Scott Webb (Host): Many folks drag their feet on being screened for colon cancer because they've heard that the prep for colonoscopies is unpleasant. But unlike the old days, there are pills now that we can take; that makes the prep much more tolerable. And joining me today to discuss the importance of getting screened and the advantages of the new option for prep, is Dr. Jennifer Nayor. She's a Gastroenterologist with Emerson Health Gastroenterology.

 This is the Health Works Here Podcast from Emerson Health. I'm Scott Webb.

Doctor, it's great to have you on today. We're going to talk about colonoscopies and maybe specifically about the prep, right? So anytime the topic of colonoscopies comes up, people immediately, and inevitably, those of us who've had them before, colonoscopies, that is; we immediately start telling our war stories about the prep. And I know things have changed. There's a pill. And it's great to have your expertise today. So let's just start here. Before we get to that, why are colonoscopies so important?

Jennifer Nayor, MD: So colonoscopies are an important test to provide colon cancer screening to patients. So everyone is at risk for colon cancer. Some people have more risk than others. But everyone, should have a screening colonoscopy starting at the age of 45. Sometimes people need to come earlier if they have a family history or other medical issues that increase their risk of colon cancer, but at some point everyone is going to need a colonoscopy for colon cancer screening.

Host: And Doctor, you said 45 there, and I was going to maybe just jump ahead a little bit here. You know, it used to be 50 was the gold standard, again, unless you had a family history and there was some reason for concern, but now it is 45, that's the recommendation. So maybe you can just take us through that. When and how did the timeline change and what are the benefits?

Jennifer Nayor, MD: So it used to be that everyone would start colon cancer screening at age 50 and about a year ago, all of the GI societies came out with new recommendations recommending we start colon cancer screening at the age of 45. The reasoning behind that is that we're seeing more colon cancers in younger people, and so starting colon cancer screening earlier means that we're going to pick up those colon cancers in younger people. It's important, you know, to know family history and other medical issues because some people need to start even earlier than that. But across the board, for someone who's average risk, has no family history of colon cancer; the new screening age is to start at age 45.

Host: Yeah, and I'm wondering, you know, it, it's sort of alarming the stats that I've heard about younger folks getting, colon cancer. And so thus, you know, moving the timeline back, starting earlier again, unless there's a family history or reason to start even earlier than 45. But do you have any sense, even anecdotally, of why more people are being diagnosed? Is it simply because we're screening better and earlier? Or is it behavior, lifestyle? Do you have any sense of things?

Jennifer Nayor, MD: It's a great question. I think we don't really have the final answer there. There were initially some thoughts that maybe because we're screening more, we're finding more. But that doesn't really answer the question of why younger people who are before the age of 50 when we were starting colon cancer screening, would be diagnosed with, you know, earlier colon cancers because they're not getting screened. So these are people who are really having symptoms, who wind up at their doctor with things like rectal bleeding or weight loss, or changes in their bowel habits and get diagnosed with colon cancer. There have been a lot of theories out there, but I think there's no real evidence yet to really understand why people are getting colon cancer at an early age. But it's definitely a trend that we can see.

Host: Definitely a trend. So let's come back now and talk about the prep, right? As I mentioned and prefaced there in my intro, uh, that always seems to be the topic of conversation when I talk to folks about colonoscopies, regular folks, lay people, about why they tend to put these things off or the thing they dread most about colonoscopies.

So, let's talk about the prep. Maybe what has been done historically and what's here now, in the form of pills, who that's appropriate for and so on.

Jennifer Nayor, MD: So I completely agree that the number one reason people don't want to come in for a colonoscopy is because they don't want to do the prep. That's the part that gets everyone worried. And the point of a colonoscopy prep is to cleanse the colon so that I'm able to see when I put a camera in and I'm able to get a good look for polyps and remove them to prevent colon cancer or diagnose a colon cancer early.

So the prep is really essential. And having a good prep, you know, allows me to get a really good look at the colon. The colonoscopy preps have evolved over time, so, initially years ago we had Go Lytely or Nulytely, which is a large gallon jug of liquid that people would have to drink. And it was salty. It didn't taste good. It was really not very pleasant. So when people think about colonoscopy preps, that's often what comes to mind. Over time, the preps have improved. So a few years ago we had, you know, smaller volumes. The liquid didn't taste quite as bad, but the most recent advance in colonoscopy prep is that we're now able to use pills to prep for colonoscopy.

So the current pill prep that we are using is called SUTAB. It is a pill. It contains salts that pull water into the colon and help the colon clean out for the time of the colonoscopy. When I talk to patients about SUTAB, I always kind of go through the details. So SUTAB is a lot of pills, so it's 24 pills in total, which I know sounds like a lot, but you split it in half.

So you do 12 pills the night before and you do a second, 12 pills, six hours before you come in for your colonoscopy. So it's really 12 pills at a time, which is still a lot. But not as many as 24. And you drink it with a lot of water to help flush it through the system, and that means that the only thing you're drinking with the pills is water. So it's not the bad, salty stuff that we used to have people drink for a colonoscopy prep.

Host: Yeah.

Jennifer Nayor, MD: The other thing I tell patients about SUTAB is that it has the same end result. So it doesn't stop the prep effects. So you're still going to have diarrhea. It's still going to be a clean out. So that's the downside. That part, we can't get around. That's just how you have to clean out for me to get a good look. But in terms of the tolerability of the prep, I think it's much better than the previous ones we've used.

Host: Yeah, I haven't had one yet with the pills, but in some sort of bizarro world, Doctor, I'm sort of looking forward to it. Right. I'm having flashbacks of the big salty jugs and I'm looking forward to the pills for my next colonoscopy. And, it's been really educational today and I just want to give you a chance here at the end, what are some of your best tips for preventing colon cancer? Is there anything we can do? We can't outrun our family history, but is there other stuff we can do, behavior, lifestyle, that sort of thing?

Jennifer Nayor, MD: So number one thing is to get screened. I think a lot of people don't like the idea of coming in to get screened or they get nervous about it, and so they delay the screening. And I think that that's the number one thing people can do is talk to their doctors about screening and what they're worried about. Because there are often ways that we can help work around those things that make people anxious. For example, if people have nausea with the preparation, we can do things to help with that. There are some people who colonoscopy is just not in the cards for them. And for those patients, there are alternatives to colonoscopies, like stool-based testing for colon cancer screening. So there are alternatives. I do think colonoscopy is a really good option, but if it's not for you, it's not for you. And the best test is the one that gets done. So it's best to just talk to your provider and find a good option for you.

Host: Yeah, that sounds right. And just wondering then, besides being screened obviously, and now being screened at 45 or earlier if we have a family history; is there any other behavior and lifestyle things? Eating right, eating better, quitting smoking, you know, all the above things that we can do?

Jennifer Nayor, MD: Good questions. Living a healthy lifestyle makes a big difference. So smoking definitely increases rates of polyp and colon cancer. Maintaining a healthy weight. So people who are overweight and obese have increased rates of polyps and colon cancer. Eating a healthy diet is generally good for colon health. We don't know that necessarily will prevent colon cancer, but it'll help with maintaining a healthy weight and that we know is something that's really important. Again, staying active is another thing that goes along with that. Probably won't prevent colon cancer, but in general, for colon health is something that's super important.

Host: Yeah, definitely. So, the messages here today, of course, get screened, live healthier if possible, quit smoking. All good stuff. So thanks so much, Doctor. You stay well.

Jennifer Nayor, MD: Thanks so much. Thanks for having me.

Host: For more information, go to emersonhealth.org/gastro or call 978-287-3835 to schedule your colonoscopy.

 And thanks for listening to Emerson's Health Works Here podcast. I'm Scott Webb. And make sure to catch the next episode by subscribing to the Health Works Here Podcast on Apple, Google, Spotify or wherever podcasts can be heard.