Dr. John Fondran discusses the importance of colorectal health, and why getting screened is important.
John Fondran, MD
John Fondran, M.D. is a native of Cleveland. He attended Case Western Reserve University School of Medicine and trained in surgery at Summa Akron City Hospital. He completed training in colon and rectal surgery at the Rhode Island Colorectal Clinic, and he is active in teaching both medical students and residents.
Scott Webb (Host):March is National Colon Cancer Screening Awareness Month, but there's never a bad time to discuss the importance of colon cancer screening and how critical early detection is. And joining me today is Dr. John Fondran. He's a Physician with Summa health, and he's here to update us on the latest screening guidelines and to encourage all of us to get screened for colon cancer.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So, doctor, thanks so much for your time today. We're talking about colorectal screening and colonoscopies and all that good stuff. So, let's start up front here, why is colorectal screening so important?
John Fondran, MD (Guest):The importance of colon cancer screening is that it is the third most common cancer in the country. And it's the second most common cause of cancer deaths. But it's also a cancer that is preventative through screening. So, we can actually, through screening, stop colon cancer from even happening. And then also if somebody does have colon cancer, if we catch it early, it is very treatable, very curable, in the early stages. So, we want to catch things early.
Host:Are colonoscopies still the gold standard. And if so, why?
Dr. Fondran:Yes. That the gold standard. A few different reasons, like I said, we're looking for cancer. And if we find cancer, obviously we treat it. The other main thing that we're looking for is polyps and polyps are little growths inside the colon. They're like little bumps, they're abnormal, but they're not cancer. They do have a potential to turn into cancer in the future. So, with the colonoscopy, we can see those polyps, we can detect those polyps. And then for the most part, we can remove those polyps. That way we're getting rid of them before they even become a problem. So, the colonoscopy is the gold standard both because it is the best most sensitive way to detect a cancer and to detect polyps. And then it's also the only way that we can remove those polyps, to prevent cancer from happening.
Host: Yeah. And so, when we talk about colonoscopy and we'll talk about the length of the procedure and that kind of stuff coming up here, but I think one of the things that maybe frightens people just a little bit, because of word of mouth or social media, whatever it is, is really the point prep. And that seems to be the thing that maybe not prevents people, but sort of has them kind of delaying getting in for their colonoscopies. Let's go through this. What's the prep like, is it really that big of a deal?
Dr. Fondran:It's not the best night of your life, but it's not terrible. Some things with the prep have changed. We used to use a big gallon jug of what was called Golightly. For the most part, we don't use that anymore. We use MiraLax that people can mix with Gatorade or lemonade or any clear liquid. What I've found is it's a lot easier for people to get down than the stuff that we used to use. So, I used to get a lot of calls about people being really bloated, nauseated, throwing up, not being able to get the prep down. I hardly get any of those calls anymore. So, yeah, as far as drinking, it's not as big a volume as it used to be. It's easier for people to get down. The effect on the back end is that you have diarrhea for a few hours, but that's as unpleasant as it gets.
Host:Yeah, that's good to know. And at least in my case, I'm 52. I ate a lot of jello. And so, let's talk about the procedure itself. It's relatively short, right. And people wake up and they're usually like wait, have you started They’re often surprised right at how quickly the procedure is.
Dr. Fondran:Oh, yeah, absolutely. The standard is to do these under sedation. And again, over the years, this has changed. The sedation we used to use was kinda more like a Valium and morphine combination. What we're using now for most people are using anesthetic, that is something that we can turn on and off very quickly.
So, when people go to sleep, they fall asleep very quickly. When they wake up, usually they're awake and lucid within about 10 minutes, and I can talk to people. They remember everything. And by the time you get home, you actually feel pretty much back to normal. As far as the time goes, usually about 20 to 25 minutes to be able to do a full colonoscopy depending on things. And people are there for a couple hours. By the time you come in, you get checked in and get an IV, have to go through the system and recovery and everything like that. So, the whole process is a couple hours. The procedure itself is only about 20 to minutes. 25 min.
Host:Yeah, that's good to know. And is there anything else, you know, like in my case, I had my son drive me and drive me home and took some time off of work that day. So, that's pretty standard stuff. Right? Don't have to work that day. Make sure there's somebody there, especially to drive you home. Right?
Dr. Fondran:Correct. And that's just a safety thing. We can't let you go home by yourself, even people that take a cab or a bus, you need a need a responsible adult there, to take care of you. I've never had anybody have a problem going home and having any problem after the procedure as they're going home, but, that's just a precaution that we take. And then yeah, all the standard precautions about don't work, don't change your will, don't operate heavy machinery that day. It is a day that generally people take off of work, but you don't need the day before off. You don't need the day after, just the day of.
Host: Don't change your will, you kind of slid that one in there. I have not heard that one before that, but that would not be a good day to make any major life changes, I think is your point, which is great. So, let's talk about the screening guidelines, you know, used to be 50, was kind of the marker, unless you had a history of colon cancer in your family, but now I'm hearing that they're moving it down to 45. There may be some complications with insurance. Catch us up to speed on that.
Dr. Fondran:For the older group, I'll get in trouble for saying older, but for the kind of like 50, 60, 70 year old group we've actually started to see a decline in incidence of colon cancer. And we think that it is due to the screening and preventative removal of polyps. But the trend that we've seen in the last several years,10 years is that the younger cohort of people is where we're having an increase in the incidence of colon cancer.
We don't really know why, but it does seem to be hitting people earlier, hence the dropdown to 45. Most of the major societies have endorsed that. The Colorectal Society, the GI Society, the American Cancer Society. I have yet to have trouble with an insurance company, not paying for a screening at age 45. And just with the trend of things, I expect that it's probably not any time soon maybe, but I think we are going to gradually go towards screening even younger than that.
Host:Wow, that's good to know, especially that the insurance companies are on board and all the major societies as well. And as we, you know, kind of prefaced today as we got started early detection is key. So, that's great to know. Now, are there some people who can't get colonoscopies or are there just some other complicating factors that might prevent somebody or might delay someone? And if so, are there other options besides colonoscopies?
Dr. Fondran:Very rare that somebody that can't have a colonoscopy sometimes for medical reasons, they can't have it done. But for most people, the colonoscopy is an option. The biggest deterrent to a colonoscopy is one it's, it is invasive. It's also inconvenient. It's a day off of work. And then like, you alluded to the fear of the prep. The other main option for screening are stool tests and there's something called a FIT test, F-I-T, which detects blood in the stool. And then there's also various, DNA tests. The current main one that we use that's on the market is called Cologuard. And that looks for both blood and abnormal DNA in the stool. Both of those are alternatives to doing the colonoscopy. If one of those turns out positive, then it is followed up with a colonoscopy. If those are negative, then they just get redone, the FIT test needs to get done every year.
The DNA tests are usually three years. With a normal colonoscopy, you get 10 years in between screening. The alternatives are there, they're easier, more convenient. They do need to be done more often, would be the main disadvantage of those. In the end, people ask, you know, what's the best screening test. My answer is always the one that somebody gets done. Whether it be a colonoscopy, a FIT or DNA. As long as somebody is getting a screening done, then we're doing it. We're doing good for them.
Host:This has been really informative today. As we wrap up here, anything else you want people to know about colorectal cancer, early screening, the procedure, anything else?
Dr. Fondran:I would just like to emphasize again that the screening whether it be colonoscopy or one of the stool tests, in general, is very straightforward and easy. And any of the downsides when you compare it to actually having colon cancer, the choice there is obvious. Really want to strongly advocate for just getting some kind of screening done. If we can get everybody screened, then I would be happy to be put out of the colon cancer business.
Host:I love that when I hear that from doctors that they would prefer not to see people in the office, they would prefer perhaps to find a new profession or a new specialty. And that's the dream. That's the goal, right? Get everybody screened, put an end to colorectal cancer. So, doctor, thanks so much for your time today and you stay well.
Visit Summa health.org/colorectal. Or call (234) 867-6076 to schedule a screening. And if you found this podcast to be helpful and informative, please share it on your social channels and check out the entire podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.