Over the last year, there have been several major changes in the field of gastroenterology, especially when it comes to colonoscopies and colorectal cancer screenings.
From new blood- and stool-based screening options, to changes in colonoscopy age and quality recommendations, here are what seven leaders have told Becker's about major colonoscopy screening changes since the beginning of the year.
Hitesh Chokshi, MD. Gastroenterologist at Atlanta Gastroenterology: Colonoscopy is still the gold standard and, compared to DNA based stool and blood tests at their current pricing, still most cost-effective. However, I believe there will be a shift to the noninvasive tests, especially if their costs come down. Also, they may be favored over screening colonoscopy based on patient, comorbidities and resource availability. If there is a shortage of anesthesia personnel, or of G.I. personnel, such that gastroenterologists are unable to provide care for patients with illnesses either as inpatient or outpatient due to the time burden of doing colonoscopies, non-invasive screening tests may be utilized in order to free up those resources to help take care of the general population.
Jeffrey Fine, MD. Gastroenterologist at Fine Digestive Health. (Irving, Texas): I think optical colonoscopy will still have a role as it has the highest level of sensitivity and specificity to identify polyps and cancers. Cologuard and other tests continue to be used, but they have lower sensitivity and specificity. Cologuard [costs] around $600. Recently, I’ve seen several patients with positive Cologuard and stool DNA which subsequently needed colonoscopies, which identified both polyps and one rectal cancer. Recently, I’ve also had two patients with negative Cologards and both ended up being diagnosed with colon cancer. Those are the patients I’m concerned about. I do recommend Cologuards for patients who decline colon cancer screening. Unfortunately, none of the noninvasive tests yet have [the same] sensitivity and specificity as cancer screening via colonoscopy.
Benjamin Levy III, MD. Gastroenterologist at University of Chicago Medicine: I am very excited about the new Shield circulating tumor blood test, which screens for colon cancer-related DNA markers in the blood. There are many patients who would prefer blood-based screening instead of a colonoscopy or stool-based testing. The convenience of screening for colorectal cancer with a simple blood draw is pretty amazing.
Lauren Bleich, MD. Gastroenterologist with Miami-based Gastro Health: The new FDA approval of the Shield test for colon cancer screening highlights the ongoing efforts to prevent or identify early colon cancers, which seem to be more prevalent in our younger population than ever before. While it highlights the need for colon cancer screening, as well as may allow us to reach a broader audience, especially with the long wait times for colonoscopy patients encounter, it should not be used in place of colonoscopy, which is the gold standard for colon cancer screening and prevention.
Omar Khokhar, MD. Gastroenterologist at Illinois GastroHealth (Bloomington): I would love to see payers and clinicians sit down at a table and have a conversation about the benefit of early endoscopy for diagnosis and screening. In particular, how EGD/colonoscopy can potentially prevent patient morbidity and decrease downstream cost to the healthcare system. Yes, endoscopy isn't cheap, but cancer is a bad diagnosis and is more expensive.
Mel Ona, MD. Chair and Medical Director of Gastroenterology at Pali Momi Medical Center. (Aiea, Hawaii): The smartest decision we made was implementing an artificial intelligence-assisted polyp detection device during screening colonoscopy. We were the first private practice in Hawaii to use an AI module in July 2022. Since then, my adenoma detection rate increased from mid-40% to over 50%. We have also diagnosed over 60 colorectal cancers at our ASC since October 2020, many of which have occurred in younger patients (ages 20 to 45). We look forward to more innovations in the field of gastroenterology to assist in the detection and prevention of colorectal cancer.
Shakeel Ahmed, MD. Gastroenterologist and CEO of Atlas Surgical Group. (St. Louis): I think that screening a colonoscopy in a healthy patient in an inpatient hospital setting should be malpractice. Over time this will become mainstream. People will realize what a huge expenditure we're wasting by keeping simpler electives — and I'm not talking about necessary procedures – but I'm talking about colonoscopies and other minor surgeries on healthy patients. These need to 100% move to the outpatient setting.