Despite some very public efforts to educate the public about the importance of screening for colon cancer, the percentage of Americans who get screened for the second-leading cause of cancer death is still low. On today’s show, we talk with a colonoscopy expert about the limitations – and some of the alternatives – to what remains the gold standard screening procedure for the disease. And later in the show, a colorectal surgeon talks how genetic testing is changing treatment options and how to choose a treatment when you’re diagnosed. But first: did you ever imagine that a conversation with a surgeon would include the question: “Is the robot going to do my surgery?”
Listen to this episode.
Segment 1: Robots in the OR
Guest: Dr. Sonia Ramamoorthy, Assistant Professor of Surgery and a colorectal surgeon at the Rebecca and John Moores Cancer Center at the University of California San Diego
Physicians and hospitals are as likely to promote new technology as often as they are their safety record. And while it's true that a new generation of surgical robots is giving today's doctors important new tools for minimally invasive surgeries, the jury is still out about whether newer always means better - or safer.
Surgical robots made their debut in the OR only a couple of decades ago, providing a steady arm for surgeons performing the first endoscopic - or minimally invasive - surgeries. Today, robots are used for even minor gynecological procedures and to remove cancerous prostate glands or to repair bladders and repair or remove kidneys.
But unlike pharmaceuticals that go through lengthy clinical trials and get federal approval by the FDA, medical devices - including surgical robots - have no similar federal oversight. And there are no national standards for using these complex new tools - hospitals are free to establish their own credentialing system. That doesn't mean that robotic surgery is unsafe, only that there are currently no outcomes that prove its any safer than more conventional surgery.
Further complicating matters is the pressure that hospitals and physicians are under to adopt these unproven - and expensive - new technologies. With robot manufacturers marketing their products directly to patients, a kind of arms race for technological superiority has developed, with competing hospitals forced to invest in equipment that has yet to be proven beneficial to patients.
Segment 2: Making the Case for Colonoscopy
Guest: Dr. Kenneth Forde, former vice chair of surgery at Columbia University's College of Physicians and Surgeons
Colorectal cancer is the second-leading cause of cancer death in the United States, but compared with screening for breast cancer or cervical cancer, screening for colon and rectal cancers is incredibly low. Only 54 percent of adults over 50 have been screened. Part of the reason may be the screening procedure itself. Although other methods exist, the colonoscopy is still the gold standard. But colonoscopy is expensive and - compared with screening for other cancers - uncomfortably invasive.
Segment 3: Treating Colorectal Cancer
Guest: Dr. Kirk Ludwig, Chief of the Colorectal Surgery Service at the Medical College of Wisconsin in Milwaukee
For those diagnosed with colon cancer, there are options for treatment. And for people with a family history of colon cancer, genetic testing can make pre-emptive surgery an alternative. But the most important thing you do may be to take your time making a decision about treatment.
Like all medical treatment - whether surgical or pharmaceutical - treating colon cancer comes with its share of risks.