Melanie Cole, MS (Host): Welcome to Conversations with MIT Health. I'm Melanie Cole, and today we're talking about the importance of colon cancer screening. My guest is Nicole Napier. She is a Population Health Manager at MIT Health. Nicole, thank you so much for joining us today. So what is colorectal cancer and how common is it?

Nicole Napier, MSN, MSM, RN: Well, thank you for having me. Colorectal cancer is a cancer that starts in the colon or the rectum. Now, colon cancer typically starts as a polyp, which is a growth of abnormal tissue. Some polyps are benign while others can turn into cancer over time. Now, according to the American Cancer Society, if you exclude skin cancers; colorectal cancer is the third most common cancer diagnosed in both men and women in the United States.

Host: Wow, that's just so interesting, our statistics as we're seeing them with colorectal cancer. So what are some of the biggest reasons why people should get screened for colorectal cancer, as you've just said, and the rising numbers?

Nicole Napier, MSN, MSM, RN: Screening is one of the most important tools in our toolbox in preventing colorectal cancer. So certain screening methods help find those polyps and remove them before they turn into cancer. And even if cancer is found, if found early enough; treatment options are abundant and therefore increase survival rates. If we are told we have cancer, the goal is to beat it. The earlier cancer is found, the better our chances are at beating the cancer.

Host: So when should someone start screening for colorectal cancer?

Nicole Napier, MSN, MSM, RN: Well, in the more recent years, colorectal cancer screening guidelines have changed. It used to be that you started screening at age 50, but it has since been lowered to age 45, which is great, in that it allows us to start screening individuals sooner. Now, some individuals may start their screening before age 45 if they are considered higher than average risk.

So conversations with your healthcare provider can help identify if you are in this category and make plans for when you should start your screening. Now I'm sure individuals are eagerly wondering, when should I stop my colorectal cancer screening? This is typically at age 75, but between ages 75 to 85, there should be an individualized conversation between the patient and the healthcare provider based on personal preference, life expectancy, and other health related factors.

Host: Can you talk about why the recommended age was lowered and what that means for patients?

Nicole Napier, MSN, MSM, RN: Sure. Well, according to the American Cancer Society, colorectal cancer rates have increased in people younger than 50 years old. So I suspect this is why they lowered the age. I think this makes sense as I have seen that it does take some convincing on the part of the health care provider to get one to agree and follow through on colorectal cancer screening.

So if the screening age were in fact still 50, it may take an individual some time to actually perform the screening. Having the conversation earlier gets one to start considering earlier and hopefully follow through on completing the screening. And again, early detection is key, so screening earlier certainly has its benefits.

Host: Nicole, some people feel nervous or hesitant about screening. What would you say to someone who's unsure about getting tested?

Nicole Napier, MSN, MSM, RN: Fear is normal. We naturally fear the unknown. People wonder, what will they find? What if I have cancer? But information is power, and that is how we overcome that fear. I think that if you're hesitant about screening, talk with your healthcare provider so they can understand what those true fears are and provide education to eliminate or at least minimize those fears.

Host: This is great information and what are some of those different screening options that are available? We've heard of colonoscopy and we know that there's others available as well.

Nicole Napier, MSN, MSM, RN: Right. There are many different screening options for colorectal cancer, but I will focus on two most common options we at MIT Health recommend. Now one test, as you just said, we commonly offer is the colonoscopy. Many individuals are familiar with this procedure that examines the rectum and colon with a flexible narrow tube. Now the advantage to the colonoscopy is that the colon is being directly visualized and polyps, if seen can be removed.

Now some individuals are higher than average risk for colorectal cancer and I hinted at that earlier, but I'll give a little more detail now. You are higher than average risk if you have a personal or family history of colon polyps, a family history of colorectal cancer, or if you're experiencing any rectal bleeding or bleeding with a bowel movement.

In these cases, you should have a colonoscopy. Also, there are stool based tests, one which is called the fecal immunochemical test, also known as FIT, which is a great test for average risk patients. With this test, you can screen for colorectal cancer within the comfort of your own home. You provide a small stool sample, and if you obtain the kit from MIT Health, just mail that back or bring it to our lab.

That test looks for hidden blood. If the test is negative, you'll repeat it in a year. If positive, we will recommend that colonoscopy procedure.

Host: Well then how does someone decide which screening method is right for them?

Nicole Napier, MSN, MSM, RN: Yes, well, we have a great resource for individuals on our MIT Health website. Just go to health.mit.edu and search the word colonoscopy and click on which test is right for me. There's a beautiful document that gives you basic information, the pros and cons of the colonoscopy and stool based test, and it will also go over those risk factors that can make one higher than average risk.

Host: What is MIT Health doing to support colorectal cancer prevention and help patients really to stay up to date with their screenings?

Nicole Napier, MSN, MSM, RN: Yes, we are doing quite a bit. So first and foremost, we at MIT Health are committed to ensuring our staff are knowledgeable and up to date on colorectal cancer screening and general awareness. We also have the ability to outreach directly to patients via texts and emails to inform them that they are either overdue for their screening or coming due soon.

The patient can easily respond to the message and opt to have the kit mailed to their home. Now for those who need or want a colonoscopy procedure, we have a team called the colonoscopy team that helps with different components of the scheduling process, such as providing a list of sites if needed, making sure appropriate records are sent to the preferred site, and answering basic patient questions.

And last, but certainly not least, we have systems in the background that serve as a safety net to identify individuals that may be high risk and overdue for their colorectal cancer screening. So we engage a special team of individuals called patient navigators who will outreach to these individuals and address any barriers that may get in the way of their ability to get a colonoscopy completed.

So we're doing a lot here to help individuals get their colorectal cancer screening.

Host: And what steps do you advise people to make sure they're staying on top of their colorectal cancer screening? 

Nicole Napier, MSN, MSM, RN: It truly takes a village, so we all have to work together here. If you see any of these emails or texts asking about colorectal cancer screening, please engage and respond promptly so we can get you the colorectal cancer screening you need. And I think patients should feel empowered to ask their health care provider at a visit or via the health portal, am I up to date with my colorectal cancer screening? If yes, great! Ask when you will next be due for your screening so you can stay on track. If not, have a conversation about what test is right for you and we will assist in getting that set up for you. And just as important, is letting your healthcare provider know if you have a higher than average risk for colorectal cancer.

So those risk factors that I mentioned previously will be important for your health care provider to know so they can recommend the appropriate screening method for you.

Host: Nicole, you've given us such great information. What's the one key message you'd like listeners to take away from this conversation?

Nicole Napier, MSN, MSM, RN: There are many types of cancers out there, but only a select amount that we can actually screen for. So we should take advantage of that whenever possible. So getting your colorectal cancer screening is you taking advantage of that because prevention is key. Listen, your colon is a hard working organ, so show it some love. Get your colorectal cancer screening.

Host: Thank you so much, Nicole, for joining us. And that concludes this episode of Conversations with MIT Health. Please visit our website at health.mit.edu for more information and to get connected with one of our providers. I'm Melanie Cole. Thanks so much for joining us today.