January 31, 2024 Breakfast Meeting Notes

Dr Casey speaks to the group about colonoscopy

 

Guests: Erica Labella and Dr Casey

 

Announcements: Our joint event with the Chamber of Commerce will be held next Wednesday at the 6 Burner Bistro from  5-7pm. 

 

If anyone is interested in holding a position on the board, or serving as an officer, see Beth as soon as possible.

 

Super Bowl squares are now available.  Each member should purchase or sell 3 tickets @$20 each. Give cash to Braden or checks to Ken Evans.

 

Tony presented his NH trivia. Today’s theme was Damp and Dark Places in NH.

 

The 50/50 was won by Ken Williamson.

Tony won the chance to draw for the ace of spades but was unsuccessful. The game continues. 

 

Our guest today was Dr Joseph Casey. He has been a surgeon for 30 years with Plymouth General Surgery. He is president of the Speare medical staff and a former chair of the Holderness School Board. His talk today is on colonoscopy. 

 

Speare Hospital has tried hard to stay abreast of changes in medicine, adapting to new medical recommendations as well as changes in technology, the population, diseases pathogenesis, and treatments of disease. Political reform and societal and ethical perspectives have also affected where we spend our dollars. Speare has tried to prepare for changes, understanding the value of the change to the patient and the community and adapting to the future.

 

Colonoscopy is a crucial tool for cancer screening. Two million people were diagnosed with cancer in the USA in the last year. Breast cancer was most common overall, while prostate cancer is the most common in men. Lung cancer is now “only” the 3rd biggest cause of cancer,, as a result of decreasing smoking rates. Colorectal cancer is the 4th leading cause of cancer, representing about. 8% of new cancer diagnoses. Over 600,000 people died from cancer in the US last year, and lung, colorectal, and pancreatic cancers are the most common causes of death. 

 

More people are being diagnosed with cancer than ever before, but deaths from colon cancer have decreased 33% since 1991 because of improved treatment modalities. There is a significant increase in colon cancer diagnosis in people under 50 and it is now the #1 cause of cancer deaths in men under age 50. It is the #2 cause  of cancer deaths in women, second only to breast cancer. By 2030 it is expected that colorectal cancer will be the #1 cancer diagnosis in the USA.

 

1/20 adults will be diagnosed with colon cancer. There were 2 million cancer cases worldwide in 2018. 90% will survive if the cancer is detected and treated early. Colon cancer is also preventable through early removal of precancerous polyps.

 

As you can see, screening is important. 9/10 patients with stage 1 or 2 cancer will have 5 year survival. Only 1/10 with stage 4 will have a 5 year survival. Most cases do not have symptoms and most persons diagnosed with this disease do not have a family history of colon cancer. Sadly, only about 50% of eligible people are choosing to be screened nationwide. Here in New Hampshire we do a bit better, screening 65-70% of adults per recommended guidelines; the  goal is to screen 80%.

 

Incidence of colon cancer is 30/100,000 in 45 year olds. Patients 45-55 years old account for almost 25% of deaths from colon cancer and these numbers are increasing. Medical guidelines now call for screening starting at age 45 rather than 50, and screening is now suggested for  patients 75-85 years old, depending on other health factors. (Rates of colon cancer are lower in persons over 75, but screening at this age can still reduce diagnosis and deaths from colon cancer by 40%. Higher risk individuals (those who have pain, blood in their stool, or weight loss) should definitely be screened. Family history should also suggest more screening. In addition, removal of small polyps, ie those less than 3 mm in diameter, is now suggested and seems to be reducing the rate of development of new cases of colon cancer. 

 

Some factors can help mitigate the risk of developing colon cancer.  Diet is the most important risk factor that we can control, as additives, preservatives, and carcinogens can promote colon cancer. Maintaining a healthy lifestyle (exercise, good diet, proper weight, and seeing your doctor regularly) is the best thing you can to to reduce your risk.

 

There are a variety of screening tools available. Some are better than others, but any screening is better than none. The fecal occult blood test is still done because it’s easy but it’s not a good test. The Fecal Immunochemical test (FIT) looks for hemoglobin in stool and it is a much better test for picking up blood. DNA based tests such as Cologuard detect blood but also suspicious DNA sequences in stool. Flexible sigmoidoscopy used to be done in office but this is seldom done any more; it is not very effective as a screen as it only looks at part of the colon. 

 

The FIT test must be done annually in order to be effective. There is no risk to the procedure but it misses many polyps. Cologuard can detect over 90% of colorectal cancers, but only about 40% of large polyps. 10% false positive rate. To be effective, Cologuard must be repeated every 2 to 3 years. 

 

Note that the Affordable Care Act provides for only one type of screening (so if you have a Cologuard and it’s positive, the subsequent colonoscopy is NOT covered). Colonoscopy is the only test that has been shown to be preventive, by allowing early detection and removal of precancerous polyps. 

 

Note that not all endoscopists are equally skilled. Bowel prep is crucial in order to do a quality exam. Good sedation (propofol). Is essential. Good endoscopists are also important. Doctors keep track of their adenoma detection rate; the range is 7% to 50 or 60 %, but the average is only 25-30%. Dr Casey’s is 42%.

 

Happy dollars were shared by Tony, Mike, and Greg. Greg noted that he will  need volunteers to help with the ski event on Feb 10 at the Plymouth Regional High School.

 

Respectfully submitted,

 

Lora Miller, secretary