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Joey Wahler (Host): It's one of the leading causes of cancer deaths in the U.S. So, we're discussing colorectal cancer screening. This is Jamaica Hospital Med Talk. Thanks for joining us. I am Joey Wahler. Our guest, Dr. Sophia Jagroop, an interventional gastroenterologist, and Director of Endoscopy for MediSys Health Network, Jamaica Hospital Medical Center. Doctor, welcome.

Dr. Sophia Jagroop: Thank you. Glad to be here.

Host: Glad to have you aboard. So first, what exactly is colorectal cancer in a nutshell?

Dr. Sophia Jagroop: So basically, colorectal cancer is a growth, you know, pre-cancerous growth or polyps, which arise from the colon. It's also the third leading cause of cancer in both men and women. And it's the most preventable cancer at this time.

Host: And when you talk about it being preventable, we're certainly going to talk about that. So, what are the warning signs and symptoms of colorectal cancer? But correct me if I'm wrong, at times, there are no overt signs, right?

Dr. Sophia Jagroop: Exactly. Exactly. Most of the time, there are no symptoms when it's diagnosed. It's microscopic blood in which you don't see so that's why it often goes misdiagnosed. It's not diagnosed, actually. Sometimes you'll see in patients that they'll have new-onset abdominal pain or changes in their bowel habits, most often is blood in the stool. But in the grand scheme of things, they often have no symptoms.

Host: So, this can be a silent killer, literally, right?

Dr. Sophia Jagroop: Exactly.

Host: So, who's considered high risk for colon cancer?

Dr. Sophia Jagroop: So obviously, patients that have a personal history of known colorectal polyps, you know, known polyps from previous colonoscopy; if they have their own personal history of colorectal cancer.; a strong family history of colorectal cancer definitely puts you at higher risk, first degree, meaning your first degree relatives, mom, dad, if they have history of having colon polyps, you are at increased risk of having colon polyps; if there's any inherited forms of colorectal polyps or cancer, so there's inherited diseases; and lastly, inflammatory bowel disease, such as Crohn's disease or ulcerative colitis, puts you at higher risk for colon cancer.

Host: Gotcha. And so, can we ourselves do anything toward preventing colon cancer? And if so, how?

Dr. Sophia Jagroop: I would say the one-step screening test is the most effective, which would be colonoscopy by a gastroenterologist such as myself. We can detect and remove polyps during the colonoscopy and thereby prevent colorectal cancer.

Host: Now, having had multiple colonoscopies myself, I know firsthand that the bark is worse than the bite, right?

Dr. Sophia Jagroop: Yes. The prep is the hardest part. We know that. Taking the preparation, we have all different types of preparations now, which are smaller volumes, easier to manage. But the most important part is really clearing out your colon, doing a very effective prep. And there's a lot to choose from now.

Host: And so when we say prep, for those unfamiliar, we're talking about drinking a solution the night before, early in the morning of, that helps clean out your system by basically making you run to the bathroom way more than usual, right?

Dr. Sophia Jagroop: Yes, exactly. Your colon can hold stool for months, so it's important that we clear all of that out. So yeah, it involves a one-day, pre-procedure prep, and we do a split prep, so that's the most effective prep right now, which is drinking the solution. But as I'm saying, you know, a lot of people from 10 years ago, we used to drink this large-volume prep, and it was also very difficult to take. But as the years have gone by, we have better preps and more effective preps and more tolerable preps that patients can take.

Host: Gotcha. And then as far as the colonoscopy itself goes, again, for those unfamiliar, doc, give people an idea of exactly what's involved because there's really not much to it, right?

Dr. Sophia Jagroop: No. So, you've done the hardest part when you've done the preparation. So when you come in for your procedure, you'll have an anesthesiologist that'll be putting you to sleep. It's basically through an IV. You'll be positioned by our nursing staff. We have three staff members in the room with us. And I'll have a technician that's next to me so that if there's any lesions that I see while doing the colonoscopy, I would remove it. And basically, the colonoscope is a very small hose for lack of better words that is inserted through the anus and it's directed all the way around the colon to the end of it, which is where the small bowel meets the large bowel. And we have parameters that we look at to make sure that we're there. And then, any polyps that we see at that point, I would plan on taking them out. For the most part, we remove most of the polyps. And if there's anything that's concerning for a malignancy, then that will be managed appropriately.

Procedure itself is at most a half an hour and the patients often, because of the anesthesia, they think that the procedure was a minute, so they can't tell the time. And then, they recover in our recovery area just for about a half an hour to 40 minutes and we discuss what we've found, if there's any concerns, give them their report and they're on their way.

Host: Yeah. And as you mentioned, from a patient standpoint, it really does seem as though it flies by in a second, because one moment the anesthesiologist is saying, "Okay, I'm going to put you to sleep." And the next moment, the nurse is saying, "Okay, you're ready to go home," right?

Dr. Sophia Jagroop: Exactly.

Host: Yeah. It really doesn't get any easier than that. A few other things. So if you are diagnosed with colon cancer, obviously, there are different stages. Talk about please the huge difference between having it caught early and having it caught later.

Dr. Sophia Jagroop: For the most part, colon cancer, when it's confined to the bowel, is often curable. You can have a resection, chemo, radiation. There's treatment for it. But the prognosis really depends on the degree of penetration of the tumor itself through the bowel wall. And if there's any nodal involvement, which would then make it a little bit more complicated. The whole approach to treatment beyond the bowel and everything, basically, it has to be a multidisciplinary approach.

Here at Jamaica, we have Memorial Sloan Kettering that has joined us and are helping us with our cancer patients. So, we can offer that approach, and our surgeons are very capable of managing these cases. I've had patients that come in, diagnosed with colon cancer and they've left without it. We have discharged them straight. You know, we've done the surgery and sent them home. So, we have the multidisciplinary approach to manage these kind of cases. You really want to find the right those polyps before they become cancer. And that's the role of colonoscopy, is that we find those polyps that are pre-cancerous and we remove them so that you don't get colon cancer. So, I think that's the most important thing that I want everyone to take away from this, is that you should get your colonoscopy, even though we do have these stool tests that are out there. They're a two-step process. And ultimately, if you're positive, you do need the colonoscopy. And you should do the one-step, I would advise. But if you absolutely can't and you really don't want to, get some sort of screening.

Host: And so just to clarify that, you make a great point, these stool tests that you do at home where they send you a box and you mail in a sample, et cetera, it's important to stress, isn't it, doctor, that's not a substitute for a colonoscopy.

Dr. Sophia Jagroop: Exactly. It's not.

Host: Has that been harmful in a way, do you think, in that it can be a little misleading or confusing to patients? They think they're in the clear when they're not necessarily?

Dr. Sophia Jagroop: Yes. I think that some people feel that, "Okay. If my Cologuard is negative, I don't need to go back and get another one in three years. You know, I'm great. I'm fine. It's just as effective as a colonoscopy." And they don't quite understand the guidelines about it. And that will leave a lot of patients lost to follow-up.

Host: Because really all it may tell you, correct me if I'm wrong, is, "Okay, maybe you should see a doctor," right?

Dr. Sophia Jagroop: Yeah. So basically, it's a stool DNA test. It's less accurate than a colonoscopy at detecting polyps of any size. Colonoscopy can detect 95% of large polyps, but the stool test only detects 42% of those size polyps. There is a false positive rate, which is around 13%. But one thing about the Cologuard, you know, it has a very high specificity, so meaning 92% of cancers can be detected by it. So, that's an important thing. That's why it is a very popular test to do, because it can detect colon cancer.

Host: Gotcha. Now, in recent years, colon cancer is affecting people younger than had been the case. But correct me if I'm wrong, it's really not known exactly why that is, is it?

Dr. Sophia Jagroop: No, it's not. I mean, you know, they've done a lot of studies and we started first at, when I was in my training, 50 years of age, that everyone 50 years of age should get their colonoscopy. And then, after further research and looking at retrospective data and all of that, they were able to realize that we're actually finding the large polyps at 50 years. So, we should go back. And ACS, American Cancer Society, came up with their guidelines that everyone 45 years and above should be screened. And this was everyone, not just a particular race. At one point, it was just African Americans at 45. Now, they realize, looking at all the data, that it should be everyone at the age of 45 should start their screening.

Host: Gotcha. And so in summary here, how crucial is early prevention when it comes to this and, therefore, regular screenings? What do we mean by regular screenings?

Dr. Sophia Jagroop: So, you know, I tell my patients, if you do a great colonoscopy, meaning that you prep very well, you follow our directions, and you have no risk factors, meaning no family history of colon cancer, I'm going to tell you your next colonoscopy is going to be in 10 years. And these are the guidelines that we should be providing for our patients.

Now, however, if they have a history, a family history, then I'm going to bring them up at a closer interval or any genetic history as I had discussed before. So, it's very important that our patients know that colonoscopies are important, that they should still be used as your screening tool. If you have a normal colon, no polyps, you can go potentially 10 years without going for another colonoscopy. So, I think it's worth the sacrifice overall.

Host: I think everyone would agree with that and even in a "worst case scenario" if you are predisposed or higher risk, we're talking every two or three years, right?

Dr. Sophia Jagroop: Exactly. Three years.

Host: Yeah. Well, folks, we trust you're now more familiar with colon cancer screening. Dr. Sophia Jagroop. Thanks so much again.

Dr. Sophia Jagroop: Thank you.

Host: And for more information about their services, please visit jamaicahospital.org/podcasts. To schedule an appointment with a gastroenterologist at Jamaica Hospital, please call 718-206-7001. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler, and thanks again for listening to Jamaica Hospital Med Talk.