Screening saves lives, with Jeffrey Crespin

Episode Transcript

Ariel: Hello everybody, and welcome back to another episode of the “Colon Health Podcast.” I am your host Ariel Bridges, and today we have Dr. Crespin on the podcast. Hello, Dr. Crespin. How’s it going?

Dr. Crespin: Good. How are you today?

Ariel: I’m well, thank you so much. Can we just start out with you sharing exactly what it is that you do with our audience?

Dr. Crespin: Sure. Well, I’m a gastroenterologist, I’m a clinical assistant professor at NYU as well as medical director of the largest GIAC [SP] in Manhattan. And I do GI gastro and technological consults and perform jab procedures like colonoscopies.

Ariel: And what is it that made you decide to specialize in gastroenterology?

Dr. Crespin: Well, believe it or not, when I was 14, my father had a gastric ulcer that required surgery. And so I got interested in it. And in my third year of medical school, I did a gastro rotation where I observed colonoscopy and really what it was that gastroenterologists do and did. So because of those experiences, that’s what made me want to enter the world of gastroenterology.

Ariel: It’s really cool. I feel like all of those moments in the past are so formative. Back when I was on my medical track, I got to shadow a gastric sleeve surgery, and I was, like, “This is actually very fascinating and interesting.” There’s so much going on down there that I feel like people don’t normally think about.

But I would love to know, you’ve been practicing for a long time, at this point, more than 20 years. What changes have you seen in the field? Is there more or less screening, more or less information? I’m curious to see how patients have changed and evolved over that time?

Dr. Crespin: Yeah, well, there’s several changes, you know. We didn’t have flat screens and high-definition monitors in the 1990s. So we used high-definition scopes where we do procedures. I think there’s more screening now.

People were doing a little bit more what we’d call sigmoidoscopies in the 1990s and now they’re doing much more colonoscopies. I think, unfortunately, there’s a little bit more misinformation now. It used to be just people would “Reader’s Digest,” and now there’s just so much information out there on the web and some is accurate and some is not.

Ariel: Yeah, that would make sense that with the internet becoming what it is that there is more in misinformation, which is quite the bummer. But do you mind just going into, I think you mentioned a different type of scope that was more popular in the past. Can you briefly just share the difference between that and what we know as is a more familiar colonoscopy today?

Dr. Crespin: Right. So I think not actually my medical school, but there were doctors using sort of fiber optic scopes in the ’90s that they would have to look through [inaudible 00:03:12]. And then their video scopes that have been around, but they weren’t high definition 20 years ago.

And at least, I’d say, for the last 15 or so, the scopes are high definition. The monitors are high definition. We don’t have the big clunky CRT monitors the way TVs used to be. So, I mean, the optics are better than they were.

Ariel: That has to be great for just getting better visualizations of any type of pathology and things, I imagine.

Dr. Crespin: Yes.

Ariel: So for those who don’t know, it is Colorectal Cancer Awareness Month, which is very, very exciting. And here on the “Colon Health Podcast,” we often chat about the importance of screening for colon cancer.

But I think it’s a message that bears repeating, it’s so, so important. And maybe we have some first-time listeners today. Can you please share why is it important to get screened for colon cancer, who should be doing it? How often should it be happening? All that good stuff?

Dr. Crespin: Yeah. I mean, it’s very important to get screened because not only you can prevent colon cancer, but you can also diagnose it at early stages and save people from getting surgeries. One of the major changes is really in the last three years is because the fastest current group with colon cancer was between the ages of 46 to 50.

Now it’s been recommended by the U.S. Preventive Services Task Force [inaudible 00:04:34], that anybody really 45 and over should get screened for colon cancer. And if you have a family history, like a first-degree relative, you really should start at 40 or 10 years before your relative got colon cancer, whichever comes first.

So what I tell people is that having a first-degree relative with colon cancer doubles your risk of colon cancer. So it’s very important, you know, if you’re in your 40s, haven’t had it done, to get it done by, you know, a board gastroenterologist or GI surgeon. Those are the most common doctors that perform these procedures.

Ariel: And how often should we be getting screened? Is it something that’s, like, an annual physical? Is it less or more often?

Dr. Crespin: Yeah, no. I mean, the reality is that a lot of patients only need a colonoscopy maybe every 10 years or so if it’s a normal colonoscopy. Those with family histories, those with genes, those that have had pre-cancerous polyps, which probably [inaudible 00:05:26], probably, you need to have it done more, like, every three to five years.

Ariel: Okay. So everybody, I hope you are not only just quickly googling your GIs in the area to make your appointment, but also marking it on your calendar as a reminder to sure that you’re not missing your regular screenings for the timeframe that makes sense to you.

I’m curious, since you have been practicing for a while, do you have any kind of incredible stories about how screening really helped one of your patients? Maybe you caught them just in time or it made a huge difference in their life?

Dr. Crespin: Yeah. I had someone whose mother had colon cancer at 62 and ironically, he really got screened at his birthday at age 40. And we caught an early colon cancer, and so he got treated and is currently doing very well. And I think that, you know, knowing that history, knowing that because he was a higher risk and knowing that he shouldn’t wait until 45 or 50, that really made a big difference, made a big impact.

Ariel: That’s amazing. Yes. Even more proof and reason to make sure that you go in and get screened. And then I guess, too, we’ve talked about this in the past, but I think it is another thing that bears repeating. Can you just share a bit about the process because I know some people are really nervous to get a colonoscopy? Can you maybe destigmatize some of the fear and things surrounding the procedure?

Dr. Crespin: Yeah. The actual procedure itself is really not a big deal. People are sedated to make them comfortable to in this country. And, you know, the video cameras are not that big. I think the main fear that people have is really the preparation, which is, you know, how do they get ready for this?

And there are better preps that we didn’t have 20 years ago. It still requires some being on a liquid diet the day before, but there are a dozen different preparations that [inaudible 00:07:19] to get people cleaned out, and it’s really, you know, a one-day sort of cleanse that really shouldn’t be a big deal.

And, but it’s important to have a good cleanse so that your doctor can see well in the colonoscopy. But in the actual procedure itself, people get sedated. Usually, people ask “Am I gonna have a lot of pain?” I’m, like, “No.” A lot of times, we’ll use CO2 for inflating the colon. People don’t have discomfort the way they did, and it’s a relatively painless procedure these days.

Ariel: That’s great news. And that makes it easy. There’s nothing to be nervous about. It’s relatively or incredibly pain-free. So we’re just knocking out all those excuses. You mentioned earlier, unfortunately, there’s more misinformation out there now surrounding kind of colon and GI health. Can you share what some of those biggest misconceptions are that you hear when you’re chatting with your patients on a regular basis?

Dr. Crespin: Yeah, I think the biggest misconception is patients will be, like, “Well, I’m fine, so I really don’t need to do anything.” And that’s really the point of screening, which is that you do it be before you have symptoms, before you’re bleeding, before you’re having, you know, abdominal pain and weight loss. So that’s the biggest misconception, which is that, “Oh, because I feel fine, I don’t need to do anything.”

And the second thing, lots of people are, like, “Well, but I really don’t have any family history.” And I’d say more often than not, people I find with colon cancer don’t have a family history of any cancer. And I think the third misconception is that a lot of people think, “Well, only old people get colon cancer.” I think that’s been dispelled a lot by, you know, the actor who played “Black Panther” was very young when he got colon cancer.

So it really, if I’d suspect of ages, in 13% of people who get colon cancer now are really under the age of 50. So it’s not just old people, there are younger people or people in their…something, might say in late 30s or late 40s, middle age, but you’d be surprised who can get colon cancer.

Ariel: Yes. That makes a lot of sense. Yeah. We’ve brought up Chadwick Boseman a couple of times as an example as to the importance of getting screened earlier because it isn’t just older people. I do feel like there’s this, like you mentioned, a misconception about it just being an old-people thing, and I’m here to dispel that it is not just an old people thing. I’m also curious, too, with how you’ve seen things change.

We were talking about those high-def scopes that we’re using now that were much different then. Are there any kind of new, exciting changes on the horizon that you expect us to see somewhat in the near future surrounding, not only the colonoscopy procedure, but I guess just anything to help with GI and colon health in general?

Dr. Crespin: You know, there’s…even now, there are gene tests. We don’t know all of genes that cause colon cancer, but I certainly have found that helpful, doing genetic testing in certain patients. And I think that there may be other genes will isolate the link to colon cancer. Certainly, there are links between families with sort of ovarian and colon cancer. So that’s one thing.

There’s been some early usage of artificial intelligence in colonoscopies, and that is not quite right for prime time, but maybe within the next 5 to 10 years, may be used a lot more as we’re doing the colonoscopies. I think that’s an exciting thing.

And what else is probably new in the GI field is that it’s possible that we’ll, 5 to 10 years from now, be able to kinda assess our microbiome and say, “This is more a microbiome associated with colon cancer, and this one’s less associated with colon cancer.”

Ariel: Oh, I love the options of potentially more specificity, so we can really dive in there and assess things in a different way. That’s also for, it seems like with things like genetic testing, for those people who are nervous about colonoscopies, even though we are trying to dispel those fears, there’s other options for them.

I think options are great so we can meet people where they’re at, which is something else that we chat about on the podcast. But it’s great to be able to have all these different tools to assess people’s conditions. We’re just about out of time. Is there anything else you’d like to share with our audience before we go?

Dr. Crespin: Yeah. I mean, I think that, you know, I often get asked, like, people out of state, like, “How do I know if my doctor, you know, was any good or how do you assess that?” And, you know, again, normally, like someone who’s a board gastroenterologist or GI surgeon, there are parameters where we really say that the average gastroenterologist should find polyps in about 1 in 4 women at 50, and 1 in 3 men at 50, and it’s something that’s called adenoma detection rate.

And that normally, I’d sort of say that if your doctor’s adenoma detection rate is less than 25%, you probably should find a better doctor. But say, you know, my adenoma detection rate is, like, 43%. And I think it’s…you use more and more as sort of a scale as to how good is the doctor looking…

You know, it’s not just being able to look at the colon, it’s being able to recognize, you know, what is the precursor of colon cancer moving it versus, you know, what is sort of known, and that is an important skill that we train years to learn.

Ariel: That’s such a helpful metric to even know exists. So everybody, make sure, when you are going to your appointments and you’re chatting with your GIs, make sure you ask them what is your adenoma detection rate? And that can give you a good idea about whether you need to get a second opinion or how comfortable maybe you feel with that particular provider. Dr. Crespin, this has an awesome, thank you so, so much for being here.

Dr. Crespin: Well, thank you for talking with me today

Ariel: And everybody, like, I always say we all have colon. So just ask your questions, do your research and have a conversation. All right, we’ll see you next time. Happy National Colorectal Cancer Awareness Month. Bye.