Gastroenterologist: ‘We’re diagnosing people in their 30s and 40s with colon cancer,’ he says as he discusses ways to prevent the disease
By Chris Motola
Q: Tell us a bit about your work with colorectal cancer prevention in younger patients.
A: With screening guidelines going from 50 to 45 we’re diagnosing people in their 30s and 40s with colon cancer. It’s just becoming more prevalent, so we’re trying to be more proactive with those guidelines. The US Preventive Services Task Force made that recommendation in 2021. It takes a little time for the insurance companies to get onboard with new recommendations, but I think we’re pretty much there now, where they’re willing to cover screenings for at 45 for people who don’t have a family history of colon cancer. People born in the 1980s or beyond are at twice the risk of developing colon cancer under 50 compared to someone born in the 1950s. So that and just seeing these kinds of numbers in practice. It used to be the fourth leading cause of cancer death in men under 50, now it’s the leading cause of cancer deaths for that age group, and second for women under 50. The thing about colon cancer is that it’s preventable, so we want to intervene where appropriate. We’re seeing a lot of patients around age 45 who know someone who got a diagnosis or had polyps, so they tend to be motivated to get screened themselves.
Q: Does screening mean colonoscopy or is it a broader umbrella?
A: We have multiple screening options. You’ve probably seen commercials for the non invasive testing options like Cologuard.
Q: I got a Cologuard test last year. How effective are they relative to invasive screenings?
A: It’s a stool test, so it’s a bit easier to do. The thing is, you can’t have any family history of colon cancer. You can’t have any symptoms. The idea is that as the stool is rolling around in the colon, it would bump into any polyps and cancers and pick up the DNA that the test is looking for. There is a high false-positive rate of around 13%. The main benefit to a colonoscopy is when we do the procedure we’re looking for pre cancerous polyps that we can remove. Ideally, we’d remove them when they’re less that a centimeter. They can get larger and larger until they eventually become colon cancer. So we can just clean out anything we find. The large the polyp becomes, the higher the risks. So a colonoscopy is both diagnostic and deal with the polyps immediately if they’re there. With a positive Cologuard — and it may be a false positive — there’s a risk of stress from getting a positive result and having to wait with that knowledge until you get a colonoscopy.
Q: Why are colon cancer rates increasing this much?
A: There are a lot of theories. Sedentary lifestyle. Obesity. Smoking. Alcohol. Low fiber, high-fat diets. Processed meats and foods.
Q: If you do find polyps, what kinds of recommendations do you have for the patient afterwards?
A: First, we’ll send the polyps off to a lab, because there are different kinds of polyps that can occur. Some may be completely benign. Depending on the number and size and whether there’s family history, we can clear you for up 10 years. If we find just a few adenomas, which are pre-cancerous, we’re looking at a five-year follow-up. If we find five or more, then we’re looking at three years. If we take a very large polyp off, then we’d need to keep a closer eye on it for six months to a year.
Q: Considering how effective early interventions are, what are the main barriers to preventing colorectal cancer?
A: Unfortunately, the data shows that less than half of Americans who qualify for one are hesitant to proceed with a colonoscopy. It’s uncomfortable; they don’t like the idea of an invasive test. The worst part of it is probably the bowel prep. You have to be on a liquid diet the day before. The bowel cleanse itself has a lot of options now, though, where you don’t have to drink as much of the medicine, just more fluid. We even have pills as an option. So it’s a matter of finding which option works best for the patient. We also use sedation to make the patient more comfortable, so we do require a driver for the day of the colonoscopy. But thanks to the sedation most patients don’t feel or remember the procedure. They’re shocked we’re done by the time they wake up. Most people do pretty well.
Q: What got you interested in gastroenterology?
A: I like the combination of the surgical and procedural element mixed with the medical. You get to take direct action, preventing colon cancer with interventions, address bleeding issues. At the same time, we also treat a lot of chronic conditions where we can develop long-term relationships with patients with conditions like inflammatory bowel disease or liver disease. So you can watch patients you’ve diagnosed when they were young reach life milestones while helping to improve their quality of life and manage their condition.
Lifelines
Name: Thomas Lee, M.D.
Position: Gastroenterologist at Associated Gastroenterologists of Central New York, P.C.
Hometown: Buffalo
Undergraduate: Yale University; medical school: New York University School of Medicine; internship: New York University School of Medicine; residency: New York University School of Medicine; fellowship: Cooper University Hospital, Camden, New Jersey; board certification: internal medicine and gastroenterology
Affiliations: St. Joseph’s Health Hospital
Organizations: American College of Gastroenterology; American Society for Gastrointestinal Endoscopy
Family: Wife, two children
Hobbies: Scuba diving, skiing, cooking, tennis, international travel