MARCH 2023

DOCTOR IS IN
March is National Colorectal
Cancer Awareness Month
BY DR. RENA DAIZA
Colorectal screening
saves lives.
Part of raising
awareness is helping people
understand the value and
importance of getting regular
cancer screenings for early
detection. As a primary care
doctor, a large part of my role
is preventive medicine. The
goal of preventive medicine
is to ultimately prevent disease,
disability, and death.
Colorectal cancer screening
is one way of implementing this.
Despite the benefits of getting
screened, only about two-thirds of
adults in the United States are on
schedule with the recommended tests,
according to the CDC.
There seems to be a lot of hesitancy
among Chaldean patients when it
comes to cancer screenings - especially
colorectal cancer screens. I spoke to a
gastroenterologist, Dr. Jolian Kathawa,
to break it down for us. Dr. Kathawa
specializes in preventing, diagnosing,
and treating conditions of the gastrointestinal
(GI) tract, or digestive system. I
asked him 5 important questions that
every patient needs to know:
What is colorectal cancer (CRC) and
what are different ways to detect it early?
Colorectal cancer is cancer of the colon
or rectum. It is the third most common
cancer diagnosed among men and
women and it is the second most common
cause of death among all cancers.
It can present in many different ways,
a few of which include patients experiencing
blood in their stools, weight
loss, abdominal pain, changes in their
bowel habits — or they could be completely
asymptomatic.
There are factors which can increase
your risk for colon cancer such
as smoking, obesity, family history of
colon cancer, or certain dietary habits.
There are multiple ways to detect colon
cancer and to prevent it. There are
DR. RENA
DAIZA
SPECIAL TO
THE CHALDEAN
NEWS
ways where we can directly
visualize the colon such as
with a colonoscopy, sigmoidoscopy,
or CT imaging. Then
there are a few stool tests that
can be used as well, such as
FIT testing and Cologuard.
However, the gold standard
(best test) is a colonoscopy —
this is the most efficient way
to detect and prevent colon
cancer. During a colonoscopy,
you are put to sleep by
anesthesia and we use a flexible
scope that is inserted through the
anus to examine the entire colon. We
look for polyps that can be removed in
an effort to prevent colon cancer from
occurring. This is the only test where
we can actually prevent cancer. The
other tests are mostly used to detect
cancer or advanced polyps.
Describe when someone is an appropriate
candidate for FIT test or Cologuard
versus Colonoscopy.
It is important to know that FIT testing
and Cologuard testing is only appropriate
for patients who are at average risk
for colon cancer. Average risk means a
patient has no history of colon polyps,
no family history of colon cancer, no hereditary
conditions that increase their
risk for colon cancer and no history of
Crohn’s disease or Ulcerative colitis.
Also, patients need to be asymptomatic.
So if a patient is complaining of rectal
bleeding, or changes in their bowel
habits, or weight loss, then they should
not undergo these stool based tests. If
a patient uses these stool tests and the
results are positive, the next step would
be to undergo a colonoscopy.
They say a majority of new cases of
CRC occur in people aged 50 years
or older. Why do recommendations
suggest screening earlier now, for
instance, at age 45 years?
The guidelines from the American Gastroenterology
Association were recently
changed to start screening at 45 years
of age for all average risk patients. This
was done after reviewing multiple studies
and looking at the data that showed
colon cancer was rising in patients
younger than the age of 50. The studies
also showed that colon cancer rates
were increasing in patients between
50-60 years of age. So by screening earlier,
we hope to catch these cancers at
earlier stages so that patients can be
successfully treated. We also hope to
prevent many of these cancers by finding
polyps earlier and removing them
before they become cancerous.
“45 is the
new 50”
Can or should CRC screening go
beyond 75 years of age? When can
gastroenterologists make that call?
For patients over the age of 75, there are
no clear guidelines in terms of colon
cancer screening. The American College
of Gastroenterology recommends that
we have a discussion with the patient
and discuss the risks versus benefits of
performing colon cancer screening beyond
this age. It essentially comes down
to the patient’s health, their risk of undergoing
a procedure and their values
or wishes. For example, if we have a
76-year-old patient who is completely
healthy with no significant health issues,
then it may be worthwhile to proceed
with colorectal cancer screening
because we have every reason to believe
that this patient will live an additional
7-10 years. However, if we have a 76-yearold
patient who is on chronic oxygen, is
on dialysis and has significant cardiac
disease, then the risks of undergoing
colon cancer screening most likely outweigh
the benefits. My job, as a gastroenterologist,
is to provide them with the
facts and the risks and benefits of both
approaches.
Any other important facts to know
about CRC and/or screenings?
The main thing I will say is to get
screened. Talk to your primary care
doctor and get screened - it could potentially
save your life. Encourage your
loved ones to do it as well. If you have
questions or concerns about undergoing
a colonoscopy, you can always schedule
an appointment with your doctor to discuss
it in the office beforehand.
Dr. Issam Turk, a gastroenterologist
based out of Rochester and Troy
said, “The hesitancy within the Chaldean
community when it comes to
preventative medicine and specifically
colon cancer screening is a major issue
that needs to be tackled urgently,
especially given that colorectal cancer
is on the rise.
“The classic line that I often hear
from patients and sometimes, my own
family members is, ‘I feel fine. Why do
I need to do this test?’ In the end, although
it will be challenging, we must
continue to raise awareness regarding
this issue and urge our patients,
friends, and family members to get
screened in a timely fashion.”
The outlook for people with the
disease has slowly been improving for
several decades, largely due to screening.
Don’t forget that “45 is the new
50”. If you are age 45 or above, please
talk to your doctor now about getting
screened.
Dr. Rena Daiza is a board-certified
primary care physician at the Henry
Ford Bloomfield Township Medical
Center. She serves as Vice President of
the Chaldean American Association for
Health Professionals and as Co-Chair
of the Chaldean Women’s Committee -
a subgroup of the Chaldean Chamber
of Commerce. Dr. Jolian Kathawa is
a board-certified gastroenterologist.
He is credentialed with Beaumont
Hospital and the Detroit Medical
Center. He practices in both
Farmington Hills and Commerce.
40 CHALDEAN NEWS MARCH 2023