolff and Dr. Hiromi Shinya of Beth Israel Medical Center in New York City invented the fiberoptic colonoscope, the first device to allow doctors to actually examine the entire length of the colon, thanks to its flexible, dynamic design.

Dr. Shinya also invented the polypectomy snare in 1969, a device which was able to physically remove colorectal polyps using a wire and electro-cauterizing mechanism. 

By 1973, the pair had performed over 5,000 colonoscopies, demonstrating the validity and safety of the procedure. 

1980s-90s: Increasing Awareness

In 1983, the Welch Allyn Corporation invented the first video endoscope, allowing doctors to see the procedure on-screen. Before, they were only able to observe the colon through a small eyepiece. 

Although the colonoscopy continued to develop, there was still a lack of general public accessibility and awareness towards the procedure. Many people opted for tests such as fecal occult blood testing and sigmoidoscopy. It wasn’t until 1985, when President Ronald Reagan underwent a life-saving colonoscopy, that the procedure began to garner national attention. 

In the mid-90s, the first screening recommendations were established in the United States. Adults over the age of 50 were suggested to receive regular colonoscopies. However, in a 1999 survey conducted by the CDC, only 40.3% of American adults over the age of 50 reported ever having a colonoscopy or sigmoidoscopy.  

2000-Now: New Developments

In 2000, the American Society for Gastrointestinal Endoscopy (ASGE) published the first colonoscopy guidelines. This seminal work allowed the quality of a colonoscopy to be measured with a numeric value, the Adenoma Detection Rate (ADR) as well as evaluate measures such as the quality of bowel preparation, patient assessments, rate of complications, cecal intubation rate, and withdrawal time. Doctors were finally able to be pragmatically evaluated for their ability to perform a colonoscopy. 

The early 21st century saw a significant increase in colonoscopies. Self-reported colonoscopies across the United States increased from 20% in 2000 to 47% in 2008. This can be contributed to many factors: a variety of educational campaigns and visibility measures pushed by doctors, government, and public organizations; Medicare coverage of colonoscopy, beginning in 2001; even celebrity stunts such as the Today Show’s Katie Couric’s publicized colonoscopy.

From 2000 to 2015, colon cancer rates rose considerably across increasingly younger populations. For adults aged 40-44, colorectal cancer incidence increased by 28%, for those aged 45-49, colorectal cancer increased by 15%, and while colonoscopy rates increased 17% in those aged 50–54. 

Rising colorectal cancer rates have led to efforts such as the U.S. Preventive Services Task Force’s 2020 recommendation that all adults aged 45-75 should be regularly screened. This was an update from the 2016 guidelines that suggested adults without risk factors should begin screening at the age of 50.

What is the future of the colonoscopy?

The colonoscope of the present remains largely unchanged from that first created by Dr. Wolff and Shinya in 1969. While it has developed in mechanical quality, such as flexibility and control, and now features a light source, suction device, lens cleaning, and a camera, it doesn’t really vary in its fundamental use: to observe and remove colorectal polyps, acting as both a diagnostic and therapeutic instrument. Why is this the case? Likely because it is highly effective at what it does! 

With this in mind, the most important development concerning colonoscopies, arguably, is in the public sphere. While the mechanisms of the procedure itself will undoubtedly continue to evolve and innovate, it’s important to consider the future of public access and opinion towards the colonoscopy.

There is still a surprising amount of misconception surrounding the colonoscopy. A 2020 survey of several European countries found that only 45% of people understood that it can prevent colon cancer. In the United States (pre-pandemic), around 68.8% of adults were up-to-date with their colonoscopy. Many people remain uninformed, fearful, and resistant to receiving the  life-saving screening test. Other people are limited by financial means or geographic accessibility to the procedure. 

By working to increase public awareness around the value of the colonoscopy, we can continue to prevent and reduce colorectal cancer deaths around the world. By educating your friends and loved ones about the importance of colonoscopy, partaking in events such as #DressInBlueDay and National Colorectal Cancer Awareness Month, getting involved with organizations like the Colon Cancer Coalition, and getting screened, yourself, you can help promote widespread change. 

See new infographics created by the Digestive Health Physicians Association below. To read stories about people’s experiences with colonoscopies and colorectal cancer, click here. To see our favorite online resources for promoting awareness, click here. To learn more about what exactly colorectal cancer is, click here.

The colonoscopy a historical timelineColorectal screening tests

An Overview of Colorectal Cancer Screening Tests

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March is National Colorectal Cancer Awareness Month, an important time to spread awareness and learn more about the risks associated with colorectal cancer.

Colorectal cancer is one of the most common forms of cancer and the second-leading cause of cancer deaths in the world. In the United States this year, an estimated 151,030 adults will be diagnosed with colorectal cancer and ​​an estimated 52,580 will die from the disease. 

Despite its significant rate of incidence, colorectal cancer is highly preventable through the use of screening tests. Gastroenterology Health Partners, in conjunction with the American Cancer Society and Digestive Health Partners Association, recommends that those with an average risk start screenings at age 45. 

Of the colorectal cancer screening tests that we offer, colonoscopy remains the gold-standard of effectiveness and is strongly suggested for anyone eligible. Observational studies have suggested that colonoscopy can reduce colorectal cancer occurrence by 40% and mortality rates by 60%. 

If you’re considering scheduling a screening test, talk to an experienced gastroenterologist. They can help you make the right decision for your needs. 

Keep reading to learn about six commonly-offered colorectal cancer screening tests.

6 Common Colorectal Cancer Screening Tests

1. Colonoscopy

As mentioned above, the colonoscopy is the best diagnostic tool available. This out-patient procedure involves the use of a thin, flexible tube with a camera to exam the lining of the colon (large intestine) for abnormalities such as polyps. Some polyps can be removed with a scope during the procedure. Your doctor may also take tissue samples for analysis as well.

While the colonoscopy does require prep and recovery time, it is a fast, virtually risk-free procedure. Afterwards, your doctor will discuss your results with you and recommend whether you should be screened in 1, 5, or 10 years. To learn more about the colonoscopy, how it works, how to prepare, and more, read here. 

2. Fecal immunochemical test (FIT)

Often considered the second choice after a colonoscopy, the fecal immunochemical test (FIT) offers a non-invasive method for identifying colorectal cancer. The test, often performed at home, tests for hidden (occult) blood in the stool. This unnoticeable blood is often an early-sign of colorectal cancer. 

If you test positive for hidden blood during a FIT test, your doctor will want to perform another test, most likely a colonoscopy. FIT, unlike colonoscopy, is unable to actually identify or remove polyps and abnormal tissue. Therefore, the FIT is not really a viable “preventative” test and has a much lower accuracy rate. 

3. CT Colonography

The CT Colonography is also known as a “virtual colonoscopy.” This test uses a CT scan (a form of x-ray technology) to exam the colon for polyps. A small scope is inserted slightly into the colon to inflate it with air. Then, pictures are taken of the entire colon. The CT Colonography is highly effective, and, unlike a colonoscopy, it doesn’t require sedation. However, unlike a colonoscopy, this exam doesn’t actually remove precancerous polyps, it only can identify them.

4. Cologuard

Cologuard is another non-invasive, at-home colon screening test. Much like the FIT test, it looks at stool DNA samples. While Cologuard is generally more effective than FIT, it still doesn’t compare to the effectiveness of the colonoscopy–while colonoscopy is known to identify over 70% of precancerous polyps, Cologuard only identifies around 42%.

5. Flexible Sigmoidoscopy

A flexible sigmoidoscopy is a comparable procedure to the colonoscopy. It is an exam of the lower part of the colon using a small, flexible, lighted tube. The tube, called a flexible sigmoidoscope, has a camera which allows the doctor to view the inside of the rectum and the sigmoid colon—about the last two feet of the large intestine. Unlike a colonoscopy, this procedure does not allow the doctor to see the entire colon; any cancers or polyps far in the colon cannot be detected. 

6. Capsule Endoscopy

A capsule endoscopy is a procedure that examines the lining of the middle part of the small intestine, the duodenum, jejunum and ileum. This procedure is necessary because a standard endoscope or colonoscope cannot reach this part of the bowel. Capsule endoscopy is often used to search for causes of bleeding as well as detect polyps, tumors, ulcers, and IBD.

During this procedure, the patient will swallow a tiny pill containing a video camera, light source, and battery. The camera will take 2-3 pictures per second for up to 12 hours, traveling through the GI tract. The photos are saved automatically to a recording device and strung into a video. 

While capsule endoscopy is effective for detecting and documenting significant lesions attributed to conditions such as IBD, tumors, and ulcers, it is significantly less effective as a colon screening test compared to colonoscopy. 

 When it comes to colon cancer screenings, the experienced medical team at Gastroenterology Health Partners is here to serve you. To learn more about our services or to schedule an appointment at one of our offices in Southern Indiana or Kentucky, contact a Gastroenterology Health Partners location near you.

Identifying Different Types of Colorectal Polyps

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What Are Polyps?

Polyps are small growths of abnormal tissue, found projecting from the inner lining of the colon (large intestine). Polyps can range in size from a few millimeters to several centimeters. Polyps are very common: In fact, an estimated 25 to 40% of Americans over the age of 50 develop colon polyps. While developing polyps is most associated with being 50 and older, other factors are also considered including: having a family history of polyps/colon cancer, being obese, smoking, heavy alcohol consumption, a history of inflammatory bowel diseases, a poor diet, and other environmental factors. 

The vast majority of polyps are harmless, but they can also be precancerous or cancerous in nature. Polyps can take a long time to become cancerous, and are best to be removed upon identification. During a medical exam or colonoscopy, your doctor may identify and remove polyps. Larger or complex polyps are more likely to be cancerous, and can require additional procedures to remove. Colon polyps rarely cause any symptoms, which means scheduling a colorectal screening test is vital for identification.

Identifying Types of Polyps

There are two main categories of polyps: nonneoplastic and neoplastic. Neoplastic polyps are typically precancerous or cancerous, while nonneoplastic polyps are usually benign (non-cancerous). Within these categories, there are many types of polyps. Some of the most common include:

Types of Neoplastic Polyps

  • Adenomatous polyps (Adenoma): The most common type of polyp as well as the most common cause of colon cancer. Structurally, they’re described as tubular, villous, or tubulovillous. Tubular adenoma is less likely to develop into cancer, and makes up 70% of adenomatous polyps. Villous adenoma is flatter and more difficult to remove, and makes up 15% of adenomatous polyps. Tubulovillous is a mix of the two.
  • Serrated polyps: Serrated polyps cause 20-30% of colon cancers. They are divided into two categories: sessile serrated adenoma (SSA) and traditional serrated adenoma (TSA). SSA’s and TSA’s are very rare and almost always precancerous. 

Types of Nonneoplastic Polyps

  • Inflammatory polyps: Typically found in people with Inflammatory Bowel Disease. Usually benign.
  • Hamartomatous polyps: Rare. Usually caused by autosomal disorders. 
  • Hyperplastic polyps: A form of serrated polyp, but are very common and almost always benign. 

Polyp Shapes

Polyps generally grow in three different shapes: pedunculated, sessile, and flat. Pedunculated (polypoid) polyps grow out from the side of the inner lining of the colon like mushrooms, a clump of tissue on a thin stalk. Sessile polyps, on the other hand, do not have a stalk, but rather grow against the side of the colon. The least common shape is a flat polyp. Flat polyps grow completely flat, or depressed into the side of the colon. Sessile and flat polyps are generally more difficult to detect than pedunculated polyps.

Symptoms of Polyps

There are typically no signs of polyps. However, in some rare cases, they can be associated with symptoms such as:

  • Abdominal pain
  • Blood in stool
  • Diarrhea 
  • Constipation
  • Anemia caused by internal bleeding
  • Weakness or tiredness caused by anemia
  • Weight loss
  • Changes in bowel habits
  • Changes in stool color

Diagnosis and Treatment

If you experience any symptoms of colorectal polyps, it’s recommended that you consult a medical professional as soon as possible. Otherwise, most polyps will be diagnosed and treated through a screening test, like a colonoscopy or flexible sigmoidoscopy. In some cases, polyps are too large or complex to be removed immediately and require further surgical procedures.

It’s also important to note that if you have a neoplastic polyp, like an adenoma or a serrated polyp identified and removed during your screening test, you’re still at an increased risk of developing cancer, and will need regular screenings for polyps. The type, amount, and size of the polyps identified will determine how often you need a screening. This can vary from 6 months to 10 years. 

The experienced team at GHP has years of experience treating patients with various GI conditions including colorectal polyps. We can help establish the best plan of care for your situation. Contact any of our office locations to learn about the options we offer and to schedule an appointment today.

 

Importance of Colon Screening in Younger Adults – Dr. Sohi Interviewed

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Dr. Sunana Sohi of Gastroenterology Health Partners was recently featured in a WHAS-11 article and video about the increasing rates of colon cancer in younger adults.

The story featured Amanda Blackburn, a 37 year-old mother of two who was diagnosed with stage 3 colon cancer in 2017. She received a diagnosis after coming to Dr. Sohi with her symptoms of rectal bleeding and a change in bowel habits.

Blackburn had no family history of colon cancer and knew very little about the disease, like many younger adults. “It wasn’t on my radar. The ‘C’ word wasn’t a thing for me,” she said.

Dr. Sohi was able to help Blackburn receive diagnosis and treatment.

“If you have symptoms, don’t wait. There are a lot of tests that can be done, including stool tests, but the number one, the gold standard is colonoscopy. That’s because it’s not only diagnostic but preventative, where we can find and remove small polyps before they become cancer,” Dr. Sohi said.

Read the rest of the Dr. Sohi’s write-up here.

Colon Cancer is not a disease of the elderly anymore; article

 

 

 

 

 

 

 

 

 

 

 

 

 

The article also discussed the upcoming Kicking Butt 5K Run/Walk, scheduled for Saturday September 25th at the Louisville Waterfront Park. This event, sponsored by the Colon Cancer Prevention Project, was started in 2003 as a way to bring together cancer survivors and advocates, spread awareness, and encourage screenings. It’s not too late to sign up for the 5K, 1 mile, or virtual event, and support this worthy cause.

If you or a loved one are experiencing symptoms of colon cancer or another GI condition, don’t hesitate to contact Dr. Sohi or one of the many experienced physicians at Gastroenterology Health Partners.

As the largest independent gastroenterology practice in the region, GHP is considered the only one of its kind providing results-orientated treatment for a full spectrum of digestive system disorders. Call to set up an appointment at one of our locations in Southern Indiana, Northeast & Central Louisville, and Lexington.

Why You Shouldn’t Wait To Get A Colorectal Cancer Screening

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Are you on the fence about getting screened for colorectal cancer? Perhaps you think you’re too young to get cancer, or you don’t have a family history of it, or you’re anxious about the procedure. You push off the appointment, allowing yourself to think, “I’ll do it sometime soon…”

When it comes to colorectal cancer screenings, you shouldn’t ever wait. Regular screenings are recommended for those 45 years and older, and even younger if you have certain risk factors. For example, people with certain inherited conditions are at a higher risk for colon cancer, including those with Lynch syndrome and those with adenomatous polyopsis. You are also at higher risk if you suffer from certain inflammatory bowel diseases like Crohn’s colitis, or ulcerative colitis.

Early detection is the key to effectively dealing with colorectal cancer. When detected early, colorectal cancer has a 95% survival rate. However, that rate drops to 25% if the cancer is not detected and spreads to other organs. 

Screening tests aren’t just used to identify existing cancer. Through screening, your doctor may find and eliminate precancerous polyps (abnormal tissue growths) in the rectum or colon, removing them before they even have the chance of becoming cancerous. Between 25-40% of adults in the United States are estimated to have colorectal polyps.

Colorectal Cancer Increases in Younger Populations 

While the overall occurrence of colorectal cancer has dropped in recent years (largely due to a rise in screenings), its rate among younger populations has actually increased. In fact, according to the American College of Gastroenterology, a millennial now has 2 times the risk of getting colon cancer and 4 times the risk of getting rectal cancer than someone from the baby boom generation. Research shows that rates in adults younger than 50 are continually increasing by 2%, every year. Mortality rates are also increasing.

What is causing this alarming change? Researchers attribute higher colorectal cancer rates in younger adults to a number of factors, including higher rates of obesity, more sedentary lifestyles, poor diet, and other environmental factors. A study released this May found a link between the consumption of sugar-sweetened drinks and colorectal cancer in women under 50. According to the study, women who drank two or more servings of sugary beverages had twice the risk of developing early-onset colorectal than those who consumed less. Furthermore, adolescents ages 13-18 who consumed sugary sodas had a 32% risk of eventually developing early-onset colorectal cancer. Research is only beginning to unlock certain lifestyle and dietary factors that play a role in developing colorectal cancer.

Colorectal Cancer and Covid-19

During the beginning of the Covid-19 pandemic, lockdowns and closings forced many people to cancel or put off every type of screening test. Colorectal screening tests in particular decreased by over 90%. In the following months, the numbers of tests only increased to 50% of what they were before the pandemic began. This drastic decline in testing is associated with troubling data about cancer outcomes. In June 2020, the National Cancer Institute predicted an excess of 10,000 colorectal cancer or breast cancer related deaths in the U.S. over the next 10 years, just because of pandemic-induced delays in testing, diagnoses, and treatments. Remaining up-to-date on testing is more important now than ever. 

If you’re due for a colorectal screening test or appointment, but are concerned about Covid-19 safety, don’t hesitate to book an appointment at Gastroenterology Health Partners. We uphold a number of safety procedures in-office, including mask requirements, cleaning and sanitization practices, disinfecting common spaces, and upholding social distancing when possible. Maintaining your safety is of the highest importance to us, just as is providing you with colorectal screening tests such as colonoscopies, flexible sigmoidoscopies, and more. Give us a call today to schedule your appointment.

Remembering Chadwick Boseman and the Importance of Colon Cancer Screening

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The loss of Chadwick Boseman on Friday, August 28th came as a tragic surprise to the world. Only 43 years old, the actor, writer, and director had made a name for himself through his leading portrayals of American heroes such as Jackie Robinson in 42 (2013), James Brown in Get On Up (2014), and Thurgood Marshall in Thurgood (2017). His most iconic role was that of superhero T’Challa in Black Panther (2018). This role cemented his place in the Marvel franchise and the hearts and minds of people worldwide. Boseman’s cause of death was colon cancer, of which he had privately fought for four years prior.

This form of cancer is the third most commonly diagnosed and second most likely cause of death in men and women. Boseman’s death serves as a moving testament to our own mortality and the silent struggles many face. It also is a reminder to practice preemptive measures against this aggressive form of cancer. 

About Chadwick

Chadwick Boseman was born in 1976 in Anderson, South Carolina. He attended Howard University, where he pursued the dream of becoming a director. After graduating, he moved to New York City, where he wrote and directed plays, teaching acting on the side. It was only once he was cast in a recurring role on ABC’s “Lincoln Heights” that he began to consider a career as an actor.

On a whim, he moved to Los Angeles, acting in a number of roles before his breakout lead as Jackie Robinson in 42. Brian Helgeland, the writer of 42, noticed Boseman’s talent and stage presence immediately. “It’s the way he carries himself, his stillness — you just have that feeling that you’re around a strong person…” In the following years, Boseman continued to gain widespread acclaim, earning MTV Movie Award’s “Best Hero” title in 2018 and the top award of Outstanding Performance at the 2019 SAG Awards. Indeed, it felt as though Boseman’s career was just beginning.

Colon Cancer Screenings

Chadwick Boseman’s untimely death shines a light on the very serious risks of colon cancer. According to the Colon Cancer Coalition, one in 24 people develop colon cancer, with an equal risk in males and females. There are often no signs or symptoms associated with the onset of the disease. Therefore, diagnosis can be late, worsening chances of remission. A lot of people are only diagnosed through routine screenings, which doctors recommend to begin at 45 years of age. Many people fail to follow through with these recommendations. According to The National Colorectal Round Table, “if 80% of the eligible population was screened at the age of 50, the number of colorectal cancer-related deaths could be cut by 230,000.” Thus, following through with basic preventative measures can drastically reduce incidence.

Prevention

Prevention can begin at any age. Regular exercise, good diet, not smoking, and limiting processed foods/red meats can reduce the risk of developing colon cancer. Colon cancer does run in the family. Those with relatives who have had it have a 2 to 3 times higher chance of developing the disease.

You can dramatically reduce the risk of developing colon cancer. Educate yourself on personal risks and stay up-to-date with colon cancer screenings. For more information on colon cancer prevention and screenings in Kentucky and Southern Indiana, you can schedule an appointment with a gastroenterologist at Gastro Health Partners. Contact an office near you today for details.

Featured article: Colon cancer screening should start at 45, government panel recommends

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Colon cancer screening guidelines are changing, and starting screenings earlier will help save lives. Gastro Health Partners fully endorses these changes. Read more about the changing guidelines in this featured article from NBC News:

Colon cancer screening should start at 45, government panel recommends

Screening for colorectal cancer should start at age 45, five years earlier than is currently recommended, according to draft guidelines from the U.S. Preventive Services Task Force.

The update was prompted by recent studies showing the rate of colorectal cancer rising in younger people, according to the draft, published Tuesday.

Click here to read the full article…