Michael R. Anderson, MD (Host): Hello everyone. And welcome to this episode of The Forecast, the official vodcast of Fort HealthCare. I'm your host, Dr. Michael Anderson, ear, nose and throat doc, and serving as President and CEO of Fort HealthCare. I'm very excited for my guests today. We have Dr. Marc Erickson with us today to talk about colorectal cancer screening and the different entities that help us with that screening. Dr. Erickson, thank you so much for joining me on this episode of The Forecast.

Marc Erickson, MD: Happy to be here, Mike. Good to see you again.

Host: Before we get started, Dr. Erickson and I, we've known each other for quite a while. I've been with the organization for a little over 20 years. But Dr. Erickson, how long have you been with Fort HealthCare?

Marc Erickson, MD: Oh, man. This is my 32nd year here, believe it or not.

Host: Okay. So, I have to ask, what color was your hair when you started?

Marc Erickson, MD: Yeah, it is going blonde at this point. It was darker.

Host: It was darker.

Marc Erickson, MD: It was darker.

Host: Well, Dr. Erickson, you've just done an incredible job over the decades serving our patients and our community. I can't thank you enough. And really, what we're talking about today, colorectal cancer screening, is very important to our patients and community. So, Dr. Erickson, if you can just kind of give us an overview, why is it so important to be screened for colorectal cancer?

Marc Erickson, MD: Thanks for having me, Mike. Honored to be here. The real reason is this is one of the preventable cancers. There aren't very many of those. So, it's a fourth leading cause of cancer in America, and it's the second leading cause of cancer deaths. So, something like 60,000 people die of colon cancer every year, but it's highly preventable. So if we could screen people for cancers, first of all, we'd get them earlier. But if we can do colonoscopies, we can actually take out polyps and prevent you from getting cancer in the first place. So, hugely important topic.

Host: I mean, when I hear this cancer can be preventable or this cancer can be caught at a very early stage, I think the health importance of that cannot be understated. So, Dr. Erickson, when we look at screening guidelines for colorectal cancer, at about what age should people start having that conversation, or what age should they be thinking about, "Hey, I'm reaching this age. I may want to get screened for colorectal cancer"?

Marc Erickson, MD: Really good question, because it's changed over years. We used to say 50. The reason that was important was because most cancers affected people over 50. In the mid-2000s, that changed, and we're not sure why, but it's increased dramatically so that it's now the number one cause of cancer deaths in people under 50 who are male and number two for females. So, we've changed from 50 to 45 in the last five years.

Between, I don't know, around 2000 and the mid-2000s, because we started screening around 2000, Medicare started paying for it. We decreased the risk of colon cancer by 1% per year. And then, it kind of flattened out because we saw an increase in that under 50 group.

So, it's really important that around 45, you start getting screened. And there are people that should get screened younger than that. So if you have a family member, like your parent or sibling who's had colon cancer or has had pre-cancerous polyps, the recommendations that you start screening 10 years younger than they were diagnosed with either a precancerous polyp or a cancer.

Host: I can't emphasize that point enough, and you highlighted it beautifully that we have to follow the data when it comes to our screening practices. And it has really shifted towards a much younger age demographic than we ever predicted as a healthcare field in the aspect of colorectal cancer screening.

Now, Dr. Erickson, there's a lot of thoughts out there on potential screening tools. Could you walk us through maybe what those screening tools can be and maybe a little bit the pros and cons of each one?

Marc Erickson, MD: I would say that you have to break it down into whether you're screening to find out if people have colon cancer, or if you're screening to see if they have polyps, because they're very different. If we're screening for polyps, we're trying to prevent colon cancers. And if we're screening just for cancers, we're trying to pick them up early. So if you are talking about like testing for blood in your stool or doing a Cologuard test, those are essentially looking for cancers. I should say Cologuard's pretty good at that. Looking for blood in your stool is not good at that. Cologuard is, with their newest iteration of their product, about 95% successful in picking up people with colon cancer. So if that's all you're trying to do, it's a pretty good test. It's not perfect, but it's pretty good. They were at 91% until last year, and their new iteration is up to 95%. That still means you're missing 5% of cancers, but you have to look at polyps because we're talking about the difference between preventing and detecting. So if we want to prevent cancer, we got to pick them up before they become cancer. And Cologuard is not good at that. And testing for blood in your stools, even worse at that. So if we just look at all the polyps that could become cancers, they're called adenomatous polyps. Something like 10-25% of those would go on to become polyps if we left them behind. More than 80% of those are missed by Cologuard. So, we're really good at picking up cancers, but not good at picking up pre-cancerous lesions.

It is important to pick up cancers because, if you get a contained colon rectal cancer, that I mean stage II or II, your five-year survival-- the chance of you dying from this is about 16%. But if it's beyond that stage III or IV, 91% are going to die of this in five years. So, it is important to pick up cancers, but we'd much prefer to pick up polyps before they become cancers. And colonoscopy is the only tool for doing that really well.

Host: There's a lot of information, and thank you for defining those different goals. Because I think it's very important for our patients and communities to know that polyps in the colon can become cancer, first of all. And secondly, Cologuard won't pick up the polyps per se. Only a colonoscopy can pick up the polyps. Once it becomes a cancerous lesion, then Cologuard could pick it up or a 95% chance of picking up, still one in 20 are going to be missed. So if you're really trying to prevent or pick up polyps before they develop into a cancer, really, colonoscopy is the tool to do that. Am I understanding that correctly, Dr. Erickson?

Marc Erickson, MD: You understand that perfectly. And if you look at the actual-- go to the website for Cologuard, it's Exact Sciences and it's in Madison, so it's one of our local businesses. But they look at high-risk polyps, which are polyps, bigger than a centimeter that have high-risk criteria. They're only 46% successful in picking those up.

Well, that's only 10% of polyps we take out. And anything that's adenomatous has potential to become cancer, and they're less than 20% successful in picking those ones up. So if you're looking at a population of people who refuse to get screened because they've heard terrible things about colonoscopies, we'll at least get them a Cologuard. You'll find out if they have colon cancer and there's a chance you're going to pick up their polyps. And then maybe you can talk them into a colonoscopy. But we'd much prefer to convince everybody to get a colonoscopy. It's the gold standard, there's no doubt. And if you test positive based on a Cologuard test, you still have to have a colonoscopy then.

Host: I know one thing that prevents a lot of people from getting a colonoscopy is fear of the prep. But I can tell you, I again was under that 50 guideline. When I turned 50, I got my colonoscopy done and my fears were allayed a little bit, because the prep wasn't nearly as extensive as what I anticipated it to be. Dr. Erickson, can you give us a little bit of a historical perspective on how the prep has changed for colonoscopy?

Marc Erickson, MD: Yeah. So, I'm old enough. I've had three now. So, I've had three different preps. The original one was a gallon jug. A lot of people have had this, it's called GoLYTELY. It's polyethylene glycol and you drink the whole gallon and then get washed out. Your colon's six feet long, it's full of stool. It's got to get washed out so that it is pristine so we can pick up tiny little things.

We moved on to smaller volumes, and then actually COVID helped us a little bit because we couldn't get all of the products we were using. And we switched over to using Gatorade or whatever drink you'd like to mix in. I mean, there's several options. But we'll put MiraLax into five bottles of Gatorade and you drink those over about an eight-hour period.

There are easier ways to prep your colon, but it's all got to be washed out eventually. So if you're worried about it or you have had a bad experience, you have a family member that scares you about it, you could just go on a liquid diet for a few days, and then you have to drink a much lower volume. But if you want to just get it all done in one evening, it's pretty easy now. You drink five things of Gatorade with MiraLax mixed in, and it does a good job for the majority of people.

Host: Well, it worked for me. I'm here to tell that. But the other part about the colonoscopy, what an amazing screening tool it is, but then also to take care of those polyps at point of site, point of treatment. But I was really surprised at how easy the process was, meaning check in, to colonoscopy, to discharge. Can you talk a little bit about that?

Marc Erickson, MD: And actually, I have to commend Fort Atkinson because our hospital's very good at getting people in quickly. In Madison, it might be eight or 10 months to get a screening colonoscopy. That varies depending on some factors. But, you know, within a couple of weeks, we can generally get you in.

So, you do it through our office. They give you the instructions, they'll send them out, as well as discuss them with you on the phone. But in the morning, you come in usually an hour, hour and a half before your procedure, you get checked in. The whole procedure takes about 20 minutes. The nurses start the IV beforehand. But when you come into the room, we've got a tech, a nurse anesthetist and myself or one of my partners, hook you up to monitors, give you oxygen to breathe, and then you are asleep in a matter of seconds.

The procedure takes, on average, 15 minutes. And you wake up within minutes of that. Usually out the door within half an hour. So, we don't let you drive that day just because you've had sedation. But you'll feel really good and back to usual activities the next day.

Host: I got to tell you, I was really remarkably surprised at the quick recovery. I know myself, I was a little bit fearful of having a colonoscopy done. Now being through it, I have no hesitations. I think mine's coming up again in about five or six more years, but that's a good point. Dr. Erickson, if somebody has a clear colonoscopy, how soon is it before they need to have another one?

Marc Erickson, MD: What we know is that if you are low risk, which means you don't have any family history or you haven't had polyps before, by going every 10 years, you reduce your risk of colon cancer by almost 90%. So, that's the number that we use now, is you should have one every 10 years as a screening procedure.

Now, having said that, about 35% of people will have a polyp, or have a family member with a polyp or cancer. And those people are usually every five years. If they have a high-risk polyp, we find like, it's got some aggressive features or it's very large. It might be redone in three years. But in general, the average person for screening, it's every 10 years.

Host: Well, that's very good to know. And I think, for now, that's my scheduled cadence. We'll see if that changes as I continue to get screened. I want to say overall, Dr. Erickson, thank you so much for joining us on this episode of the vodcast. As always, I always learn something when I talk to you. And I'm really, really hopeful that our patients and community learn something as well. So, thank you for being on this episode.

Marc Erickson, MD: It's my pleasure, Mike. Thanks so much.

Host: And thank you for tuning in to this episode of The Forecast. Please share us on your social media channels. Again, this is Dr. Michael Anderson signing off. And thank you for joining us. Take care. Bye-bye.