|Dr. Joan Culpepper-Morgan, Harlem Hospital Center|
A study published last month in the New England Journal of Medicine found that the death rate from colorectal cancer was cut by 53 percent in patients who had a colonoscopy and had precancerous polyps removed, affirming the life-saving role of this cancer screening test. Joan Culpepper-Morgan, M.D., FACG, Chief of Gastroenterology and President of the Medical Board at Harlem Hospital Center, talks about the importance of colonoscopy screenings for both men and women to prevent, treat and beat colon cancer.
Q. If I feel well and I’m not having any health problems, why should I get screened for colon cancer?
A. Colon cancer can be a silent killer. Most patients do not have symptoms of pain or bleeding until it is too late. That’s why it’s so important to get screened early, starting at age 50, and at least every 10 years after that, since the risk of developing colorectal cancer increases with age. I tell my patients that it’s indisputable that if you are screened, it reduces the risk of cancer. A colonoscopy can find and remove precancerous polyps and early-stage colorectal cancer. When polyps are removed, cancer is prevented. And when cancer is found early, treatment can be more effective. I let my patients know that I’ve had a colonoscopy and I can testify truthfully to everything that I’m telling them. Colon cancer is preventable, beatable and treatable.
Q. How common is colon cancer? Is it true that women don’t have to worry about it as much as men do?
A. Anyone can get colorectal cancer. So both men and women are equally at risk. It’s the third most commonly diagnosed cancer and the third leading cause of cancer death among both men and women in this country. In fact, men and women have the same 5 percent risk of developing colon cancer in their lifetime. The disparity exists between races. Both black men and black women have a higher incidence of the cancer compared to whites. And they are more likely to die of colon cancer, which is a frightening statistic that is caused by disparities in access to preventable screening and early treatment. Incidence and mortality rates among Hispanics and Asians are lower than those among whites, but still alarming, and they too should get screened.
Q. What are some barriers to screening?
A. Men in general and African-American men in particular have said to me that there’s a fear of feeling violated. Many of them look at the colonoscopy as an invasion and a violation and emotionally it’s very hard to wrap their mind around it. Also in the African- American community there is a certain level of distrust toward the medical community and anything that might be seen as experimental, based on history in that community, specifically the Tuskegee Experiment. Even though they may trust their individual primary care doctors, there’s a tendency to be apprehensive. Lack of a primary care doctor and lack of health insurance are also big barriers. In Hispanic, Asian American and other communities often times there is a language barrier.
Q. How do we overcome these barriers?
A. At HHC, we have made colonoscopy a major part of routine preventive healthcare offered to all patients over 50 who are under our care, regardless of their ability to pay. We make sure our patients are linked to a primary care doctors who play an important role in referring patients for the colorectal screening, explaining the procedure and allaying their fears. For patients who don’t speak English or have limited proficiency, we use interpreters and patient navigators to explain the procedure and to reinforce what they have heard from the doctor through an interpreter who is also culturally sensitive. If the patient has a navigator who speaks their own language, they are more likely to actually present for their colonoscopy.
I assure my patients that I will not let them be in any way uncomfortable or embarrassed. But, you don’t want to be embarrassed to death. Dying from colon cancer is a terrible way to die. And it’s preventable.
Q. What else can I do to prevent colon cancer?
A. A healthy lifestyle is key. Maintain a healthy weight, exercise, eat a healthy diet with plenty of green, leafy vegetables, don’t smoke and limit your consumption of alcohol. And once you turn 50, have your regular colon cancer screening every 10 years.
HHC doctors performed more than 100,000 colonoscopies over the last five years and removed pre-cancerous polyps for more than 18,000 patients. HHC is committed to colon cancer prevention and early detection and colonoscopies are available at little or no cost year round at all 11 public hospitals.
Update 03/01/2013: Dr. Culpepper-Morgan still serves at Harlem Hospital as Chief of Gastroenterology and President of the Medical Board.