Mark Pochapin, MD: Loving the Gastro-Intestinal Tract

Advances in colon cancer screening technology, better education on colonoscopy techniques, and successful public health campaigns have the ailment on the run, said Mark Pochapin, MD, director of the Division of Gastroenterology at NYU Langone Medical Center.

“We are doing amazing,” Pochapin said in an interview at the medical center recently, “It’s a great success story in public health.” That is one reason, he said, he loves his specialty more every day.

The other, he added, is that he finds the gastro-intestinal tract fascinating, due to its many parts and functions.

“Lymphoid, immunologic, neuro-endocrine components—the GI tract has something for everyone,” Pochapin said.

With advances in finding and treating colon cancer, the field also offers physicians a rewarding interaction with many patients, Pochapin said.

”We can prevent significant disease,” he said.

The incidence of colon cancer has dropped by 30% and the death rate is also dropping he said. Screening rates are climbing, with 70% of New Yorkers in the appropriate age brackets having been screened. Pochapin is part of a national campaign to get that percentage up to 80% by 2018. Thought colon cancer still ranks second in the list of the highest numbers of US cancer deaths, “If this continues I expect it to drop of the top-10 list.”

Weapons in that fight include refinements to colonoscopy instruments. The latest include high-definition imaging, scopes with three cameras, and a rubber cuff that can get behind folds in the colon to look for hidden polyps. Detecting very small, hidden, or flat polyps is the challenge he said. Part of the approach to doing that is better education for practitioners and new standards.

“We’re focusing on quality metrics and a national standards,” he said. Those metrics include noting whether the practitioner reached the end of the colon, withdrew the scope in an appropriate timeframe, and whether he or she found polyps at an acceptable rate.

Non-invasive stool tests such as Cologuard and the fecal immunochemical occult blood test have proved useful in picking up cancers.” Cologuard picks up 92% of adenomas but the problem is it’s not as good at polyps,” he said. “It finds 42% of advanced polyps, so it is not terrible, and certainly better than nothing,” he added.

Virtual colonoscopy, a CT scan, may appeal to patients who are put off by the invasiveness of the usual colonoscopy, but it is not covered by insurance, involves the same preparation of the bowel, and if cancer or polyps are discovered, the patient will still need a regular procedure, he said. Unless insurance starts covering it, Pochapin said he doubts the test will become popular.

Another sign of progress is that screening guidelines have been fine-tuned. The current recommendations still advise screening for average-risk people starting at age 50, but the American College of Gastroenterology more recently advised that African Americans get screening starting at age 45, due to their higher colon cancer mortality rate.

By age 75, most people are no longer considered candidates for colonoscopy, due to the small but real risks involved in the procedure: perforation and bleeding. He says the risk of infection should be zero, as long as scopes are “meticulously cleaned.”

Despite research that shows aspirin has a preventive role in colon cancer, Pochapin does not recommend it unless patients are taking it for other reasons, such as cardio vascular conditions. That is because it can also cause bleeding.

Pochapin, who has written a book “What Your Doctor May Not Tell You about Colorectal Cancer” stresses the importance of diet in prevention, along with “keeping lean” and not becoming overweight or obese.

Caught early, colon cancer is highly curable, he said. “The more people we get screened, the more disease we can prevent.”

His biggest obstacle is getting patients to understand that visiting a physician when they are well can help keep them that way. “Prevention is not in the American psyche,” he said, “We go to the doctor when we are sick.”

He discusses his work in the videos below.