Episode Details

Colorectal cancer screening update, COVID-19 vaccine update, and abnormal uterine bleeding basics.

Today is May 24, 2021.

Colorectal cancer screening update 
Written by Hector Arreaza, MD. 
Participation: Ikenna Nwosu, MD, and Daniela Viamontes, MD.

Today is May 24, 2021.

On august 29, 2020, we were in the midst of a pandemic and we woke up with the sad news about the death of Chadwick Aaron Boseman (also known as Black Panther). An interesting fact: The tweet in which his family announced his death on Twitter became the most-liked tweet in history. But why are we talking about Chadwick’s death? Because he died of colon cancer. I do not know if this recommendation came because of Chadwick, but it’s a good way to open this episode: remembering Black Panther.

We heard the rumors, but now it’s official. On May 18, 2021, the USPSTF released their final recommendation statement about colorectal cancer screening. The age to start screening has been changed from 50 to 45 years old. This is a grade B recommendation. Grade B means that this recommendation has moderate to substantial net benefit, so offer this service to your patients. 

Screening adults between 76 and 85 years old who have been previously screened has a small net benefit (grade C recommendation). So, select patients may be screened for colorectal cancer in this age group (76-85), especially those who have never been screened.

Do you remember this recommendation from medical school for high risk patients? Start screening at age 40 or 10 years before a patient’s direct-relative was diagnosed with colon cancer. This was a recommendation given by the US Multi-Society Task Force (which includes the American College of Gastroenterology, American Gastroenterological Association, and American Society for Gastrointestinal Endoscopy). This same organization already recommended in 2017 to start screening at age 45 in African American patients, and the American Cancer Society recommended screening all patients at age 45 in 2018. The ACS does not have a guideline to screen high risk patients for colon cancer. Most organizations agreed on not screening after age 85.

Strategies for screening:

High-sensitivity guaiac fecal occult blood test (HSgFOBT) or fecal immunochemical test (FIT) every year

Dani: Stool DNA-FIT every 1 to 3 years (Cologuard®)  

CT colonography every 5 years 

Flexible sigmoidoscopy every 5 years OR Flexible sigmoidoscopy every 10 years + annual FIT 

Colonoscopy screening every 10 years

Discuss different options with your patients, choose your favorite and do it!
 

Introduction: Update on COVID 19 vaccines  

By Hector Arreaza, MD, and Lillian Petersen, RN.

COVID-19 vaccines now can be co-administered with other vaccines according to the ACIP. COVID-19 vaccines and other vaccines may now be administered without regard to timing. They can be given on the same day or within the 14 days previously recommended between vaccines. 

It is not known if reactogenicity of COVID-19 vaccine is increased with co-administration with other reactogenic vaccines (such as vaccines with live attenuated viruses). 

How do you decide if you want to co-administer a vaccine? 

1. Consider whether the patient is behind or at risk of becoming behind on recommended vaccines.

2. Consider their risk of vaccine-preventable disease.

3. Consider the reactogenicity profile of the vaccines. If multiple vaccines are administered at a single visit, administer each injection in a different injection site, at least one inch apart or in different limbs. 

Current or previous SARS-CoV-2 infection: 

Everyone should be offered COVID-19 vaccination regardless of their history of COVID-19 infection. Viral testing or serologic test is not recommended