By Leslie Krowchenko
March celebrates Women’s History, Disability Awareness, and the first day of spring.
For Nathaniel Holmes, M.D., the focus is on Colorectal Cancer Awareness.
Holmes, a board-certified colorectal surgeon, practices at Bayshore and Old Bridge medical centers, divisions of Hackensack Meridian Medical Group. His more than 30 years of experience treating the full range of conditions puts patients at ease discussing issues they would rather not be thinking about, much less talking about.
“It’s the month when we can remind people about the importance of screening and maintaining healthy habits,” he said. “If you’ve never had a screening, schedule one; if you are having symptoms, address them.”
A 1987 graduate of Rutgers Robert Wood Johnson Medical School, Holmes considered various specialties before choosing colorectal surgery. He completed his surgical residency at the same institution in 1993, followed the next year by a fellowship with St. Vincent Health System. Dr. Holmes has given more than 35 abstracts and presentations and authored a number of nationally-recognized publications and research papers.
The field is one which needs his expertise. Excluding skin cancers, colorectal cancer is the third most common form of the disease (following breast and lung cancer) diagnosed in men and women in the United States. The American Cancer Society projects 106,970 new cases of colon cancer, and 46,050 of rectal cancer, which will be identified this year. It is also the second deadliest cancer; 2022 estimates predicted 52,580 deaths (lung cancer, 130,180).
For most adults, the statistics are trending in a positive direction. The rate of those diagnosed with colon or rectal cancer each year has dropped overall since the mid-1980s and at a rate of one percent annually from 2011-2019. The lower numbers are the result of earlier and increased screening and changes in lifestyle-related risk factors.
Screenings provide doctors with the ability to detect two types of polyps – hyperplastic (not precancerous) and adenomatous (precancerous). Colorectal cancer typically develops from the latter and a biopsy determines the type of growth. Early detection allows for removal before they become cancerous.
The downward-trending data is mostly seen in older adults, however, as rates have been increasing by one-two percent a year since the mid-1990s for people younger than 50. Patients at average risk of colorectal cancer are now encouraged to have their first screening at age 45, five years earlier than once recommended. Those in good health should continue regular screening through age 75, with the decision for mid-septuagenarian and older based on the person’s overall health and prior history.
Dr. Holmes stressed knowing the patient’s immediate family history is a determining factor to begin screenings.
“If one’s mother/father/sister/brother is diagnosed, the person should get his or her first screening 10 years before the index case,” he said. “If the close relative is 43, for example, the patient should have their initial screening at 33.”
Screenings may be conducted in the privacy of one’s home, a doctor’s office/surgery center, or a combination. Tests such as Cologuard require the individual to collect a stool sample and ship it to the company, which forwards the results to the person’s healthcare provider. A colonoscopy, conducted by a physician, is preceded by overnight preparation.
“Cologuard is a good test if the person has no family history of colorectal cancer and no symptoms,” said Dr. Holmes. “We recommend first having a colonoscopy to establish a baseline, then using it in between.”
Although once a decade is the generally-accepted frequency for screenings, Dr. Holmes prefers seeing his patients and their tushes more often. He recommends every seven-eight years; every five if one or two polyps were previously removed, depending on type and size.
“Technically the span is 10 years, but as a surgeon, I like a different routine,” he said. “I prefer to see my patients sometime between five-10 years.”
Dr. Holmes credits Katie Couric with helping to educate the public about the life-saving procedure. Her first husband, attorney Jay Monahan, succumbed to colorectal cancer in 1998, and two years later, she had a screening live on TODAY in an effort to raise awareness. A study by the University of Michigan showed the rate of colonoscopies increased by more than 20 percent in the months following the broadcast.
“Her decision really made a difference,” said Dr. Holmes. “Viewers who saw it decided ‘if she can get one, so can I.’”
Patients can take daily steps to reduce their risk of colorectal cancer. The ubiquitous phrase “maintaining a healthy lifestyle” can be easier said than done, but increasing fiber, decreasing fatty foods, and starting (or intensifying) exercise are among the ways to minimize the possibility. Adding fresh fruits and vegetables and a bowl or bar of Fiber One every day, reducing fatty food and red meat consumption, and walking several times a week are effortless ways to improve one’s overall health. Dr. Holmes added patients should monitor their diets to prevent obesity and avoid smoking and excess alcohol.
Colorectal polyps and cancer do not always display symptoms. Individuals should contact their health care provider if they notice a change in bowel habits, blood in or on the stool, diarrhea or constipation, ongoing abdominal pain or bloating, nausea, and/or unexplained weight loss.
Dr. Holmes stressed patients should schedule a screening to detect any precancerous conditions and prevent the need for a more extensive procedure.
“I say ‘just come in and have it,’” he added. “’Get the screening and be done with it.’”
