Interview By: Nadine Elhage
Dr. Abdallah Kobeissy is currently a gastroenterologist at the University of Toledo Medical Center, in Toledo, Ohio. He received his medical degree from the American University of Beirut in 2007. Dr. Kobeissy completed his Residency at Henry Ford Hospital in Detroit, Michigan in internal medicine in 2013, and went on to complete his Gastroenterology fellowship at the University of Toledo Medical Center and finished in 2017.
Why is it important to bring awareness to Colorectal Cancer?
Colorectal cancer is a public health issue that should be addressed since it is the 3rd most common cancer. In the last two decades, there has been a decrease in the incidence of colon cancer. This is most probably attributed to increased awareness and screening.
What are you looking for when you are screening for Colorectal Cancer?
Most colon cancers begin as polyps. When screening for colorectal cancer via endoscopy we specifically look for polyps. Generally speaking, polyps are growths in the colon. There are different types of polyps. Some types of polyps (adenoma), although benign, they are premalignant and over the course of several years can turn into cancer. Because polyps have a tendency to grow into cancer screening for polyps is important. By catching a polyp we are therefore preventing the development of colon cancer. Screening would also help us detect colon cancer at its early stages at which point the chances of cure are very high.
Are there specific risk factors you believe are more prevalent in a community or country?
One of the most important risk factor is age. After 50 years, an individual's risk of colon cancer increases. The other most important risk factor is family or personal history of polyps or colorectal cancer. Gender is another important risk factor, males tend to have higher rates of colorectal cancer than women. Diseases such as inflammatory bowel diseases, such as ulcerative colitis, have an increased chance of colorectal cancer.
Another risk of colorectal cancer is the consumption of processed foods, red meat, and low fiber diet (low in vegetable and fruit, for instance). People in developing countries have less rates of colorectal cancer than developed countries, possibly due to dietary differences in lifestyle, such as eating more fruits and vegetables. Recent studies have shown that developing countries rates are starting to rise due to an increasing consumption of processed foods. Low physical activity and obesity are also a risk factor, which are often associated with the dietary lifestyles mentioned.
Based on a report by the state of Michigan in 2013, it was reported that the Arab population in Michigan have a less screening rate compared to the average Michiganders. The reported screening rates were 45.7% for Arab Americans, and 70% as the Michigan average of reported screening (Heiman K, Weir S, Fuss man C, & Lyon-Cello S., 2015). It is also important to note that the Arab population had the lowest screening rate of ethnic groups, such as Hispanic, Caucasian, and African American. This is of utmost importance to look at specifically for the Arab community, since proper screening programs can help prevent cancer development or even catch the cancer at an early when it is still curable.
What types of tests do physicians use for screening?
There are several ways to screen people for polyps or colon cancer. These fall into three broad categories: endoscopic, radiographic or stool tests. The endoscopic techniques are colonoscopy or flexible sigmoidoscopy. Colonoscopy is a tube with a camera at the tip. It allows the direct visualization of the entire colon. If the exam does not show any polyp, the patient won’t need another one for 10 years. If a polyp is seen during colonoscopy it can be removed instantly. Flexible sigmoidoscopy is a shorter endoscopic version of colonoscopy, during which only a part of the colon is examined. For this reason, flexible sigmoidoscopy should be repeated every 5 years if it does not show polyps. Regarding the radiographic modalities, these include CT colonography and double contrast barium enema. Stool tests include the Fecal Immunochemical Test which is done on a yearly basis or stool DNA tests are also done every 3 years.
People in general should start screening for colon cancer at the age of 50, and at an earlier age for someone with a family history of colon cancer. A patient and their physician can discuss which option is best in each situation, but usually colonoscopy is the gold standard modality.
If an individual suspects they have symptoms for colorectal cancer, what should they do?
Polyps are mostly asymptomatic, but occasionally may present as blood in the stool. Colorectal cancer symptoms depend on the size, stage, and the location. Early stage cancers are mostly asymptomatic, meaning they do not usually have symptoms. Colon cancer at advanced stages may present as weight loss, abdominal discomfort, blood in the stool, and change in stool habit and consistency. Do not wait until symptoms show, early detection by screening is key to catching early cases before advances symptoms may appear.