Routine colonoscopy, which provides an internal image of the rectum and colon, is widely considered the best way to prevent colon cancer. Yet health experts say that too few middle-age Americans get screened because they don't know they need to be tested or they find it inconvenient, embarrassing or unnecessary.
Prepping for a colonoscopy - more than the procedure itself - is what many people dread. The day before a colonoscopy, the person must go on a clear-liquid diet. Also, the bowels must be cleared. This means drinking special solutions, taking laxative-type pills or some combination.
"A lot of people want to bury their heads in the sand," noted Dr. Alfredo Kalafatic, a colon and rectal surgeon in Bethpage. "They don't want to hear bad news, and they don't want to put up with the prep, especially male patients."
Most colonoscopies are performed under sedation, to keep the person relaxed. The physician uses a colonoscope, which is a lighted, flexible tube equipped with a tiny video camera. It is inserted into the anus and guided though the rectum and into the colon to look for abnormal growths, called polyps. If anything looks suspicious, a biopsy can be done, removing a small piece of tissue for testing, or whole polyps can be removed. Instruments needed for this can be passed through the colonoscope.
Colorectal cancers often begin as polyps. Removing them can prevent this typically slow-growing cancer from ever developing.
"In 30 years of doing colorectal cancer surgery, it was the exception to the rule that I operated on any patient who had colon or rectal cancer who had had a colonoscopy," said Dr. Michael D. Moseson, a Great Neck colon and rectal surgeon who serves as chief of the division of colon and rectal surgery at ProHEALTH Care Associates in Lake Success.
Though the death rate has declined over the past two decades, colorectal cancer remains the third most common cancer in men and women. The American Cancer Society estimates that 142,570 new cases of colon and rectal cancer will develop this year, and 51,370 people will die.
Colonoscopy is generally considered a safe procedure, but there is a small risk of complications, according to the American Gastroenterological Association. The scope can puncture the wall of the colon or rectum, for instance, sometimes requiring surgical repair. Removing polyps also can cause bleeding, and controlling the bleeding sometimes requires blood transfusion or reinsertion of the scope.
Colonoscopy is considered the gold standard for colorectal cancer detection, but it is not the only method around.
So-called virtual colonoscopy, a popular alternative used to detect polyps, captures images using computed tomography (CT) or magnetic resonance imaging (MRI).
The problem with virtual colonoscopy, Kalafatic and Moseson agreed, is that, if a polyp is discovered or something questionable turns up on the scan, the person will end up having a colonoscopy anyway.
The Cancer Society's recommendations for colorectal cancer screening vary, depending on how at risk people are for the disease. Risk factors for colorectal cancer include:
People with no identified risk factors, other than age, should begin regular screening at age 50 and have the testing repeated every 10 years, the Cancer Society recommends.
THE LONG ISLAND SCENE
From 2005 to 2009, Stony Brook University Medical Center and the Suffolk County Department of Health Services participated in a federally funded demonstration project designed to boost colon cancer screening rates among the region's uninsured and underinsured.
To increase people's compliance with the colonoscopy protocol, a lead clinician conducted the initial visit by phone, taking a detailed medical history, scheduling the colonoscopy and providing detailed instructions. That phone call eliminated the need for the person to make two visits to obtain a colonoscopy.
Based on the success of "Project SCOPE" (the Suffolk County Preventive Endoscopy Project), Stony Brook's gastroenterology service now routinely places precolonoscopy telephone calls to people before their procedures.
This is the 17th installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: colon and rectal surgery, thoracic surgery and vascular surgery
COLON & RECTAL SURGERY
Dr. Marc Greenwald
310 E. Shore Rd., Great Neck, 516-482-8657
Dr. Alfredo Kalafatic
4277 Hempstead Tpke., Bethpage, 516-735-3001
Dr. Arnold Leiboff
3400 Nesconset Hwy., East Setauket, 631-689-2600
Dr. Michael Moseson
60 Cuttermill Rd., Great Neck, 516-487-8738
Dr. John Procaccino Jr.
Chief, Division of Colon & Rectal Surgery, North Shore University Hospital, 900 Northern Blvd., Suite 100, Great Neck, 516-730-2100
Dr. William Smithy
222 Middle Country Rd., Smithtown, 631-638-2800
Dr. James Sullivan III
North Shore Oncology Assoc., 600 Northern Blvd., Great Neck
Dr. Leonard Barrett
Nassau Univ. Medical Center, 2201 Hempstead Tpke., East Meadow
Dr. Thomas Bilfinger
Stony Brook Univ. Medical Ctr., Dept. Surgery, T19-080 Health Sciences Ctr., Stony Brook
Dr. Harold Fernandez
100 Port Washington Blvd., Roslyn, 516-627-2173
Dr. Stewart Fox
444 Merrick Rd., Lynbrook, 516-255-5010
Dr. Lawrence Glassman
225 Community Dr., Great Neck, 516-918-4388
Dr. Alan Hartman
North Shore Univ. Hospital, Div. Cardiothoracic Surgery, 300 Community Dr., Manhasset, 516-562-4970
Dr. Gary Kline
Summit Thoracic Institute, 410 Lakeville Rd., New Hyde Park, 516-233-1952
Dr. Terry Palatt
15 Park Ave., Bay Shore, 631-581-4400
Dr. Newell Robinson
Vizza Bldg., 100 Port Washington Blvd., Roslyn, 516-627-2173
Dr. Todd Rosengart
Stony Brook Health Science Ctr., Cardiothoracic Surgery, Stony Brook, 631-444-7875
Dr. Chanchal Saha
754 Old Country Rd., Plainview, 516-931-0182
Dr. Scott Schubach
120 Mineola Blvd., Mineola, 516-663-4400
Dr. James Taylor Jr.
St. Francis Hospital, The Heart Center, 100 Port Washington Blvd., Roslyn, 516-627-2173
Dr. Vadim Zeltsman
225 Community Dr., Great Neck, 516-918-4388
Dr. Thomas Arnold
1110 Hallock Ave., Port Jefferson, 631-476-9100
Dr. Saqib Chaudhry
2001 Marcus Ave., Lake Success, 516-328-9800
Dr. Glenn Faust
2201 Hempstead Tpke., East Meadow, 516-572-4848
Dr. Robert Pollina
1110 Hallock Ave., Port Jefferson Sta., 631-476-9100
Dr. William Purtill
900 Northern Blvd., Great Neck, 516-466-0485
Dr. Apostolos Tassiopoulos
Stony Brook Univ. Medical Ctr., Dept. Surgery, Nicolls Rd., Stony Brook
How they were picked
Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.
Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.
Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.
To see the whole list . . .
Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.