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American Cancer Society Updates Colorectal Cancer Screening Guideline

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A new American Cancer Society guideline says colorectal cancer screening, like colonoscopy, should now begin at age 45 – five years younger than previously recommended – for all individuals. Age 50 was the long-held standard age for adults to begin colorectal cancer screening. This new recommendation, to lower the age by five years, is based on data showing rates of colorectal cancer are increasing in young and middle-aged populations.

The updated screening guideline recommendation is based on colorectal cancer incidence rates, results from modeling that demonstrated a favorable benefit-to-burden balance of screening beginning at age 45, and the expectation that screening will perform similarly in adults ages 45 to 49 as it does in adults 50 and over.

The American Cancer Society now recommends:

  • Adults ages 45 and older to begin regular colorectal screening.
  • As a part of the screening process, all positive results on non-colonoscopy screening tests should be followed up with timely colonoscopy.
  • Adults in good health with a life expectancy of greater than 10 years should continue colorectal cancer screening through age 75. Clinicians should individualize colorectal cancer screening decisions for individuals ages 76 through 85, based on patient preferences, life expectancy, health status, and prior screening history. Clinicians should discourage individuals over age 85 from continuing colorectal cancer screening.

According to the American Cancer Society, colorectal cancer incidence has declined steadily over the past two decades in people 55 and over primarily due to increased colonoscopy screening that results in removal of polyps, as well as changes in exposure to risk factors.

“It is important to note that there are multiple options for someone to be screened for colon cancer, but patients should be informed that colonoscopy is still the gold standard and the procedure by which all others are measured,” says Dr. Jayant Talreja, a gastroenterologist with Richmond-based Gastrointestinal Specialists, Inc. “With colonoscopy, if an abnormality is found, the added benefit is that a therapeutic intervention can be performed during the procedure. If precancerous polyps are found, they can be removed. In the unfortunate scenario of a cancer, it can be biopsied. Colonoscopy has been very effective in bringing about the decline of colorectal cancer and related deaths in the over 50 population. If alternative screening tests are found to be abnormal, then a colonoscopy will generally still be required.”

However, according to the American Cancer Society, there has been a 51% increase in colorectal cancer among those under age 50 since 1994. Death rates in this age group have also begun to rise in recent years. A recent analysis found that adults born around 1990 have twice the risk of colon cancer and four times the risk of rectal cancer compared with adults born around 1950, who have the lowest risk.

“In my five years of practice, I have anecdotally seen a rise in the incidence of colon cancer in the younger population and that observation has been supported by the experiences of my colleagues,” says Talreja. “In many of these cases, patients may not have a typical presentation of symptoms and in some cases, the patients had no symptoms. The underlying cause could only be detected with colonoscopy.”

While the colorectal cancer incidence rate among adults 45 to 49 is lower than it is among adults 50 to 54, the higher rate in the 50-54 age group is partially influenced by the uptake of screening at age 50, which leads to an increase in the incidence rate due to detection of prevalent cancers before symptoms arise. Since adults in their 40s are far less likely to be screened than those in their 50s, the true underlying risk in adults aged 45-49 years is likely closer to the risk in adults ages 50 to 54 than the most recent age-specific rates would suggest. Importantly, studies by the American Cancer Society suggest the younger age cohorts will continue to carry the elevated risk forward with them as they age.

“Lowering the age to begin screenings is expected to benefit not only the segments of the population who suffer disproportionately from colorectal cancer – African-Americans, American Indians and natives of Alaska – but also all individuals considered to be at an average risk… which really is, everyone,” says Talreja. “We believe this
recommendation by the American Cancer Society is very positive, the correct decision and will likely save many lives.”

About Gastrointestinal Specialists, Inc.

Gastrointestinal Specialists, Inc. (GSI) is a group of 18 board-certified gastroenterologists and ten nurse practitioners/physician assistants who have been providing comprehensive GI care for more than 30 years throughout the Greater Richmond area treating the entire spectrum of gastrointestinal and liver diseases. GSI has four primary offices in the Richmond region and sees patients at all area hospitals. Procedures are performed at two conveniently located and fully accredited endoscopy centers, allowing for fast, easy access to routine diagnostic and therapeutic procedures.

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Supporting documentation

Article: American Cancer Society Updates Colorectal Cancer Screening Guideline; https://www.cancer.org/latest-news/american-cancer-society-updates-colorectal-cancer-screening-guideline.html

Article: Colorectal Cancer Screening for Average-Risk Adults: 2018 Guideline Update from the American Cancer Society; CA: A Cancer J for Clin doi: 10.3322/caac.21457. Lead author Andrew M. D. Wolf, M.D., Chair of the Committee Subgroup for CRC Guideline Update.

Mary Kathleen Engelken: Welcome to the GSI Team

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We would like to take a moment and welcome our newest nurse practitioner, Mary Kathleen Engelken, NP. Mary Kathleen Engelken joined GSI as a Nurse Practitioner in 2017 and works out of the Memorial Regional Medical Center location. She received her bachelor’s degree from York College of Pennsylvania in 2009 and her master’s degree from Virginia Commonwealth University in 2017. In 2017, Mary Kathleen received the Outstanding Student Award by the Virginia Council of Nurse Practitioners Richmond Region.

She has 10 years of experience as a registered nurse in hospital settings with a focus on critical and emergency care. Mary Kathleen is from Western Maryland and grew up living abroad in the Middle East but has lived in Richmond since 2011 with her husband and son. In her free time, she enjoys spending time with her family, running, traveling internationally, and putting her Spanish language skills to use through volunteer efforts in the Latin American community.

Kelley Osborne: Welcome to the GSI Team

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We would like to take a moment and welcome our newest nurse practitioner, Kelley Osborne. Kelley Osborne is ANCC board certified family nurse practitioner, as well as an ASMBS certified bariatric nurse and works at our Wadsworth office, primarily with Dr. Omer Khalid.

She received her bachelor’s degree in liberal arts from Virginia Tech and originally worked at GSI as a front desk and medical assistant; an experience that led her to seek her advanced nursing degrees. After graduating nursing school in Boston, she spent three years working as a nurse practitioner in the Gastrointestinal Surgery Department at Hospital of University of Pennsylvania and then three years as director for the Sibley Center for Weight Loss Surgery in Washington, D.C.

She was born and raised in Richmond and is excited to be with the practice. Happily married, she is the busy mother of three young children who enjoys gardening and reading in her free time.

Dr. Jeff LaFond: Welcome to the GSI Team

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We would like to take a moment and welcome our newest physician, Jeff LaFond. Originally from New Hampshire, Dr. Jeff LaFond enjoyed the many winter sports New England has to offer as well as spending time on the lakes. However, after high school he moved to Washington, D.C., where he completed his bachelor’s degree in psychology with special honors and medical school at The George Washington University. He also completed the master’s program in physiology and biophysics at Georgetown University.

While he never lost his passion for New England sports, he did lose his cold weather edge and decided to continue moving south. After completing medical school, he and his wife moved to Charlottesville for his residency and fellowship at the University of Virginia. During his residency he received the prestigious Mulholland Society Resident and Fellow Teaching Award, recognizing his commitment to teaching medical students and for having a positive influence on their careers. He was also fortunate to receive the American Association for the Study of Liver Diseases (AASLD) Emerging Liver Scholars Award and was subsequently chosen to serve as an AASLD Fellow Ambassador. During his gastrointestinal fellowship he was awarded the Stuart and Betsy Houston Award for Excellence in Fellowship. He was also selected by his peers to receive the Carl L. Berg Most Valuable Player Award, recognizing his dedication to “providing service above and beyond the call of duty and being an all-around team player.”

Dr. LaFond enjoys building long-term patient relationships through getting to know his patients in the clinic and by performing procedures when necessary. His specific interests within gastroenterology include inflammatory bowel disease, chronic liver disease, GERD, dysphagia, the evolving role of GI physicians in obesity management, and colon cancer screening.

In his spare time he enjoys cooking, the outdoors and traveling with his family, which includes his young daughter and son.

Dr. Jonathan Gaspar: Welcome to the GSI Team

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We would like to take a moment and welcome our newest physician, Jonathan Gaspar. Dr. Jonathan Gaspar grew up in Virginia’s Northern Neck and graduated from the University of Virginia with a B.A. in Cognitive Science. Strong positive influences from his father and grandfather, both physicians, combined with a love for patient care, made his decision to pursue a career in medicine an easy one. After college Dr. Gaspar went on to earn his medical degree at the Medical College of Virginia, where he also met his wife, Shakun Gupta, who is now a pediatrician. He then went to Chicago for seven years and completed an internal medicine residency, where he was also elected chief resident. He then completed his Fellowship in Gastroenterology. During his fellowship, he was selected as the Department of Medicine Fellow of the Year both in 2012 and 2013.

Following his training, Dr. Gaspar was selected for an Advanced Endoscopy Fellowship at the University of Virginia. During this year he developed expertise in ERCP, Endoscopic Ultrasound with fine needle aspiration, luminal stenting, and advanced polypectomy/EMR for large polyps in the colon and throughout the GI tract. After two years in private practice in Northern Virginia, he has returned to Richmond.

Dr. Gaspar’s interests in GI include disorders of the pancreas and biliary systems, endoscopic management of GI cancers, gastrointestinal polyps, Barrett’s esophagus, peptic ulcer disease, GI bleeding, and colorectal cancer screening.

During his free time Dr. Gaspar enjoys spending time with his wife and son, traveling, all sports—especially football and tennis—and is an avid foodie.

Rebecca Bae: Welcome to the GSI Team

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We would like to take a moment and welcome our newest physician assistant, Rebecca Bae. Rebecca is a native Floridian, graduating summa cum laude from the University of Florida with a background in health science and Spanish. She completed her training as a physician assistant (PA) at Eastern Virginia Medical School from where she graduated with honors and was given the Eugene A. Stead Award, presented to one graduate who exhibited overall excellence in both clinical and didactic settings.

Before PA school, she worked in a psycho-oncology research lab studying the biopsychosocial interactions of gynecologic cancers. It was here that she became passionate about the mind-body connection and how physical health heavily influences mental well-being and vice versa. She practices medicine with this holistic philosophy of care. Rebecca has long been interested in gastrointestinal disorders for their vast interaction with every other body system and power to influence quality of life. Her training in this realm took place in the general surgery setting, emergency department, oncology unit at Johns Hopkins University, inpatient and outpatient internal medicine, and (her favorite) Gastrointestinal Specialists, Inc. as a PA student. She is excited to work with such a wonderful group of practitioners.

In her free time, Rebecca enjoys outdoor activities and playing board/card games with her wonderful husband. She also delights in her church and missions involvement and is long-time adult and pediatric hospice volunteer.

Dr. Khalid: Welcome to the GSI Team

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We would like to take a moment and welcome our newest physician, Dr. Khalid. Dr. Khalid is originally from Karachi, Pakistan. He earned his medical degree from Dow medical University with top honors. He then moved to the United States and came to Bluefield, Virginia where he completed a medical externship. Dr. Khalid completed his internship and residency from Southern Illinois University in Springfield, IL. He was awarded as the best resident teacher. In addition, he also served as a Chief Resident at his training institute.

Before beginning his training in gastroenterology Dr. Khalid served on the internal medicine faculty as an Assistant Professor of clinical medicine at Indiana University. He went to St. Louis for his fellowship and completed his training in gastroenterology from St. Louis University in 2014. In addition, he acquired additional training in hepatology and transplant from St. Louis University.

Dr. Khalid has played an investigatory role on a number of trials in the area of hepatitis C infection. Results of his research have appeared in such notable peer-reviewed publications as Clinical Investigation, Clinics in Liver Disease, and Liver International, among others. Dr. Khalid has also co-authored a number of posters presented at annual meetings, including Digestive Disease Week in 2013 and ACG’s 77th Annual Scientific Meeting in 2012. His clinical and research focus is on hepatology including treatment of viral hepatitis, auto-immune liver disorders, care of patients with liver cirrhosis and liver cancer as well as colon cancer prevention, IBS, GERD, biliary/pancreatic diseases.

He is a member of the American College of Gastroenterology and the American Association for the Study of Liver Diseases.

Savita Srivastava: Welcome to the GSI Team

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We would like to take a moment and welcome our newest physician, Dr. Savita Srivastava. Dr. Savita Srivastava is originally from Buffalo, NY. She graduated magna cum laude from Brown University in Providence, RI, with a dual concentration in Biochemistry and English. As an undergraduate, her English degree focused on the art of medicine in literature. She went on to medical school at the Albert Einstein College of Medicine in New York. As a medical student, she served as the National Chair of the American Medical Association’s Medical Student Section, where she advocated for health care reform and created a national service project to enroll uninsured children into the Children’s Health Insurance program.

Dr. Srivastava completed her internal medicine internship and residency at Georgetown University Hospital in Washington, DC. She went on to serve as the Chief Medical Resident for Georgetown and INOVA Fairfax Hospitals. She presented her research as a medical resident in liver diseases at the American College of Gastroenterology, and won the Presidential Poster Award. During this time, she also served as an intern at the Office of the U.S. Surgeon General and chaired the Resident and Fellows Section of the medical Society of DC.

Dr. Srivastava completed her Gastroenterology Fellowship at Yale University in New Haven, CT, where she also pursued research in autoimmune liver diseases under the auspices of National Institutes of Health training grant. As a fellow, she won the Kushlan Award for outstanding gastroenterology fellow at Yale.

After graduating fellowship, she was a professor at Duke University School of medicine, one of the top GI programs in the nation for 5 years. She subsequently worked as a gastroenterologist for the University of Virginia Physician’s Group where she started a clinical gastroenterology practice for UVA in the exurbs of DC. She was named “Top Doctor” by Northern Virginia Magazine in 2014, 2015, and 2016.

Dr. Srivastava is a national leader in gastroenterology and currently serves as a member of the American Gastroenterological Association’s (AGA) Publication’s Committee. She was also among a handful of young physicians chosen by the AGA to participate in the AGA’s Future Leader’s Program, invested in developing the future national leaders for the organization.

Dr. Srivastava’s clinical interests include: women’s digestive health, colon cancer screening, irritable bowel syndrome, integrative gastroenterology, the microbiome and liver diseases.

Dr. Srivastava is married to her husband Sameer and has 2 young children. She enjoys spending time with her family, traveling, exploring culture, art and cuisine in Washington and Richmond, wine tasting in Virginia wine country and working out.

Ben Bradenham, Jr.: Welcome to the GSI Team

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We would like to take a moment and welcome our newest physician, Dr. Ben Bradenham,Ben Bradenham, JR.pdf Jr. Dr. Bradenham Jr. is a native Richmond, and second-generation gastroenterologist. He obtained his undergraduate degree in Neuroscience at Washington and Lee University in 2006. He subsequently attended and graduated from the University of Virginia School of Medicine in 2010. Residency training then brought Dr. Bradenham Jr. and his physician wife, Courtney Bradenham, to Saint Louis, Missouri. After completing three years of Internal Medicine residency training at Washington University’s Barnes-Jewish Hospital, he spent the next three years in the Gastroenterology & Hepatology fellowship at Saint Louis University.

After six years in Saint Louis, in 2016 he returned home to Richmond, Virginia and joined GSI. Dr. Bradenham Jr. cares for patients suffering from all gastrointestinal diseases; however, he has specific interests in the evaluation and management of pre-cancerous and malignant disease throughout the GI tract, liver disease, gastrointestinal motility disorders and the future of endoscopic weight loss solutions.

Alex Seamon: Welcome to the GSI Team

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We would like to take a moment and welcome our newest physician, Dr. Alex Seamon. Dr. Seamon grew up in Roanoke, Virginia and attended the College of William & Mary as a Monroe Scholar, graduating with a bachelor of science in Biology in 2004. Following undergraduate training, he earned his Doctor of Medicine from Eastern Virginia Medical seamonSchool in Norfolk and proceeded to the University of Florida to complete his internship and residency in Internal Medicine. Dr. Seamon was then honored to serve as chief medical resident at the University of Florida, prior to embarking on his training in gastroenterology and hepatology at the Medical College of Wisconsin, in Milwaukee.

While in fellowship, Dr. Seamon worked with a very diverse group of patients including patients with inflammatory bowel disease, irritable bowel syndrome, liver disease, gastroesophageal reflux disease (GERD), swallowing difficulties, peptic ulcer disease and stomach problems, colon polyps, diarrhea, constipation, hepatitis, motility disorders and general gastrointestinal well-being. He served as co-chief fellow, and graduated from the program in 2015, followed by joining GSI.

Out of the office, Dr. Seamon enjoys the great outdoors, playing sports and attending sporting events, running, swimming, mountain biking, snowboarding and hiking with his dog Scout. His father is an internal medicine physician in Fredericksburg, and his brother is an orthopedic surgeon in his hometown of Roanoke.