Michael Anderson, MD (Host): Hello, everybody. And welcome to the FortCast Podcast, the official podcast for Fort HealthCare. I'm your host, Dr. Michael Anderson, ENT doc, and currently serving as President and CEO of Fort HealthCare. I'm extremely excited to have my guest today, Dr. Bill Kontny, who comes with us today to talk about colon cancer and specifically colon cancer screening.

So, as most of our listeners know, I've been with the organization for roughly 20 years, and Dr. Kontny. Go ahead and introduce yourself and let us know how long you've been with Fort HealthCare.

Bill Kontny, MD: Yeah, I'm Dr. Bill Kontny. I'm one of the general surgeons that has been here for 30 years, going on 31. I've been involved with surgical care here, including endoscopy and colon cancer care over that period of time.

Host: Well, that is wonderful. I know you've served our patients and our community for a long time now and we're very thankful to you and grateful to have your services here at Fort HealthCare. So, thank you for that, Dr. Kontny.

Bill Kontny, MD: Well, I'm grateful to be here, and I appreciate you inviting me on today to talk about this important issue.

Host: Yeah. So, let's get into it. So colon cancer, colon cancer is a pretty common cancer, is it not, Dr. Kontny?

Bill Kontny, MD: It's very common. It's about 150,000 new cases per year, and it's the second leading cause of cancer deaths in both men and women. And over the past 10, 15, 20 years, we have gotten a little bit of improvement in the age of 65 and older, as people are getting more aggressive with their colonoscopies and getting screening done, which has definitely decreased the death rate from colon cancer. The problem is the younger generation, 55 and younger, has actually increased in the numbers of colon cancer and 30% of that 150,000 are in the age of less than 50.

Host: No, that is an incredible stat. So, you're seeing a younger trend, I guess you could say, which really brings to the forefront screening for colon cancer. So, obviously, most people are aware of colonoscopies and, Dr. Kontny, we talk about colonoscopies, could you just review what the indications are, when people should have their colonoscopy to screen for colon cancer? I understand the recent age limits have changed.

Bill Kontny, MD: Yes, the guidelines have changed. For everybody with average risk, that means that there's no family history of colon cancer, so if you have more than one family member with a colon polyp history or colon cancer history, you are in a higher risk category. And your colonoscopies can actually start earlier than what the general risk population is. So for an average risk person, instead of 50 years, we are starting at 45. And that is because of this increased risk that we've been noticing over the past 10 to 20 years in the younger population. So, we now recommend a screening colonoscopy at age 45. And then if you have a normal colonoscopy, then you can go every 10 years. If you are found to have a polyp at that time, then we will change it to every five years. But if you have multiple polyps, then it would be every three years. We adjust it based on what we see. But for the general rule, every 10 years after 45, unless you have a polyp, and then it changes you to automatically to every five years, even if you have a normal one that comes up.

Host: Gotcha. So, I want to touch on something that you mentioned, and that's family history. So, with family history, is it a family history of having a colon polyp, or is it a family history of having a colon cancer that adjusts your urgency to screen?

Bill Kontny, MD: If you have family history of colon cancer, if it's one or more members, that will really increase the urgency get a screening at an earlier time. And depending upon the age of those individuals that developed colon cancer, we'll kind of determine when we would start screening on the person that's involved.

Colon polyp history is also important, obviously not quite as significant as colon cancer, but it's still an important situation where more polyps in one family, one person's not as significant, but as you get to be more than one or two, then we got to consider that as a higher risk and move that person up in age to get a colonoscopy.

Host: Gotcha. So, I hear a lot in the public, or reading, or even on television, you'll see commercials for Cologuard. Can you tell us a little bit about Cologuard and how Cologuard gets integrated into colon cancer screening?

Bill Kontny, MD: Well, Cologuard is a stool sample DNA study, and that is something you can do at your home. You can get a stool sample, put it in a specimen container that's sent through the mail and they test it for basically DNA testing of potential polyp or cancer. The idea is to make it more comfortable, make it easier for people to have their screening done. However, it is definitely not a replacement for colonoscopy. About 8% of the people who get a Cologuard, if it's positive, will still have a negative colonoscopy. And I find that actually to be a little higher than 8% in my own practice, 13% if you have a negative test will actually be positive. So, you're not guaranteed that you're going to have a negative finding if your test is negative, but it is better than not doing anything. So, I would recommend, if you're just definitely not going to do a colonoscopy for whatever reason you're thinking, it's definitely better to do a Cologuard test than to do nothing, because it will pick up people who do have polyps and then we'll do a colonoscopy on those people.

Host: Right, yeah. So, with the old adage, you know, what the colonoscopy is seeing is believing, right? So, there is a false positive rate and a false negative rate for Cologuard, but it can be a useful tool in certain circumstances. Would you agree with that?

Bill Kontny, MD: Absolutely. If somebody is just not a real good candidate for colonoscopy, maybe they have medical issues, that it's not the best idea for them to have any kind of sedation, and they may want to just do that test going forward as opposed to doing a colonoscopy. And there are some people who just won't do a colonoscopy. They kind of have it in their head that, "I'm not going to have anybody do that to me," and they would rather just do the simpler tests. And I get that. But I think I'd like to try to alleviate people's concerns about doing a colonoscopy as when you come in, you don't even know that you're having it done. You're so comfortable with the sedation That you get from our anesthesia Department, that you don't even know you're having it done. And when you wake up, you'll have a test that tells you what's what. And if you have polyps, we can take care of them right away as opposed to the stool test that if it's positive, now we got to do the colonoscopy anyway.

So, that's kind of the thinking on colonoscopy is definitely the standard. There are going to be probably new improvements in Cologuard and other types of stool tests coming on the way. We'll just have to wait to see what those are.

Host: Yeah. And I'd like to go back to the actual colonoscopy itself. So, I, of course, can talk as the patient as I've had a colonoscopy. I'm 51 years old I have had a colonoscopy. And I really want to reiterate something that you said. It's a very smooth process. And for full disclosure for our listeners, Dr. Kontny actually performed my colonoscopy. And really, it is a smooth process. It doesn't take very long. The prep, I think, has gotten a lot more patient-friendly than it was 10, 20 years ago. Anesthesia, their sedation techniques are state-of-the-art. And I think, for myself, the whole process was less than an hour, hour and 20 minutes, and I was out the door. I couldn't believe how fast it was.

Bill Kontny, MD: Yeah. I've had two or three myself. And so, I totally will reiterate that that process was the same for me as well. And you get right back to your normal activities by the next day. That day, you kind of have to take it easy because you've had sedation. You can still do things at home. But by the next day you're back driving, you're going back to work, and it's a pretty smooth process. There are small risks with the procedure, it's not a zero-risk procedure. But in the long-term regarding the risk of colon cancer, it's obviously definitely a benefit.

Host: Without question. I mean, anybody with a colon should have it checked out. There's a lot of people with colons out there. It's very important to get a colon cancer screening. So, after your colonoscopy is done, and if you've had polyps removed, how long does it typically take for the patients to know whether or not those polyps are benign and whether or not they're cancerous? And what are the odds of each, Dr. Kontny?

Bill Kontny, MD: Yeah. We take out a lot of polyps. You'd be surprised when people come in for screenings how many polyps we end up taking out on people. It's at least 30% of the people we screen that didn't have any history will end up with polyps. So, that's just kind of a n interesting stat that I think people need to realize that they're there and people have them. And we remove them and now we prevent your risk of colon cancer. So, the polyps that we take out are tested, and we'll have results within about three days. And they can either be completely benign polyps or they can be adenomatous polyps. And an adenomatous polyp, it's the earliest process of a colon cancer, is an adenomas polyp. And then, it goes on to a villous polyp and a villoadenomatous polyp, and all of these different stages of polyps before they turn into cancers. You typically don't get cancer unless you start with a polyp. That's why colonoscopy removing the polyps remove your risk of cancer.

Now, it doesn't completely a hundred percent remove your risk of cancer, but it is definitely the best tool we have, and has at least over 90% chance of eradicating colon cancer if everybody did their scopes on time. And I would reiterate that the younger people, the ones who definitely typically do not want to come in for their scopes are the ones that I really want to push to think about this in the near future here.

Host: Yeah, absolutely. What was that percentage you said? You mentioned that colon cancer exists in the under 55 population.

Bill Kontny, MD: Yes, it's 30% of the colon cancer population is under 55.

Host: Thirty percent is under 55. Wow.

Bill Kontny, MD: Yeah. Fifty to 55 under that, so even less than 50 years old, you have a high risk, something like 13% if it's under 50. So, there is a decent amount of people that we can save because nothing's more sad than seeing somebody at a young age with a colon cancer, right?

Host: Yeah, absolutely. I know I can think of a couple people that unfortunately passed due to colon cancer, and it's just very, very sad. So if there's any way we can screen, prevent the advancement of colon cancer, that is definitely something that we need to do.

Bill Kontny, MD: The good news is that even if we do find a cancer in a person who has an early stage I, II colon cancer, stage I or II, you typically have a 90% or better chance of complete recovery and survival and cure. Seventy-one percent for stage III is still a good number, but when you get to stage IV, which there's metastatic disease, now it's like 14 percent. So, the progression of the disease is the issue. And we want to stop that progression as soon as we can in every person.

Host: So even if you do catch a cancer, if it's early enough in colon cancer, it can definitely be treatable.

Bill Kontny, MD: Absolutely. Absolutely can be treatable and cured many, many times.

Host: Well, that's wonderful to hear. So, I want to summarize by saying please do not put off your screening cancer for colon cancer. Don't put off your colonoscopy or talking to your primary care physician or provider about Cologuard or colonoscopy because screening for colon cancer is essential. It prevents the advancement of colon cancer, which hopefully, in turn, will save lives. So, Dr. Kontny, I cannot thank you enough for being on today's FortCast. I've enjoyed listening to you. I've learned something as usual. Every time I talk to you, I seem to learn a little pearl or two. So, thank you for that and thanks for being on.

Bill Kontny, MD: Hey, I appreciate you inviting me today. And I hope we reach out to some people to be able to help with this problem. And I hope you have a great day.

Host: Yeah, you too. Thank you once again. So if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics on our website. Once again, this is Dr. Michael Anderson signing off for the FortCast podcast. Have a great day. Thank you. Bye-bye.