keynote speaker for Victory Over Colon Cancer Symposium
February 15-16, 2019
2030 Gregg St.
Piet de Groen
Dr. de Groen is a Professor of Medicine in the Division of Gastroenterology, Hepatology and Nutrition, at University of Minnesota, emeritus staff at Mayo Clinic College of Medicine, adjunct professor at University of Arizona and former Program Director of the Mayo Clinic/IBM Computational Biology Collaboration. He is an NIH-funded clinical investigator and international expert in medical informatics, primary liver cancers and colonoscopy.
His endoscopic research is focused on measuring what happens during colonoscopy. Together with collaborators at Iowa State University and the University of North Texas he has created a first-of-a-kind new software system that automatically captures and analyzes “inside-the-patient” video information of medical procedures performed via endoscopy. At present he is studying patient- and endoscopist-specific features, including quality of the colon preparation and effort of the endoscopist to visualize mucosa, remove remaining fecal material and adequately distend the colon.
To eliminate barriers towards the eradication of Colorectal Cancer by encouraging effective screening.
Educating physicians and patients about the importance of understanding the Adenoma
Detection Rate (ADR) is our primary focus.
Create a Consensus:
- Acknowledge the variable benefits of the different screening options.
- Colonoscopy, done well, can reduce deaths 90%.
- Colonoscopy, when the physician’s ADR is below 20 gives less than 10% protection.
- Stool based tests evaluating for hidden blood in the stool have not proven to reduce deaths whatsoever.
- Stool based tests for DNA damage are promising but have not been available long enough to demonstrate clear benefit. It is effective in fining cancer, but our goal is to prevent cancer.
- Virtual colonoscopy (a fancy CT scan) misses 90% of the pre-cancerous polyps removed by high ADR colonoscopy.
- Know your colonoscopist's ADR (adenoma detection rate). If you are a physician, do not refer your patient to a colonoscopist that does not have a minimum ADR of 25. Never refer to a group. Chances are more than 50-50 the test will be performed by a doctor with a below-standard ADR.
- For the patient. Do not have a colonoscopy by a colonoscopist that does not display a minimum ADR of 25. Ask before scheduling. The American College of Gastroenterology clearly states disclosure of the ADR is expected of every colonoscopist. If you cannot get a clear answer, or if the answer is “the doctor is board certified and that is sufficient,” find an alternative colonoscopist. It is your life. You have a choice. The choice can mean life or death.
- Know your family history risk factors. If a first-degree relative (parent, brother, sister or child) had evidence of increased risk (colorectal cancer or a pre-cancerous polyp) begin testing at age 40. You are no longer an “average risk” patient. You are at increased risk and are therefore entitled to screening beginning at age 40. More and more patients are diagnosed at younger ages. The first test is the most important. That is when we occasionally encounter surprises. Do your research. If you can find a legitimate reason, begin your screening as young as possible.
- Recognize the symptoms that might prompt earlier screening. Any changes in digestion, bowel movement, bleeding or pain can be “alarm” symptoms requiring screening.
- Do not ignore the opportunity to reduce your risks with:
- Weight management
- Remember, colorectal cancer is the preventable cancer. Still, 50,000 die each year. Colorectal cancer is 10% of all cancer deaths and cancer is one-third of all deaths. You can eliminate your risk for colorectal cancer death with accepting responsibility for life-style adjustments and high-ADR colonoscopy screening.
Test Your Knowledge about
1. Colorectal cancer can be prevented.
2. Colorectal cancer isn’t a big health problem in the US.
3. I only need to get a colonoscopy if something seems wrong.
4. Most people should start getting their first colonoscopy at age 50.
5. If I have a sibling with a polyp I should begin screening earlier.
6. Lifestyle choices, such as eating right, smoking, exercise and alcohol use have an impact on colorectal cancer risk.
1. Colorectal Cancer can be prevented. - TRUE.
Studies beginning in 1980s demonstrated an 80% reduction in colon cancer when pre-cancerous polyps are removed by colonoscopy. Unfortunately, far too many patients have colonoscopy performed by doctors functioning below the minimum industry-established quality standard. This standard is to find a pre-cancerous polyp in at least one of every four screening patients. When a doctor is not able to detect and remove most of the pre-cancerous adenomas (polyps) the patient continues to be at risk for developing colorectal cancer.
So, the answer to question number one is a qualified yes. Colon cancer is preventable when you have a colonoscopy by a competent doctor. We are working with the leaders in the gastroenterology community to rectify the fact that doctors can achieve and maintain board certification without achieving minimum quality standards in performing colonoscopy.
When you are due for colonoscopy screening, IT IS ESSENTIAL THAT YOU CHECK THE DOCTOR’S ADR before having your test. If you cannot find the value, cancel. Find a competent doctor to perform your test. In 2018, 30,000 patients died despite having undergone the arduous colonoscopy screening. They were told they were safe, but in fact remained unprotected.
2. Colorectal cancer isn’t a big health problem in the US. - FALSE.
The only cancer that claims more lives is lung cancer, and we know what causes most of these cases. So, colon cancer is the most preventable cancer. It kills 10,000 more than breast cancer (50,000 versus 40,000). Not only is colorectal cancer deadly, it is an expensive and protracted death. The average case consumes more than $300,000 in healthcare expenses. A majority of the expense is in the chemotherapy that often costs more than $100,000 per drug per patient. Why allow such to occur? We can prevent nearly every case. But the number of cases in 2018 was several hundred more than in 2017. We are losing a battle we have the tools to win. A high-quality colonoscopy can prevent five of every six cases.
Selecting the doctor to perform your colonoscopy should not be an issue. But it is. In 2018, 75,000 patients were told they had colon cancer even though they had been screened. Hopefully, the doctors performing the referrals (usually the PCP) will learn of the horrendous status of quality among colonoscopists. It is quite simple. No patient should be referred to a doctor with an ADR below the standard. The current standard is that a doctor should find an adenoma (pre-cancerous polyp) in one of every four screening colonoscopies.
Only by refusing to allow incompetent doctors to continue to provide screenings will we arrest the tragedies of colon cancer despite colonoscopy (CCdC). Trusting Americans are not accustomed to questioning the competence of doctors. In this instance, it is a matter of life or death. Nearly half of the colonoscopies performed in America are of little benefit. WOW! Hard to believe, but true. Save Your Colon has as its mission to educate the public for the buyer to be aware. You can no longer blindly trust that you will receive a careful inspection and precision removal of the pre-cancerous polyps that lead to colorectal cancer.
But now we give you the tool to remedy the enigma. Just ask. Ask for the ADR value. If they refuse to give you the specific doctor’s ADR, just say thank you, cancel the appointment and find a provider that will give you both the respect you deserve and the protection you should expect.
3. I only need to get a colonoscopy if something seems wrong. - FALSE.
Symptoms from colorectal cancer only occur at the latter stages. It is far too late. Most patients with symptoms will die! Colorectal cancer screening is done based on birthdays. Birthdays and risk factors. Get your first screening as young as possible. If any family members had polyps or colorectal cancer, you must begin at age 40. The fast-growing population of victims is the younger patients. The first screening is the most critical. DO NOT DELAY.
4. Most people should start getting their first colonoscopy at age 50. - TRUE.
But nearly half of Americans should begin at 40 due to having family members with colon polyps or cancers. Every African American is considered at increased risk and should start at age 45 for routine screening. At SaveYourColon, we lobby for legislation to prevent insurance companies from denying payment for those at increased risk. The insurance companies are powerful, and patients need an equally powerful advocate to fight for the benefits they pay for.
5. If I have a sibling with a polyp I should begin screening earlier. - TRUE.
That was a softball. If you have a brother or a sister with a polyp, you should begin screening at age 40.
6. Lifestyle choices, such as eating right, smoking, exercise and alcohol use have an impact on colorectal cancer risk. - TRUE.
Many epidemiologic researchers believe we could cut the colon cancer rate in half if we followed several simple healthy lifestyle principles. These habits also benefit risks for many other diseases. Healthy diet can reduce cardiovascular disease, diabetes aswell as most cancers. Proper diet may reduce your risk by one-third! Not smoking can reduce risks by 20%. Exercise and maintain proper weight can reduce risks 15 to 20%. All of these lifestyle issues are important, but colonoscopy screening can reduce risks more than 80%.
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Colonoscopy – the ONLY way to screen.
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Colorectal cancer is the second leading cause of cancer death in America. At an average of a quarter of a million dollars per case, this represents a substantial drain on health care cost. The National Polyp Study published in the 1990’s projected an 80% drop in colon cancer with high quality screening colonoscopy. At an average of $2,000 per colonoscopy, getting screened was financially out of reach for most Americans.
The Affordable Care Act required insurers to pay for screening services with zero out of pocket expense. This has been a tremendous boon for colonoscopy screening. Far too many insurers are trying to deny payment for what are legitimate screening services. For example, if a polyp is found (which is the intended purpose of the test), some insurers claim that it becomes a diagnostic procedure rather than a screening procedure and refuse to pay the claim.
African Americans are far higher risk and the professional entities (The American College of Gastroenterology and The American Cancer Society) recommend screening begin at age 45, but the insurers fail to recognize these higher-risk populations.
There have been concerted efforts to repeal the Affordable Care Act. We believe that the maintenance of insurance coverage for screening remains a valuable asset for all Americans. We will face a landslide of cancer victims if we no longer cover screening colonoscopy for every insured American.
As our representative, we are asking you introduce and support a bill to cover all Americans age 45 and up for screening colonoscopy.
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