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Bill Klaproth (Host): Colorectal cancer is the second leading cause of cancer death among men and women combined in the United States, but it can be cured if it’s found early enough. That’s why screening is so important. Joining us now to talk more about that is Dr. Myron Morse from Columbus General Surgery. Thanks for talking with us today Dr. Morse.

Myron E. Morse, MD (Guest): Heh Bill, thanks. It’s good to be here.

Host: Well thank you and Dr. Morse, let’s jump into this. First off, can you tell us a little bit about colorectal cancer and how it is different than other forms of cancer?

Dr. Morse: Well as you mentioned, it’s fairly common and actually we’re seeing some rise in the rate in younger people which has been most intriguing here as of late. It does start as usually a benign growth inside the colon which is called a polyp and most of these then will over time, lead to cancer. So, this occurs in the large intestine which is the last part of the digestive tract. And the difference between colon and rectal is just more the position that it’s in in the colon, but it’s kind of put together because they act very similar.

Host: So, are there certain groups of people who have more of a risk of developing colon cancer?

Dr. Morse: Yeah, certainly people that have some hereditary syndromes which are a little more rare. They can be at a higher risk. People with a first degree relative that has had colon cancer; they are at a higher risk. Those with chronic inflammatory conditions such as Crohn’s disease or ulcerative colitis or people that would be on chronic immunosuppressants for like arthritis or transplant patients. They are certainly at a higher risk. And then of course, as we mentioned, the people that have had a history of polyps or a prior history of other cancers would be at a higher risk.

Host: Right. So, Dr. Morse, is there anything these people can do to decrease that risk?

Dr. Morse: Well the primary thing first off is to implement the screening recommendations, so trying to find things early before they turn to cancer and then certainly, watching for signs and symptoms that may indicate there’s a problem such as a change in your bowel habits, blood in the stool, unexplained weightloss or abdominal pain. Those things might be a sign that they should seek attention earlier rather than later.

A number of other things of course are diets and maintaining a healthy weight. People that eat more fiber are shown to have a decreased incidence. Avoidance of things like processed meats or red meats and of course moderation in like alcohol and anybody that smokes obviously, that’s another risk factor for all types of cancer.

The other interesting one that decreases your incidence by 40% is taking a baby aspirin a day.

Host: Well those are really good points to remember Dr. Morse. So, let’s turn to screening since it’s so important. What screening options do you offer at Columbus General Surgery?

Dr. Morse: Well there’s essentially two screening options that can be utilized. One is more done in an office-based setting that might be done by the primary care doctors which would be the stool-based tests where they would look for either microscopic amounts of blood in the stool or the other one that you’ve probably seen on advertising is called Cologuard which looks at DNA of cancer or precancerous cells. And those are done just as an office-based, sent into a lab to screen to look for these things.

The ones that we primarily do here in Columbus General Surgery and are done actually in the hospital setting and the gold standard is colonoscopy which is a more sensitive way to look at this lining of the colon and be able to actually take care of polyps or other problems that we find.

The other visual test that’s used in a hospital setting would be either a contrast CAT scan or a barium enema.

Host: So, let’s talk about when to start these screenings. You were mentioning earlier that there’s actually a rise in young people, so when is it recommended that someone start screening for colon cancer?

Dr. Morse: Sure and the American Cancer Society actually came out this past May and said now the age should begin at 45-years-of-age because of this younger population being seen. The other thing that we look at is the family history of colon cancer. If there was somebody that was very young with colon cancer, then we look at ten years prior to the youngest family member that had colon cancer as the starting point. And certainly again, worrisome symptoms or changes that would warrant looking for problems is also a reason to do it. That would be more of a diagnostic colonoscopy rather than a screening colonoscopy.

Host: Right and then how often after the first screening should someone get screened again?

Dr. Morse: Well, in an average risk person, that just does this as a routine screening test and no polyps are found; it’s recommended to do this every ten years. If a person does find polyps, it depends on how many and the type of polyp, but generally then it’s every three to five year intervals to do that. And also in a patient that has a strong family history of colon cancer; it’s generally recommended to do every five years.

Host: So, let’s talk about prep because this is the big thing for most people. I’m raising my hand. I have had a colonoscopy. The prep is not that bad. Okay. And when my friends say to me, “I’m not going to get a colonoscopy, ooh that prep,” I go “what is wrong with you. Would you rather get colon cancer or go through the prep? The prep is easy.” So, Dr. Morse can you just tell us, the preparation for colonoscopy, it’s not that bad, right?

Dr. Morse: No, it’s not that bad. I think the big issue is we all like to eat and we don’t like to give up food and in general, it takes about 24 hours of going on a liquid diet and not eating any solid foods and to some people, that’s the end of the world. The laxatives have been a little bit easier. The old days we used to drink a very large gallon jug of liquid that would flush you out and you would get very water logged. The preparations have become a little more palatable and we kind of can mix them into Gatorade or other solutions that make them more easily ingested. Still, the results are going to be you have to get cleaned out to get a good exam and so it’s important, the preparation is really the key to this exam.

Host: And I tell you when you get cleaned out, you actually feel good. So, let’s talk about the actual procedure itself. Again, easy. So, some people might think it’s painful or uncomfortable. It’s not. So, tell us about the procedure itself.

Dr. Morse: Sure. The procedure itself is done in the hospital setting so those that may be have given you the horror stories of being painful, that means that they probably did not have this done in the hospital or did not have sedation when they did such a procedure.

But once you do your preparation ahead of time, you come into the hospital, you check in. You’ll visit with anesthesia, then you go in a separate endoscopy room and basically you are hooked up to a monitor, so we monitor your heart and your breathing and your blood pressure. And then you start getting medicine through an IV that will rapidly make you fall asleep. The procedure itself takes about 10-15 minutes and when you wake up, you wind up back in your room and you wonder what happened. So, basically, you don’t remember anything about the procedure from the anesthesia.

Host: And that’s exactly it. You wake up, you feel good. You are under a warm blanket. The doctor comes in and goes “heh you look good, we’ll see you in ten,” at least that’s what happened in my case. And it was easy. So, please, go get a colonoscopy.

Dr. Morse: I know a lot of people say that’s the best sleep they’ve had in a long time.

Host: I’m telling you, it’s true. I felt great when I woke up. Oh my goodness. So, please go get the colonoscopy and as Dr. Morse said earlier, it is the gold standard. Go do it. Dr. Morse one last question for you. Are these screenings covered by most insurance companies?

Dr. Morse: Most insurance companies do cover these. They actually are encouraging this as prevention and so a lot of people that have wellness and screening type things built into their insurance, they cover these 100%. The interesting thing with insurance is they don’t always follow the recommendations of the American Cancer Society, so they all haven’t gotten on board with this early age adoption yet. Also, if we do and the reason, we are doing this is to look for polyps, if we find polyps and we do then immediately remove them; then they change this from a screening test to a diagnostic or therapeutic test and then it kind of gets into a little different category for insurance. But I would highly encourage people to do this because it is paid and if we are doing this for prevention, that’s really the key.

Host: That is the key. Prevention. Dr. Morse, thank you so much for your time today. Listen to Dr. Morse how calming and soothing he is. I’m telling you, that’s what you need for the colonoscopy, a good doctor like Dr. Morse. He’s going to take care of you. It’s going to be the best thing you’ve ever done. Thank you so much for your time today Dr. Morse. We appreciate it. For more information on colon cancer screening or Columbus General Surgery, please visit www.columbushosp.org, that’s www.columbushosp.org. This is Columbus Community Hospital Healthcast from Columbus Community Hospital. I’m Bill Klaproth. Thanks for listening.