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Early Detection and Straight Talk

David Dresner, MD, completed 10 years of active duty in the U.S. Navy prior to joining Gastroenterologists of Southern Indiana in 1994.

NEW ALBANY, IN. David Dresner, MD, gastroenterologist with Gastroenterology Health Partners in New Albany, Indiana, speaks to his patients in clear and simple terms, no hyperbole, just direct.

“I’m very blunt with my patients,” he says. “Folks understand when you speak to them in plain, simple language. So, when I say ‘You’re trying to pass five pounds of mud through a one-pound hole,’ they understand what I’m saying.”

That’s how he describes a blockage in the colon to the patients he treats who have colon cancer. So, when Dresner says he’s genuinely excited about the progress being made in colon cancer survival rates, you can trust it’s not false enthusiasm or misplaced optimism.

“We are putting a distinct notch into colon cancer mortality,” he says. “Without any question we are making a dent and people are living longer.”

Dresner comes by his love for finding solutions to problems naturally. His father was a nuclear physicist and his mother was a schoolteacher. Dresner grew up in Oak Ridge, Tennessee, and attended Washington University in St. Louis, earning a degree in biology. From there, he attended the University of Tennessee Medical School in Memphis via the U.S. Navy’s Health Professions Scholarship Program. Per the program regulations, he remained on inactive reserve while attending medical school, except for six weeks of active duty per year. After completing medical school, he had a four-year obligation of service to the Navy.

Dresner completed his internship, residency, and fellowship at Portsmouth Naval Hospital in Virginia. He then served as a medical officer on a ship for about 14 months in 1984–85, including participating in the bombing of Benghazi in March of 1985.

“We were off the coast of Lebanon when the journalist Terry Anderson was kidnapped,” Dresner says. “We spent about three months floating around off the coast of Beirut as a platform waiting for negotiations to get him successfully released. They finally flew him onto our ship and from our ship on to the carrier.”

Having completed 10 years of active duty, Dresner was honorably discharged from the Navy in 1994. With a wife and three children under the age of six, it was time to come home. A recruiter connected him with Gastroenterology of Southern Indiana, and he joined in 1994.

Gastroenterology of Southern Indiana is now a division of Gastroenterology Health Partners, which formed about five years ago as a partnership between Gastroenterology of Southern Indiana, Gastroenterology Health Partners East, and Louisville Gastroenterology Associates. The purpose was to form a combined group that maximized efficient quality patient care by combining resources.

“We felt the path to independence was to merge with other groups and grow,” Dresner says. “I like being independent. I believe when physicians have skin in the game, they are driven to efficiently deliver cost effective, high quality medicine.”

That’s what Dresner and his colleagues aim to do every day at their practice. Most of his colon cancer patients are 45 and older, while younger patients in their teens to 30s are more apt to present with inflammatory bowel disease, like Crohn’s or ulcerative colitis.

“The Mayo Clinic was so impressed with our detection rate that they visited to see exactly how we were doing things”-David Dresner, MD

Indiana, a Colon Cancer Hotspot

In southern Indiana, the incidence of colon cancer is 61 males per 100,000 and 45 females per 100,000, which is higher than the national average. Americans overall have a 4.4 percent lifetime risk of developing colon cancer. While there are different screening methods now available, Dresner stands by colonoscopy as the most reliable.

“The best test is the one the patient is willing to do, but my preferred tool is colonoscopy,” he says, noting that his second choice would be a fecal immunochemical test for blood or DNA. But, “why not have the patient go to sleep during colonoscopy where we can actually do something about what we find? The death rate of patients with colon cancer is definitely going down and it‘s attributable to colorectal screening.”

Right-sided colon cancers, because stool is liquid on the right side, are less likely to cause obstruction until much later and oftentimes present with iron deficiency anemia. Abdominal cramping, weight loss, thinning of the stool, and rectal bleeding are typical presentations for left-sided colon cancer where the stool is solid. The risk factors for colon cancer include many of the usual suspects: family history, obesity, smoking, sedentary lifestyle, increased alcohol intake, excessive red meat, and decreased vegetable consumption.

“The most misunderstood aspect of colon cancer among general practitioners and non-gastroenterologists is what are appropriate screening modalities; when do you start them, when do you stop them, and how are they best used,” Dresner says. “We are seeing more Cologuard testing being done on average risk individuals who might be better served with a colonoscopy. Because of their age and the years of life left, we can reduce their colon cancer risk by detecting and removing adenomas or increase survival by detecting an early stage cancer.”

Dresner points to the low risk and low miss rate, which is about six percent on small polyps, of colonoscopies as reasons why it remains the preferred screening method.

“We have standards in colonoscopy regarding who should perform them and who shouldn’t,” Dresner says. “Fundamentally, you should be able to reach the cecum in at least ninety-five percent of cases. Your average withdrawal time should be six minutes or more. You should be able to resect a polyp of less than two centimeters without sending it to a surgeon.”

“In first-time screening colonoscopy, you should be detecting adenomatous polyps in twenty-five percent of patients overall…thirty percent in men and twenty percent in women. If you’re not meeting those national standards, studies reveal post colonoscopy colon cancer rates increase. Our group has had a consistent adenoma detection rate over fifty percent for years. The Mayo Clinic Jacksonville was so impressed with our detection rate that they visited to see exactly how we were doing things.”

Naturally, early detection is a key factor in patient outcomes. Patients with stage I colon cancer have a five-year survival rate of 74 percent, versus a five-year survival rate of just 5.7 percent of those with stage IV colon cancer.

“I always tell my patients when they have colon cancer, don’t jump the gun,” Dresner says. “Take it one day at a time. Survival rates are a lot better today than they ever were and we’re always coming up with newer therapies, particularly for advanced disease. Who knows what the future is going to hold?”

It’s clear and simple advice from a physician with a clear and simple goal—to continue to reduce colon cancer deaths, one patient at a time.