Count colorectal surgeons among those who have concluded during the last generation that we often are, health-wise, what we eat.
"Our diet is definitely more industrialized and, as a result, we have more adverse effects," Dr. Daniel Leberer said. "We recommend a high-fiber diet to everybody."
Dr. Joseph Mills, one of his colleagues, said doctors in their practice also advise patients who come in with diverticulosis and other colon and rectal conditions to drink more water, limit caffeine and alcohol – each of which in abundance can stir an inflammatory response – and eat in moderation.
"These are things we've been preaching for years," Mills said.
The two specialists, both in their mid-30s, have joined the Buffalo Medical Group Colon & Rectal Surgery practice during the last two years. They are both St. Joseph's Collegiate Institute and University at Buffalo medical school alums.
Mills spent part of his undergraduate days at Canisius College working in an athletic training internship with the Buffalo Bills. Later, Dr. Jeffrey Visco became a mentor to him while Mills was in his UB residency program. The two now work together in the same practice.
Leberer, who got a bachelor's in psychology from Villanova University, and his father, Dr. Joseph Leberer, are among the other six surgeons.
"When I first got to medical school, he encouraged me to do orthodontia," the younger Leberer said of his dad, with a smile. "After that, it was dermatology. After I got into general surgery, and was considering surgical specialties, he was encouraging at that point."
Q: What are the most common conditions and have you seen increases in any of them since you started medical school?
Mills: Diverticulitis. It's something I feel is more frequent over my career. In speaking with some of the more senior surgeons, they think there's been a significant increase in the frequency since they started.
Mills: A change in our diet. A low-fiber diet predisposes a patient to diverticulosis, which can lead to diverticulitis (painful inflammation or an abcess in the colon wall).
Leberer: I think Buffalo's got some of the best food in the world but, unfortunately, it's not necessarily some of the healthiest. That's certainly a contributing factor.
Q: How much of your job focuses on prevention and treatment of colon and rectal cancer?
Mills: That's probably what we spend most of our time on.
Leberer: A unique aspect of colorectal surgery in Buffalo is that the surgeons, along with gastroenterologists, do a large amount of colon cancer screening, which isn't always the case in other cities. A large part of our practice is routine colonoscopies for average risk individuals to screen for colon cancer.
Q: Once you've detected colon cancer, then what happens?
Mills: It's patient-dependent. Once they're diagnosed, we offer them the therapeutic options we feel are most appropriate. It's usually surgery that we perform unless it's at an advanced stage, and even then the patient might still be a candidate for palliative reasons.
When it comes to chemotherapy or radiation, Buffalo Medical Group has some really great oncologists. Ultimately, it's up to the patient about where they're going to follow up for the remainder of their treatment but there's a protocol we all follow for patients after they have surgery for colon cancer, in terms of when they need to have scopes and labs and CT scans.
Leberer: One of the nice parts about a colorectal surgeon performing the colonoscopies is that initially, if a colon or mass is found, we've been involved from the very beginning.
Q: What causes colon or rectal cancer?
Mills: It's a combination of genetic and environmental factors. There are a number of hypotheses out there. Starting out with the genetic component ... where a patient is born with a gene mutation and an environmental factor will lead to a second hit of the parallel gene which starts a cascade. In these cases, there are also associated cancers like endometrial, ovarian and renal.
Leberer: Then there are sporadic forms in which you develop a mutation in DNA due to environmental factors.
Q: What can be done from a behavioral standpoint to prevent these cancers?
Leberer: A high-fiber diet, and pay attention to any concerning symptoms such as rectal bleeding, change in bowel habits or weight loss. Take care to understand your family history because that could put you at increased risk. Based on your risk level, there's a certain time to undergo a colonoscopy.
For average risk patients, we recommend a colonoscopy at the age of 50. For patients that are deemed high-risk - a family history or history of colorectal polyps - we recommend a colonoscopy 10 years prior to the diagnosis of cancer in the family or the age of 40, whichever comes first.
Q: What's indicated for colon resection surgery for diverticulitis?
Leberer: There used to be set guidelines. Now, it's a more individualized approach. There are two types of diverticulitis: complicated or uncomplicated. Complicated means you either have an abcess, obstruction or fistula. If you have complicated diverticulitis you can make the argument you have a resection after only one episode. The more common form is uncomplicated, meaning you have inflammation surrounding the diverticuli. We look at the severity, how many episodes you have, the timing between recurrence of episodes, patient preference.
Q: Years ago, patients were also told not to eat nuts or seeds.
Leberer: That's a fallacy. The recommendation is just a high-fiber diet for diverticulosis. Patients are cleared to eat peanuts and seeds. I tell patients if they have a hard time with a food - if it bothers them - don't eat it anymore.
Q: Talk about ways to detect colon cancer. Which are the most popular and effective?
Mills: The gold standard for colon and rectal cancer screening is the traditional colonoscopy, which involves an endoscopic examination of the lining of the colon and rectum. Over the years, other studies have been approved by the United States Preventative Task Force Services to screen for colon cancer. That includes a flexible sigmoidoscopy and stool blood test. There is CT colonography, barium enema. All of the things compared to colonoscopy are less sensitive. The new kid on the block is Cologuard. What it represents is testing of the stool.
Q: What are you telling patients about Cologuard?
Mills: The test is being recommended by Medicare and Medicaid services to be done every three years. The task force article says it's indicated for average risk individuals that are unable or unwilling to undergo a colonoscopy. Our official recommendation from the group is that it shouldn't be offered to average risk patients who have access to a colonoscopy, are able to get one and can afford one.
Leberer: The goal of colonoscopy is not to detect colon cancer. It is to detect a lesion that will progress to colon cancer so that we can find those lesions and remove them before they progress to cancer. Cologuard will detect about 92 to 93 percent of colon cancers present during a test … but only picks up about 42 percent of precancerous lesions.
Mills: Let's say you're one of the lucky ones where Cologuard does pick up a precancerous lesion. Now you need to have your colonoscopy because that will remove and treat the precancerous lesion. It's therapeutic and diagnostic.
Twitter: @BNrefresh, @ScottBScanlon