Scott Webb (Host): Colon cancer is one of the most
preventable and treatable cancers in that colonoscopies are both diagnostic and
therapeutic. I'm Scott Webb and joining me today to discuss the importance of
colon cancer screenings and the new guidelines is Dr. Riva Das.

She's a colon and rectal surgeon with Manatee Memorial
hospital.

 So, doctor, thanks so
much for your time today. Why is it important to get colon cancer screenings?

Riva Das, MD (Guest): It's very important to get colon
cancer screenings because colon cancer is actually one of the only cancers that
we have a screening test for. Breast cancer, we have mammograms and then colon
cancer, we have a number of screening tests available. That being said, it's
one of the only cancers that is actually preventable because we have a
screening test for it.

Host: Yeah. And I want to rely on the expertise of an
expert, the verbiage of an expert, but my understanding from colon cancer
screenings, what really makes them unique is it's both a screening tool, but
also a treatment option as well., right?

Dr. Das: That's right. It is different based on which
screening test we're using, but the one that we'll be discussing today, for the
most part, is colonoscopies. And during the colonoscopy, we are able to both
detect precancerous colon polyps, and remove them at the same time, which makes
them both a diagnostic and a therapeutic test.

Host: Yeah, which is pretty amazing. And we're going to
come back to that. Before we get there, though, who's eligible for colon cancer
screenings.

Dr. Das: Recently, back in 2018, the recommendations
have actually changed. So, as most people know, colon cancer screenings used to
start at age 50 for an average risk patient. Back in 2018, the recommendations
have actually been updated to recommend screening starting at age 45 for most
individuals.

Host: Yeah. And I'm 53. So, I started at 50, but as you
say, the recommendations have changed. Yeah, so coming back now to the
screening options, you mentioned colonoscopy, which is obviously the gold
standard, and I'm sure there are some others, but let's go through the screening
options and really what's involved with each.

Dr. Das: I'll go through a few different options here.
Of course the gold standard remains a colonoscopy. There are less invasive
options as well. There are various stool tests that can be used to screen for
colon cancer and I'll touch on a couple of them. So, a fecal occult blood test
is one of them.

And then one very common one that people have heard of is a
Cologuard test. The other option people ask a lot about is a virtual
colonoscopy. So, I'll expand a little bit more on, on those. Fecal occult blood
test is a stool card that you get from your primary care doctor, most of the
time. It's a very easy, usually you just take it home, you perform the test,
you mail it in, and then you receive your results. The downside to this test is
it can have a lot of false positives, so different things in your diet or any
type of kind of blood, even red meat in your GI tract can actually set off a
false positive for this test.

So, it's good for detection, but it's not perfect and not
perfectly sensitive for colon cancer. Moving onto the Cologuard. So Cologuard
is actually another type of stool test, but it's specifically a DNA test that's
used to detect DNA that's found in colon cancer. So, it's much more sensitive
and specific for colon cancer.

 A virtual colonoscopy,
that's something that a lot of people are quite interested in. It's actually a
special kind of 3D rendered CT scan. So, it's a completely non-invasive
radiographic study. The downside to this test, I would say, is the part of
colonoscopies that people hate the most are the bowel prep. So,, having to
clean out entirely for the colonoscopy and you do have to perform this for a
virtual colonoscopy as well as a regular colonoscopy.

Host: Yeah. So you're not getting off easy. You're not
avoiding the prep, which you know, which is you say is, is usually what holds
people up. And I know there's been a lot of advancements right, in how the prep
is administered and what people go through, because that's always been sort of
what held people up, I think just a little bit. So, maybe you could just talk a
little bit about how it's really not that big of a deal anymore. And really
shouldn't be a reason why people don't get colonoscopies, right?

Dr. Das: Right. right. Well, a couple things to touch on
there. For one, we have had a lot of advancements with the type of preps that
we use. So, there used to be this notorious, you know, gallon of liquid that
people had to drink and, you know, spend hours on the toilet, cleaning out and
all of this. We have made a lot of advancements. There's now smaller volumes of
fluid that you can drink. There, there's also a pill form, which is brand new,
and within the last year, so, preps are becoming more and more tolerable. And I
think the other important thing to note here is that, you know, with these
other tests, they're not therapeutic tests like a colonoscopy would be.

So, if any of these tests come back positive, we're still gonna
have to do a colonoscopy to go in and find out what set them off to become
positive.

Host: Yeah. Cause as you've said, it's still the gold
standard. And so there are these less invasive screening options, but
oftentimes people end up getting colonoscopies anyway, right?

Dr. Das: Right. If any of these tests return positives.
So, if the stool test comes back positive or somebody, something is found on
the virtual colonoscopy, then we're going to have to go in with a colonoscopy
to remove that polyp or whatever turned that test positive. So, there's really
no way around avoiding it if one of these tests come back positive.

Host: Yeah, That's right. And, you know, when my friends
ask me, younger friends asked me about colonoscopies. I say, listen, my son was
16 and he needed a colonoscopy, unfortunately. And if a 16 year old kid can do
it, a grown man can do it. Really it's, it's really not that big of a deal.
Even the prep wasn't a big deal for him. Just, you know, stay close to the
toilet, basically. And he was good to go. I wanted to ask you why some racial
and ethnic groups are more at risk than others for colon cancer.

Dr. Das: So, you know, colon cancer, it has both
hereditary and environmental factors associated with it. So, I think, about
half of that is the hereditary factors and we do know that African-Americans
are at 25% higher risk of developing colorectal cancer in their lifetime. And
there's also a 50% higher mortality if they do develop colon cancer. So, it's
very important that these particular racial and ethnic groups pay very close
attention to their symptoms and prevention, if they're able to.

Host: Yeah, absolutely. I mean, we know with most things
and especially cancer, early detection is key. So, get your colonoscopies.
That's probably your message today. Yeah. And I wanted to ask you, are there
some risk factors that are beyond our control? You know, there's behavior,
lifestyle, genetics, family history, age. There's a lot to sort through here,
but are there some things that are beyond our control?

Dr. Das: You know, one thing for example is if you have
a history of radiation to the pelvis. So, with men in particular, a lot of
older men have developed prostate cancer. And one of the main treatments for
that is radiation. That goes for women as well, of course, with various
gynecologic cancers.

So, history of radiation unfortunately is an increased risk
factor for developing colon cancer. And then a family history of colon cancer,
rectal cancer, or even highly dysplastic polyps. So, if any of your first
degree relatives, meaning your parents or your siblings have developed a high
grade polyp, that's also an increased risk factor for you, yourself, developing
colon or rectal cancer. There's also genetic conditions that are associated
with increased risk, as well as inflammatory bowel diseases, such as Crohn's
disease or ulcerative colitis.

Host: And are there some other ways to prevent or reduce
our risk of colon cancer?

Dr. Das: Quit smoking. That's one of the biggest factors
that we know increases your risk for at least developing colon polyps and the
more colon polyps you have, the higher risk you are at for developing colon
cancer down the road. Improving your diet. That's certainly a big one. So, the
biggest things are increasing fiber and water intake.

And that's something that everybody could benefit from. And I
think the other one just as a colorectal doctor, I see this a lot, you know,
people don't want to talk about it, but a lot of people deal with constipation
on a daily basis. And it's something they've just learned to live with. They've
probably had it for their entire lives. And they just don't know any other way
to go about it. But I think it's very important to prevent constipation. I
think that's a big factor that we don't think about in our daily lives. And,
you know, I always tell my patients that it's more important that you're
treated for your constipation. You know, take a stool softener and some fiber
every day, rather than be constipated and deal with those consequences down the
road.

Host: Yeah, as you say, there are consequences. And I
think you're so right. I think that's one of those things that you know,
there's just some things that people don't want to talk about, even with
doctors and that's the type of thing, constipation, as you say, people just
sort of tolerate and they may be doing it for decades. And there are these
things that are uncomfortable to talk about. People don't want to treat and
really affect our quality of life. But as you say, suffering from constipation
year after year for decades can only, you know, end up badly for people. It can
only increase your risk of colon cancer, right?

Dr. Das: Right. Right.

Host: Yeah, I want to ask you too, you know, during this
time of COVID, have you found that people have not been getting their
colonoscopies? Have your numbers been down or have people still been willing to
come in and everybody do the right thing, wear the PPE and all that? How have
things gone during COVID-19?

Dr. Das: You know, I think for quite some time, our
numbers were down because people were trying to stay home as much as possible.
And unfortunately, a bad side effect of that was that people put off their
preventative care. So, you know, things that when they really weren't sick,
they didn't want to come see the doctor.

 Thankfully, Telehealth
has been a blessing, so we've been able to see a lot of patients, over virtual
visits, which was not very predominent before. That's gotten people back to
taking care of themselves. And I think now our numbers are picking back up and
elective procedures are starting to come back again.

Host: As we wrap up here. Anything else you want folks
to know about colon cancer, colon cancer, screenings, anything that you think
would help listeners?

Dr. Das: Sure. Just a couple things. So one, I want
everyone to remember that screenings are only for asymptomatic individuals, so
that does not hold if you are having any symptoms. So, the most common symptoms
of colon or rectal cancer are rectal bleeding, abdominal pain, or change in
your bowel habits. And if you've had any of those, then you need a colonoscopy
and that can hold true for anyone younger than 45. Older ages, you know, if
you're outside of the range of colon cancer screening, we still need you to get
checked out. Colon cancer screening is only meant for asymptomatic individuals.
And the other thing I wanted to mention is I know we talked about starting
screenings at age 45. I also wanted to mention for the older age populations.

So, the recommendation used to be, to screen until age 75. And
in recent years, we've also expanded that to actually up to 85. So, between the
ages of 75 and 85, we are now leaving it up to individuals to kind of talk to
their primary care doctors and evaluate their own risk factors. And as people
are living longer and longer, we're seeing colon cancer affect older populations
and it's becoming more and more viable to actually treat these patients. So,
with the advent of minimally invasive surgery and robotic surgery, we're able
to successfully perform surgery in older patients and actually provide a cure
where it wasn't possible previously. So, I think it's very important that
people know that between the ages of 45 and 85, you really should be getting
screened for this highly preventable disease.

Host: Yeah, that's a great way to put it. It is a highly
preventable, but people need to be screened, which again is both diagnostic and
therapeutic. So, great to have your time today, doctor. You stay well.

Dr. Das: Thank you. Thank you so much.

Host: For more information or to schedule your
colonoscopy, go to Manateememorial.com.

Scott Webb (Host): Positions are on the medical staff of
Manatee Memorial hospital. But with limited exceptions are independent
practitioners who are not employees or agents of Manatee Memorial hospital. The
hospital shall not be liable for actions or treatments provided by physicians.

Host: This has been Manatee Talk Radio. And if you've
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rate, and review this podcast and check out our entire podcast library for
additional topics of interest. I'm Scott Webb. Stay well.