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Preventing Colon Cancer - The Importance of Recommended Screenings

Melanie: The most effective way to prevent colon cancer is to get your colonoscopy as recommended. We're here to discuss why this is so important and the possible consequences of not getting your regular screening.

Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is Dr. Marjun Duldalao. He's a colorectal surgeon on the medical staff at Henry Mayo Newhall Hospital. Dr. Duldalao, it's a pleasure to have you join us today. Before we get into colonoscopies and what's involved in those, tell us a little bit about the prevalence of colon cancer itself.

Marjun Duldalao: Sure. Actually, colon cancer in the United States is still the third most common cancer amongst adults and essentially also the third highest cause of cancer-related mortality. However, over the last two decades, there's been great news in regards to the management of colon cancer and sort of the prognosis associated with it. In that, over the past two decades, we're noticing that there's actually a decline in the overall mortality and the overall incidence. But despite all this, it is still the third most prevalent cancer type in the United States as well as the third highest common related death worldwide associated with cancer. But what we're seeing now, this colon cancer mortality and colon cancer incidence are on the decline. And that's basically all related to the fact that we are doing screenings for patients older than 50.

Melanie: So we'll get into risk factors and things, but I want to jump into the screening because really that's such important, it's one of the very few truly preventive screening measures that we have for any cancer, right? Tell us a little bit about the current screening guidelines as set out by the US Preventative Services Task Force. What are the indications for your first colonoscopy?

Marjun Duldalao: Sure. The indications for your first colonoscopy now is to start at the age of 45. And that's not only related to the data from the US Preventative Task Force, but the American Cancer Society. And that, we noted that the incidence of colon cancer has gone down for the patient population of 50 and older, but where we actually do see an increase in colon cancer incidence is in the population of 50 and younger. And so because of that prevalence of that data and the numerous patients that are now presenting to our institutions for colon cancer treatment, the screening timeline to starting your first colonoscopy at the age of 45.

Melanie: Now, I'd like to talk about the actual procedure. So if you're 45 and unless, as you say, maybe there's a family history and you are told to start earlier, this is your baseline colonoscopy. I have had many of them, listeners. I personally do not mind them at all, but it's the prep, doctor, that most people are more afraid of. And then they wake up from this wonderful nap and ask you when you're about to start. Tell us a little bit about the prep and why that is such a pain for people. Are we still drinking a gallon of Trilyte? What are we doing now?

Marjun Duldalao: So actually, there are numerous different types of preps that are available for different patients, but the standard is either Golytely prep or utilizing multiple repetitious laxative therapy with clear liquid diets. And depending on the patient's prior experience with colonoscopies or preps, we can tailor it also depending on other patient factors, such as if they have end-stage renal disease, if they have a history of chronic constipation, if they have other comorbidities such as heart disease and such. We could tailor these preps a lot more specific to the patients nowadays, but the standard still is the gallon of Golytely or the multiple osmotic laxative preps. And so the importance of it is the main issue is that what you want is a clean colon, so that we could visualize and identify these small polyps and take those out without any sort of hesitancy. And so if you have a substandard prep, it's not necessarily because, you know, patient prepped bad or we gave you the wrong prep or any of those sorts of things. It's just mainly that we may need to sort of get you with the right prep and get to sort of to a point where we could see your colon and visualize things a hundred percent.

Melanie: And there's no side effects from this procedure, right? It's pretty quick. It's pretty easy. And you're under sort of a twilight, not general anesthesia, correct?

Marjun Duldalao: Correct. Typically, we don't utilize general anesthesia as a common sort of anesthetic procedure for patients for colonoscopy. They're mainly in twilight and mainly patients are amnestic to it, meaning that the medication is so effective that really you only remember the conversation 10 minutes before your colonoscopy and the 15 minutes afterwards, so to speak.

But the sort of risks and the complications associated with colonoscopy are actually very low, very rare in general. And so the complications that people think about are like massive bleeding, perforation, or the possibility that they may need like an emergent surgery. In reality, that probably only happens like one out of tens of thousands of colonoscopies that are done. And on average in the United States, almost 6 million colonoscopies are done on a yearly basis.

Melanie: So tell us a little bit about polyps now, doctor. What do they mean? What are they? I know that my husband who resisted his first colonoscopy had a 2.5 centimeter one. I have little tiny ones that they remove all the time. And that's why I have to go every three years. But tell us a little bit about what those polyps are. What do they mean? And when you take those out, we don't have to worry about them anymore?

Marjun Duldalao: So, your body does this miraculous job of reproducing cells every day. On average, you know, over 2 million cells are produced on a daily basis. And that also includes the cells on the lining of your colon. And essentially, what a polyp is it's just basically an overgrowth of some of these colon cells. And the concern is that these polyps, if you leave it with time, that overgrowth could turn into a large polyp and then that large polyp also has a population of cells that grow abnormally. And that population of cells could all of a sudden turn into a cancer, but that's something that usually takes time and certain risk factors are involved with it.

You mentioned earlier about family history, so certain genetics within the family can lead you to be at risk to forming these polyps quickly and early. So that's why the recommendations are different for patients who have family history of colon cancer, but also patients who have underlying pathology, such as inflammatory bowel disease, they have a varied rate or a much more rapid rate of forming these polyps. And so that's what dictates your sort of recommendations when you have a family history or a current history of inflammatory bowel disease.

But these polyps mainly start as these slow-growing normal cells within the colon that grow. And so they could form with some time into these abnormal cells and usually the progression's around three to five years. So that's why you see these recommendations, right? A three-year or five-year or even a ten-year recommendation, depending on the types of polyps, the number of polyps that are investigated on a colonoscopy. And so that's where these recommendations from the USPTF come from. And essentially, they start out as just benign growth polyps that have a little extra feature of a growth factor along with it. It's like as one person, you don't grow as tall, but another person grows way taller. And so when you take a polyp out, essentially what we're doing is we're taking care of that entire process and eliminating that polyp from turning into what we call a malignancy later on.

Melanie: And what about insurance, doctor? Because now, well visits are a hundred percent by most policies and now colonoscopies are included in that preventative services, correct? So what do people need to know about coding and routine screening codes? And should they be asking their doctors about that?

Marjun Duldalao: Sure. Like you said, this is part of wellness. So if you are of the age of 45 and you don't have any of the other risk factors, you're allowed to have a colonoscopy. However, say for instance, you're a person younger than 45 or you may be sort of out of the realm of normal coverage as opposed to like wellness, the main aspect is symptoms. And so what people don't understand is that actually colon cancer symptoms are very vague. They could be generalized dull pain, they could be chronic bleeding, they could be as simple as just not feeling yourself. If you talk to your physician and if you have symptoms that could be concerning for someone who has an underlying GI malignancy, then a colonoscopy, as part of a diagnostic and investigative study to your condition, is also covered as well.

Melanie: That's such important information. And before we wrap up, there are other screening tests available, yes? Can you tell us about a few of those and why you think it might be important for people not to try those at-home kits? Or really what advice you'd like them to know about colonoscopies as a way to prevent colon cancer?

Marjun Duldalao: So, these at-home kits are compared to a gold standard, and reality is that gold standard is a colonoscopy. But the limitation with at-home kits is that the interpretation is left to either the general population or practitioner who's not aware of certain sort of other risk factors as far as things go.

And so, screening tests such as Cologuard or fecal immunohistic chemistry testing or just the standard fecal occult blood test is efficient as an initial sort of screening for patients for colon cancer, and usually are best served when a colonoscopy has done previously as your initial screening tests and as a reference for those screening tests in the future, and usually it's not a first-line sort of treatment or sort of diagnostic test. And so the caution is that some patients may get a false sense of security because these tests may also have a false negativity rate along with the false positivity rate.

And so even though that is well publicized on, say for instance, like the label of the box that you get at home, it's like pieces of information that a lot of people ignore. It's like looking at the sort of labels on the kind of soup that you're buying at the grocery store and everything. You know, in reality, people need to understand that, yes, it can rule out the fact that you may have a problem, but it also could ignore the fact to rule in a problem. And so usually the gold standard test is still a colonoscopy as your initial screening at the appropriate time as opposed to obtaining one of these at-home tests.

Melanie: And would you like to give us some great advice on good gut health and good colon health before we wrap up today?

Marjun Duldalao: Sure. I mean, there's a lot of things that people read online in regards to what's good for my gut and everything. And the reality is everybody is completely different. I think a regimen that is appropriate for my neighbor may not be a regimen that's appropriate for me. And then it may not be appropriate for somebody else in my family even and such. And I think what all this means is that you should probably talk to your physician in regards to sort of the best advice of what to try and how to try it. And there's a lot of things that I spend a lot at a time conversing with my patients, not only with regards to the initial pathology that they present at my office, but also their overall sort of gut health as to what they've tried and how they felt.

And actually, probably one of the best pieces of advice that I tell my patients is actually keep a diary sometimes. Sometimes certain foods affect patients in certain ways. And it may be great for you, it may not be great for other people, but you know, keeping accountability of what you do during that time, how you have your bowel movement, how you feel, how your belly feels is a very good way to start out to sort of managing your overall gut health and actually maybe a good way to help out with your overall health. So there's a lot of apps that are out on the phone nowadays, but also just, you know, going a little old-fashioned about just recording things and just writing things down in their journal and thinking about things at the very end of the day as to what worked and what did not work.

But also just taking the advice of a good practitioner who's working with you as a team member for your overall health. You know, getting yourself screened for colon cancer, especially if you have a family history. But also starting with a good appropriate tests, such as a colonoscopy, which is now very safe and fast. And so basically, it's something that not only gives you peace of mind, but it also basically can find problems and actually take care of the problem at the same time. So very few diagnostic or screening tests do that. Mammograms don't do that or any of this sort of thing. Mammograms are great at finding a problem, but also taking care of it. Colonoscopies are that big double whammy. They could it all so to speak. And so, getting that done and getting the problem taken care of, that could bring you lot of years of life to look forward to.

Melanie: One-hundred percent agreed. Great information, doctor. Thank you so much for joining us today. And listeners, don't be afraid of a colonoscopy. They are easy and safe, effective, and fast, and you feel pretty clean afterwards. It's a real good clean-out. So listen to the experts at Henry Mayo Newhall Hospital, and check with your doctor to see if colonoscopy is right for you. To learn more about preventing colon cancer, please visit library.henrymayo.com and search for colon.

That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. For more health tips just as these and updates, follow us on your social channels. I'm Melanie Cole.