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Feature Men’s Health:
Mecklenburg Colorectal Cancer
Resilience Update
Symposium:
IBy Sam R. Fulp, MD, Charlotte Gastroenterology & Hepatology
Building Hope for Tomorrow n considering men’s health needs, colorectal cancer (CRC) screening should be
Through Action Today strongly considered in the male population. CRC, in most studies, is second to
lung cancer in causing cancer deaths in men in the United States and Western
Friday, Nov.16 • 7:30 a.m.-4 p.m. Europe. CRC is second to breast cancer in causing cancer deaths in women. CRC
Friendship Missionary Baptist Church screening generally would be followed for women, as well as men.
3400 Beatties Ford Road CRC usually arises from a premalignant polyp (adenoma or serrated polyp).
Adenomas have an increased incidence in males compared to females in most
The American Psychological Association defines resilience as the studies, although the incidence of CRC in males is relatively equal to that in
process of adapting well in the face of adversity, trauma, tragedy, females. Finding and removing precancerous polyps in the colon has been found
threats or significant sources of stress. Resilience is not a trait people to help prevent CRC.
either have or do not have. It involves behaviors, thoughts and actions
that can be learned and developed in anyone. This full-day symposium Screening for CRC should be considered in all persons between ages 50-75. The
will begin with an optional screening of the film “Resilience.” It American Cancer Society (ACS) recommends colon screening start at age 45. The
will be followed by a keynote address focused on understanding the U.S. Multi-Society Task Force on Colorectal Cancer still recommends starting
effects of adverse child events and toxic stress on the human body and screening for CRC at age 50. There is little evidence to support changing the
community. A panel of experts will discuss current programs proven average-risk screening age to 45, but the ACS recommendation is probably based
to work along with strategies for implementation. During the afternoon on the rising incidence of CRC in people younger than 50. More time is needed
breakout sessions, participants will be encouraged to brainstorm on to understand how the ACS recommendations will affect CRC screening, since
current practices and creative solutions to address toxic stress and insurance will be unlikely to cover this change in the 45-50 age group in the near
building resilience. In closing, we will reconvene to share highlights future. Symptoms such as rectal bleeding should be aggressively evaluated even in
from the breakout sessions in an effort to create a roadmap that will those persons younger than 50.
lead us to a trauma-informed, resilient community. “First-tier” methods for CRC screening include colonoscopy every 10 years and
annual fecal immunochemical tests (FIT). “Second-tier” tests for CRC screening
Objectives: include CT colonography every five years, FIT-fecal DNA (Cologuard) every three
years, and flexible sigmoidoscopy every five to 10 years. “Third-tier” tests include
• Outline the effects of adverse child events and toxic stress capsule endoscopy every five years. First-tier methods have the best evidence for
• Identify successful resilience programs efficacy, followed by second and third-tier methods.
• Devise a resilience plan of action for the community A colonoscopy should include examination of the entire colon with adequate
visualization of the entire colonic mucosa with removal of all polyps and follow-up
Contact: Gabriela Staley at gabriela.staley@atriumhealth.org colonoscopy dependent on the results. Positive tests for screening methods other
than colonoscopy generally would be followed by full colonoscopy and removal of
Register online at all polyps. Discontinuation of screening at age 75 should be considered, particularly
www.charlotteahec.com. in patients who are up to date on colon screening and don’t have a history of
premalignant colon polyps. The decision about when to discontinue screening/
Continuing Education Credit surveillance due to advanced age should be individualized.
will be provided.
If precancerous colon polyps (adenomas or serrated polyps) are detected,
Did You Know? there are guidelines for follow-up colon surveillance based on good quality
evidence. If no polyps are found on screening colonoscopy, then follow up in
MCMS membership for residents and fellows 10 years is recommended. Generally, if one to two premalignant polyps are
is automatic and free during their training removed (smaller than 1 cm), then follow-up colonoscopy is recommended in
in Mecklenburg County. five to 10 years. If three to 10 premalignant polyps are removed, or if any are
any greater than 1 cm, then a follow-up colonoscopy is generally recommended
in three years. Also, screening colonoscopy is recommended every five years
after age 40 in persons with a first-degree relative (sibling, parent, offspring)
who developed CRC at or before age 60.
Reference: ASGE.org (Guidelines)
8 | September 2018 • Mecklenburg Medicine
