President Joe Biden Avoids Cancer With Screening
- A polyp removed during President Joe Biden’s colonoscopy last week during his annual physical was pre-cancerous, according to his longtime physician.
- A report released by the White House said that the polyp “is a benign, slow-growing, but thought to be a precancerous lesion,” similar to one President Biden, 78, had removed in 2008.
- Most colon polyps are quickly snipped during the colonoscopy procedure to get a tissue sample while larger polyps may require a wire loop to harvest and then cauterize the removal site to prevent bleeding.
A report released by the White House said that the polyp “is a benign, slow-growing, but thought to be a precancerous lesion,” similar to one President Biden, 78, had removed in 2008.Read More
Cancer care and treatment have been a cornerstone of President Biden’s agenda for decades.
He headed the Cancer Moonshot program as vice president under Barack Obama. This research initiative aimed to find cures for the disease by directing over $1 billion in government funding into approximately 250 research projects and 70 cancer science efforts.
Those efforts continued with the Biden Cancer Initiative, founded in 2017 during his brief hiatus from the West Wing.
The Biden family knows all too well the toll cancer can take after President Biden’s son Beau passed away in 2015 from brain cancer.
President Biden is past the age at which the US government recommends individuals be routinely screened for colon cancer.
Recent research supports Biden’s decision to undergo the procedure, showing a benefit to getting colonoscopies past 75. One study, published earlier this year in JAMA Oncology, resulted in the American Cancer Society extending its guidelines to say that individuals between 76 and 85 who wish to get screened should get a colonoscopy. The ACS noted that “life expectancy, overall health, and prior screening history” should be taken into consideration when making that decision.
The USPSTF did not follow suit, though its guidelines state that individuals over 75 who wish to get a colonoscopy should consult with their physician.
The JAMA study found that individuals over 75 who screened for colorectal cancer had a far lower mortality rate than those not screened for the disease.
“Screening endoscopy after age 75 years was associated with a reduced incidence of CRC (colorectal cancer) —primarily distal colon and rectal cancer—and death from cancer, regardless of previous screening history,” notes the study.
“It’s a no-brainer,” explains Dr. Heather Yeo, a colorectal surgeon at Weill Cornell in New York and a SurvivorNet medical advisor. “You don’t want to have a patient in their 80s dying because they have a large obstruction that went undetected.”
Since clinical trials do not include patients over the age of 75, the evidence was gathered by analyzing the data of 56,374 participants enrolled in the Nurses’ Health Study and the Health Professionals Follow-up Study and had endoscopy for routine screening or had a family history of colorectal cancer. Of the 651 individuals over 75 diagnosed with colorectal cancer, 323 died of the disease.
Unscreened participants over 75 had a cancer incidence of 74.1 per 100,000 person-years and a mortality of 7.9 per 100,000 person-years. (Person-years is measured by multiplying participants and time in study.)
However, the study does note that there may not be benefits to individuals with comorbidities such as myocardial infarction or stroke, hypertension, hypercholesterolemia, and diabetes.
How Doctors Biopsy Polyps
During a colonoscopy, a doctor will remove any polyps he sees for further testing or take tissue from the growth for a biopsy.
In the colon, where polyps are most likely to be found, doctors will often remove the polyps using a procedure which is painless to the patient during and after their colonoscopy.
That procedure is called a polypectomy.
The majority of polypectomies are done with the colonoscope being used for the colonoscopy.
Most polyps are quickly snipped to get a tissue sample while larger polyps may require a wire loop to harvest and then cauterize the removal site to prevent bleeding.
Since most colon polyps do not cause any symptoms, they are often detected for the first time during a colonoscopy.
After being removed, the polyps or tissue will be examined under a microscope by a pathologist to determine if they are cancerous or benign (non-cancerous).
Step-By-Step Guide to Colonoscopy
Colonoscopies still cause a level of unnecessary fear in some men. Still, as Dr. Paul Oberstein, medical oncologist, NYU Langone Perlmutter Cancer Center, previously told SurvivorNet, the process is quick and straightforward. Most importantly, though, it can also be lifesaving for some men.
“A colonoscopy is a procedure that’s usually performed by a gastroenterologist, sometimes by other physicians such as colorectal surgeons, and it essentially involves placing a tiny camera in the colon, so through someone’s bottom, through their anus, into their rectum, and then the colon,” explained Dr. Oberstein.
The purpose of a colonoscopy is to look inside the entire colon and identify any polyps, abnormal growths, or other concerning masses. As a result, the organ walls need to be visible on the day of the procedure.
“In order for that to be successful, the colon has to be empty,” said Dr. Oberstein. “So the preparation for colonoscopy involves almost an essential purge of everything in the colon. Patients will drink a large amount of liquid that will clean them out and cause a lot of bowel movements.”
These “bowel preps” are laxatives that work to evacuate the entire digestive tract. It is often the least comfortable part of the procedure and the most important since it is the only way for doctors to get a thorough look inside the colon.
Once emptied, the colon is ready to be examined by the doctor, who inserts a colonoscope. That is a fragile and very flexible device that includes a camera and light guided through the colon for the doctor to examine the area and ultimately determine the colon’s health.
“It usually takes around a half-hour, if not shorter, to look throughout the entire length of the colon, identify any abnormalities,” noted Dr. Oberstein. “Biopsies can be performed at the same time if something abnormal is identified.”
A second examination of the biopsy is next to reduce the risk of missing or misdiagnosing cancer.
“The first biopsy’s performed by the person who does the colonoscopy, so usually the gastroenterologist. And they look for any growths, which are called polyps, or any changes in the surface of the colon, which may not be a growth but look abnormal,” explained Dr. Oberstein.
“And they then take a small piece of that, take that sample out, and deliver it to the pathologist. And the pathologist will cut that sample open and look for any abnormal growth that could be a sign of precancer, or cancer, inside that biopsy.”
The pathologist will then return their report, which includes their assessment of whether or not any cancer cells were present in the biopsy.
If there is evidence of cancer, the gastroenterologist will generally refer the patient to a specialist to start treatment.
There will also be further testing, known as staging. This includes blood work and a CT scan of the chest and abdomen to determine the size of the tumor and if it has spread to other organs like the liver and lungs. This informs the treatment options available and determines which will be most effective in fighting the disease.