Mercy’s Dr. Jeffery Nelson, Surgical Director, Center for Inflammatory Bowel and Colorectal Diseases at Mercy Discusses Colorectal Screenings
Jeffery Nelson, M.D., FACS, FASCRS, is an experienced colorectal surgeon who serves as Surgical Director of The Center for Inflammatory Bowel and Colorectal Diseases with The Institute for Digestive Health & Liver Disease at Mercy. Dr. Nelson recently responded to questions from the online publication, HEALTHLINE, regarding colorectal cancer screenings in light of news that early-onset colorectal cancer rates have been increasing.
1. Should the colorectal cancer screenings start at age 45 or 50? Or earlier?
The American Cancer Society released new recommendations for colorectal cancer screening in May of 2018. They dropped the starting age from 50 to 45 based on the fact that people are getting colorectal cancer at an earlier age. The reasons are unknown, but have been attributed to western lifestyle and diet. These recommendations are for people at average risk, meaning they have no history of colorectal cancer or polyps in themselves or their immediate family members (first degree relatives). Persons at average risk also have no history of inflammatory bowel disease or polyposis sydromes (or other family cancer syndromes). It's important to point out, however, that the USPSTF (United States Preventive Services Task Force) does not yet recognize these recommendations, and insurance payers follow the USPSTF not the ACS.
2. Do we have any sense of why colorectal cancer rates have been on the rise? What would we have to do from a public health standpoint to get greater public buy-in for these screenings?
Acceptable screening modalities include optical colonoscopy every 10 years, CT colonography (virtual colonoscop) every five years, flexible sigmoidoscopy every 5 years in conjuction with FOBT, FIT testing (fecal immunochemistry) every year, and sDNA testing (stool DNA or Cologard) every three years. Fecal occult blood testing every year is still acceptable, but has largely been abandoned in favor of FIT or Cologard.
Public health initiatives are ongoing and include colon cancer awareness month (March), and provider education aimed at questioning all patients on their colorectal cancer risks. The ease of the FIT and Cologard tests has helped with public acceptance of dealing with this problem, but the down side of Cologard is the false positive rate. If the test comes back positive it has to be followed up with an optical colonoscopy anyway.
Wolf AMD, et al. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA Cancer J Clin. 2018 Jul;68(4):250-281
Dr. Jeffery Nelson has over 25 years of experience in Colon and Rectal Surgery. His areas of interest include colorectal cancer, rectal bleeding, hemorrhoidectomy and diverticulitis. He brings special expertise in such areas as rectal prolapse, ulcerative colitis and complex anal pathology. Board Certified in two specialties, General Surgery and Colon Rectal Surgery, Dr. Nelson earned his medical degree at the University of Utah and completed his Internship and Residency in General Surgery at Tripler Army Medical Center. He completed his Fellowship in Colon and Rectal Surgery at Northwest Colon and Rectal Clinic, Seattle, Washington. Dr. Nelson has held the position of Chief of Colon and Rectal Surgery at Walter Reed National Military Medical Center.
Founded in 1874 in downtown Baltimore by the Sisters of Mercy, Mercy Medical Center is a 183-licensed bed acute care university-affiliated teaching hospital. Mercy has been recognized as a top Maryland hospital by U.S. News & World Report; a Top 100 hospital for Women’s Health & Orthopedics by Healthgrades; is currently A-rated for Hospital Safety (Leapfrog Group), and is recognized by the American Nurses Credentialing Center as a Magnet Hospital. Mercy Medical Center is part of Mercy Health Services (MHS), the parent of Mercy’s primary care and specialty care physician enterprise, known as Mercy Personal Physicians, which employs more than 200 providers with locations in Baltimore, Lutherville, Overlea, Glen Burnie, Columbia and Reisterstown. For more information about Mercy, visit www.mdmercy.com, MDMercyMedia on Facebook, Twitter, or call 1-800-MD-Mercy.