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When Should A Person With Colon Cancer Family History Have A Colonoscopy? - Dr. Garvie (VIDEO)

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Michelle King Robson asks Dr. John Garvie when women should have their first colonoscopy if they have a family history of colon cancer.

Michelle King Robson:
I just lost a friend last weekend – 46 years old, male, and died of colon cancer. And his sister was diagnosed as well. They caught it in the late stages. She is doing very well and it was actually, it started off as rectal cancer and then spread I guess into the colon. You know more about this than I do, but it’s surprising how many people, both male and female, have colon cancer and it goes undiagnosed until it’s too late.

Dr. John Garvie:
Yeah, that’s the tragedy and that’s why patients need to come in at a symptom-free, asymptomatic stage to get screening. The tragedy of colorectal cancer is that if a patient waits still they are symptomatic, they almost invariably have advanced stage disease and outcomes are directly related to the stage of disease at time of diagnosis. Advanced stage translates into poor outcomes. Patients must come in at an asymptomatic stage.

When we discover, and it’s unusual to discover cancer in an asymptomatic patient, when we discover that, that’s usually early stage and outcomes are excellent. Long-term survival, survivals are expected and usual.

Michelle King Robson:
Okay, well that’s good to know as well. So if you have a family history, once they, I’ve got a woman coming into the office and she emailed me a couple of days ago. She is a breast cancer survivor; her brother has colorectal cancer and she wants to be screened and she is young. She is I think 42 and the insurance company is saying no, we are not going to pay for your colonoscopy.

Dr. John Garvie:
Well, she has two reasons to be screened and I think that she can make a legitimate appeal to that process. Once you have one cancer you are at high risk for the development of a second cancer, even in a different organ system. The second point, and I think to your questions earlier about younger age colon cancer cases, is that there are genetics involved in those patients’ stories and we must screen those patients at an earlier than traditionally recommended age.

So those patients are at above average risk. We usually start screening them at ten years beneath the age of the index case. So whenever the brother developed colon cancer we would start screening that individual ten years before the brother’s time of diagnosis. If the brother was diagnosed at 42 we should start screening at 32. These are generally recommended, American Cancer Society, American Gastrointestinal Association, all organized societies have these recommendations for above average risk patients.

Michelle King Robson:
So then we should in Susan’s case I should tell Susan today that hey you need to go back to the insurance company and go back armed with all this information from other organizations, non-profits, who say, hey, here’s the screening protocol and you certainly fall in that protocol.

Dr. John Garvie:
Exactly. It’s just that she can pick up screen guidelines. Again it’s important that she look for screening guidelines for above average risk patients and having a first degree relative with colorectal cancer automatically puts you at above average risk, and then they would just deal with that data and I can’t imagine that she wouldn’t be approved to have the case.

Michelle King Robson:
Great, well that’s good. That’s also helpful information. So above average.

Dr. John Garvie:
That’s the term we used. The key terms are we all have average risk. I had a couple of endoscopic procedures, I have never had a polyp identified but I still have a natural lifetime risk for the development of colon cancer of above five percent.

Michelle King Robson:
Even though you have no . . . ?

Dr. John Garvie:
Even though I have no history, above, those patients then that have either a polyp identified, that’s identified as a pre-malignant polyp, or any stores where there’s a family history, are put into this above average risk.

So everybody has risk and I think that’s what’s important to identify. So all of the people out there in America have this risk and it’s a lifetime risk and the only way to reduce risk, and I think this has been nicely shown, is to have aggressive screening starting at age 50 or under depending upon family history.

Michelle King Robson:
Great, so the key here is, is at least to the age of 50 to start the screening process and if you have family history then you know that you need to start your screening much earlier and you need to go in and get your colonoscopy.

Watch Michelle's Story About Her Colonoscopy Experience
http://www.empowher.com/community/herstory/video-herstory-michelle-shares-her-colonoscopy-journey

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