Saving Lives Through Screening

Four of the institute’s doctors with an optics machine used for screenings (from left): Dr. Howard Minami, Dr. Cedric Lorenzo, Dr. Racquel Bueno and Dr. Mark Mugiishi | Leah Friel photo, lfriel@midweek.com

March is Colon Cancer Awareness Month, and there is no better time to get screened at the newly established Endoscopy Institute of Hawaii

According to the Centers for Disease Control and Prevention, 51,848 people in the United States died from colon cancer in 2009. And a total of 136,717 were diagnosed with the disease that year (the most recent data available). That makes it the third most common cancer in the country – and the second leading cause of cancer-related deaths.

Yet despite the prevalence of colon cancer, screening rates are lagging across the country, and Hawaii is near the bottom. Only about 60 percent of adults ages 50-75 in the state reported getting screened in 2009, according to the CDC.

In order to combat those grim statistics, eight leading doctors have teamed up to create the Endoscopy Institute of Hawaii, which uses cutting-edge technology to screen patients for colon cancer and digestive problems in a convenient, comfortable manner. Opened in October, it aims to streamline screening, increase public awareness and ultimately reach more patients.

“There is a tremendous demand for increased access to screening here,” says Dr. Mark Mugiishi, one of the institute’s eight partners who specializes in general surgery. “Shame on us as a state. We need to get better, and so that is what we are hoping to do in the next few years.”

“We were noticing that patients for screening were waiting longer and longer just to get an appointment,” says institute partner Dr. Racquel Bueno, a general surgeon who specializes in minimally invasive procedures. “We took a look at what those problems were and how we could find solutions.”

The team of doctors, along with corporate sponsor Skai Ventures, turned to an open access model – one that addresses a single area of care in an effort to make treatment more efficient and effective. In addition to long waiting periods, the doctors identified patient fear of a colonoscopy as a major hurdle to screenings.

Perhaps it is that fear that contributes to the way colon health is talked about – or not talked about.

“It is not as popular of a topic as breast cancer, for example,” says institute partner Dr. Cedric Lorenzo, who specializes in minimally invasive surgery. “It is a part of the body that people are not the most comfortable with discussing. As a result, I think it gets pushed to the back of people’s minds in terms of their exam.”

The fear that this procedure seems to invoke among patients is understandable. Screening involves inserting a 5-foot-long scope into the anus, through the rectum and throughout the colon (large intestine) to look for small growths, or polyps. The polyps are slow-growing, and while many are benign, some may develop into malignancy over time – and symptoms such as bleeding, weight loss, abdominal pain or change in stools often do not appear until the cancer is farther along.

But there is good news – well, a silver lining, at least – about colon cancer: Screening is effective. It is so effective that CDC estimates up to 60 percent of related deaths would not occur if everybody eligible received regular screenings.

“Screening for colorectal cancer is not just screening, it actually prevents colon cancer from developing,” Bueno says. During the procedure, any precancerous growths that are found will be snipped and removed.

“When you think about the prevention of the worst diseases in the United States, it is really the easiest one of all to prevent,” Mugiishi says. “When you think about what you have to do to prevent heart disease, you have to lose weight, you have to keep your blood pressure down, you have to stop smoking … In colon cancer, if you have this screening once every 10 years from the time you’re 50, you basically eradicate your risk.”

Screenings are recommended for people 50 and older. Those with risk factors such as inflammatory bowel disease or a relative with colon cancer should get screenings earlier. Other possible risk factors include a low-fiber, high-fat diet, obesity and alcohol and tobacco use.

The Endoscopy Institute utilizes state-of-the-art optics, such as a 190-degree camera that provides a clear view of the entire colon. It also works with any issues related to digestive health, including problems with swallowing, heart-burn, gastric reflux and indigestion. To treat these issues, the institute offers upper endoscopy screenings, which examine the esophagus, stomach and portions of the small intestine.

“Almost any digestive problem that we discover here, there will be somebody within our network of physicians who can take care of the problem,” Mugiishi says.

The institute is comprised of experts in all aspects of digestive health. In addition to Bueno, Lorenzo and Mugiishi, its medical team is comprised of gastroenterologists Herbert Lim, Howard Minami and Warren Ono, and colon and rectal surgeons George Lisehora and Ronald Wong.

The doctors agree a deep level of collegial cohesiveness exists among them.

And no wonder there is such a camaraderie – many of them have longstanding professional and personal connections. Bueno and Lorenzo attended medical school together, and they both later studied under Mugiishi through the University of Hawaii residency program. Lim attended Iolani School with Mugiishi, and more recently trained Bueno and Lorenzo during their residencies. Lisehora and Wong have worked with Mugiishi for years. Bueno, Lorenzo and Mugiishi also are UH professors, where they facilitate training and conduct research.

For these doctors, one goal that motivated them to start the institute was to provide care to as many people as possible. Last month, it received Medicare certification, meaning it can now treat those who receive federal insurance. Pre-procedural evaluations also are available at no additional cost.

“If you are trying to increase the rates of screening, one area that you should be targeting is the underserved,” Lorenzo says.

The passion this team of doctors has for improving digestive and colon health is evident in the way they can recount stories of patients. Some stories are uplifting – like the one about a young man who went home with normal test results after experiencing abdominal pain. Other stories don’t have happy endings – and are somber reminders of why this type of institute is important.

“The advice we would give is our tagline, which is that ‘screening saves lives,'” Mugiishi says. “Now that we have made it easy and convenient … there is no reason not to want to save your life.”

For more information about Endoscopy Institute of Hawaii or to schedule an appointment, visit endoscopyhawaii.com or call 312-6700.