#220 CRC Screening Nuances: 5 Pearls Segment Part 2

Xavier Llor (0:00)

I think it's still true that the best approach when it comes to colon cancer screening is the one that gets done, meaning we need to get people screened one way or another.

Shreya Trivedi (0:11)

Welcome to the Core IM Thigh Pearls Podcast, bringing you hot yield, evidence-based pearls. I'm Dr. Shreya Trivedi.

Steve Lebertop (0:17)

And I'm Dr. Steve Lebertop, an internal medicine resident at Beth Israel Deaconess Medical Center.

Shreya Trivedi (0:22)

And today, we're going to compare the four non-invasive, and perhaps more accurately, two-stage screening options, and we'll go through exactly what each of the tests are detecting, and how to better counsel our patients when they do get a positive result that requires a colonoscopy.

And then we'll cover surveillance intervals after colonoscopy, and really try to synthesize it in a way that makes sense, because of course, it's not only clinically relevant, but also very relevant for boards. And you'll hear from four GI experts.

Xavier Llor (0:51)

My name is Shreya Yor, I'm a gastroenterologist, and 11 years ago, I moved to Yale to head the GI Cancer Prevention Program.

Rachel Isaka (0:59)

My name is Dr. Rachel Isaka, I'm a gastroenterologist and a health services researcher at the Fred Hutchinson Cancer Center and the University of Washington in Seattle.

Joseph Feuerstein (1:08)

My name is Joe Feuerstein, I'm the clinical chief of gastroenterology at Beth Israel.

Samir Gupta (1:14)

I'm Samir Gupta, I'm a gastroenterologist and a professor of medicine at UC San Diego.

Shreya Trivedi (1:21)

All right, let's dive in.

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Okay, so let's say we're thinking about screening colonoscopies. We have a patient who's 48 years old for a well visit, talking through the different options we have for screening. Remember, this is not diagnostic, this patient's asymptomatic. How do we think about the best options for colorectal cancer screening?

Steve Lebertop (3:59)

I do think there's this implicit idea that colonoscopy is the gold standard, and that everything else is somehow, quote, second best. But I think the hot take for screening options for colorectal cancer is that there really is not a one size fits all for patients, especially those that are not at increased risk.

So practically speaking, I feel like my headcanon has always been to separate these tests into screening as invasive or noninvasive tests.

Shreya Trivedi (4:24)