Top Doctors: Understanding colonoscopy

Routine colonoscopy, which provides an internal image of the rectum and colon, is widely considered the best way to prevent colon cancer. Yet health experts say that too few middle-age Americans get screened because they don't know they need to be tested or they find it inconvenient, embarrassing or unnecessary.

Prepping for a colonoscopy - more than the procedure itself - is what many people dread. The day before a colonoscopy, the person must go on a clear-liquid diet. Also, the bowels must be cleared. This means drinking special solutions, taking laxative-type pills or some combination.

"A lot of people want to bury their heads in the sand," noted Dr. Alfredo Kalafatic, a colon and rectal surgeon in Bethpage. "They don't want to hear bad news, and they don't want to put up with the prep, especially male patients."

Most colonoscopies are performed under sedation, to keep the person relaxed. The physician uses a colonoscope, which is a lighted, flexible tube equipped with a tiny video camera. It is inserted into the anus and guided though the rectum and into the colon to look for abnormal growths, called polyps. If anything looks suspicious, a biopsy can be done, removing a small piece of tissue for testing, or whole polyps can be removed. Instruments needed for this can be passed through the colonoscope.

REASONS

Colorectal cancers often begin as polyps. Removing them can prevent this typically slow-growing cancer from ever developing.

"In 30 years of doing colorectal cancer surgery, it was the exception to the rule that I operated on any patient who had colon or rectal cancer who had had a colonoscopy," said Dr. Michael D. Moseson, a Great Neck colon and rectal surgeon who serves as chief of the division of colon and rectal surgery at ProHEALTH Care Associates in Lake Success.

Though the death rate has declined over the past two decades, colorectal cancer remains the third most common cancer in men and women. The American Cancer Society estimates that 142,570 new cases of colon and rectal cancer will develop this year, and 51,370 people will die.

RISKS

Colonoscopy is generally considered a safe procedure, but there is a small risk of complications, according to the American Gastroenterological Association. The scope can puncture the wall of the colon or rectum, for instance, sometimes requiring surgical repair. Removing polyps also can cause bleeding, and controlling the bleeding sometimes requires blood transfusion or reinsertion of the scope.

CURRENT THINKING

Colonoscopy is considered the gold standard for colorectal cancer detection, but it is not the only method around.

So-called virtual colonoscopy, a popular alternative used to detect polyps, captures images using computed tomography (CT) or magnetic resonance imaging (MRI).

The problem with virtual colonoscopy, Kalafatic and Moseson agreed, is that, if a polyp is discovered or something questionable turns up on the scan, the person will end up having a colonoscopy anyway.

The Cancer Society's recommendations for colorectal cancer screening vary, depending on how at risk people are for the disease. Risk factors for colorectal cancer include:

People with no identified risk factors, other than age, should begin regular screening at age 50 and have the testing repeated every 10 years, the Cancer Society recommends.

THE LONG ISLAND SCENE

From 2005 to 2009, Stony Brook University Medical Center and the Suffolk County Department of Health Services participated in a federally funded demonstration project designed to boost colon cancer screening rates among the region's uninsured and underinsured.

To increase people's compliance with the colonoscopy protocol, a lead clinician conducted the initial visit by phone, taking a detailed medical history, scheduling the colonoscopy and providing detailed instructions. That phone call eliminated the need for the person to make two visits to obtain a colonoscopy.

Based on the success of "Project SCOPE" (the Suffolk County Preventive Endoscopy Project), Stony Brook's gastroenterology service now routinely places precolonoscopy telephone calls to people before their procedures.

This is the 17th installment of a 26-week series in which Newsday presents Castle Connolly's list of top L.I. doctors. Today: colon and rectal surgery, thoracic surgery and vascular surgery

Who's who

COLON & RECTAL SURGERY

Dr. Marc Greenwald

310 E. Shore Rd., Great Neck, 516-482-8657

Dr. Alfredo Kalafatic

4277 Hempstead Tpke., Bethpage, 516-735-3001

Dr. Arnold Leiboff

3400 Nesconset Hwy., East Setauket, 631-689-2600

Dr. Michael Moseson

60 Cuttermill Rd., Great Neck, 516-487-8738

Dr. John Procaccino Jr.

Chief, Division of Colon & Rectal Surgery, North Shore University Hospital, 900 Northern Blvd., Suite 100, Great Neck, 516-730-2100

Dr. William Smithy

222 Middle Country Rd., Smithtown, 631-638-2800

Dr. James Sullivan III

North Shore Oncology Assoc., 600 Northern Blvd., Great Neck

516-487-9454

THORACIC SURGERY

Dr. Leonard Barrett

Nassau Univ. Medical Center, 2201 Hempstead Tpke., East Meadow

516-572-6705

Dr. Thomas Bilfinger

Stony Brook Univ. Medical Ctr., Dept. Surgery, T19-080 Health Sciences Ctr., Stony Brook

631-444-1820

Dr. Harold Fernandez

100 Port Washington Blvd., Roslyn, 516-627-2173

Dr. Stewart Fox

444 Merrick Rd., Lynbrook, 516-255-5010

Dr. Lawrence Glassman

225 Community Dr., Great Neck, 516-918-4388

Dr. Alan Hartman

North Shore Univ. Hospital, Div. Cardiothoracic Surgery, 300 Community Dr., Manhasset, 516-562-4970

Dr. Gary Kline

Summit Thoracic Institute, 410 Lakeville Rd., New Hyde Park, 516-233-1952

Dr. Terry Palatt

15 Park Ave., Bay Shore, 631-581-4400

Dr. Newell Robinson

Vizza Bldg., 100 Port Washington Blvd., Roslyn, 516-627-2173

Dr. Todd Rosengart

Stony Brook Health Science Ctr., Cardiothoracic Surgery, Stony Brook, 631-444-7875

Dr. Chanchal Saha

754 Old Country Rd., Plainview, 516-931-0182

Dr. Scott Schubach

120 Mineola Blvd., Mineola, 516-663-4400

Dr. James Taylor Jr.

St. Francis Hospital, The Heart Center, 100 Port Washington Blvd., Roslyn, 516-627-2173

Dr. Vadim Zeltsman

225 Community Dr., Great Neck, 516-918-4388

VASCULAR SURGERY

Dr. Thomas Arnold

1110 Hallock Ave., Port Jefferson, 631-476-9100

Dr. Saqib Chaudhry

2001 Marcus Ave., Lake Success, 516-328-9800

Dr. Glenn Faust

2201 Hempstead Tpke., East Meadow, 516-572-4848

Dr. Robert Pollina

1110 Hallock Ave., Port Jefferson Sta., 631-476-9100

Dr. William Purtill

900 Northern Blvd., Great Neck, 516-466-0485

Dr. Apostolos Tassiopoulos

Stony Brook Univ. Medical Ctr., Dept. Surgery, Nicolls Rd., Stony Brook

631-444-4545

How they were picked

Castle Connolly Medical Ltd. is a health care research and information company founded in 1991 by a former medical college board chairman and president to help guide consumers to America's top doctors and hospitals. Castle Connolly's established survey and research process, under the direction of a doctor, involves tens of thousands of doctors and the medical leadership of leading hospitals.

Castle Connolly's team of researchers follows a rigorous screening process to select doctors on national and regional levels. Using mail and telephone surveys, and electronic ballots, they ask physicians and the leadership of top hospitals to identify exceptional doctors. Careful screening of doctors' educational and professional experience is essential to the committee. Newsday is not part of the selection process.

Doctors do not and cannot pay to be selected and profiled as Castle Connolly Top Doctors.

To see the whole list . . .

Who else is on the list of Top Doctors? More than 6,000 listings are in the New York Metro Area edition of "Top Doctors," published by Castle Connolly Medical Ltd. The softcover list price is $34.95. For more information, go to castleconnolly.com, or call 800-399-DOCS.