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Scott Webb (Host): Colorectal cancer is almost entirely preventable if we get screened early. And though colonoscopies are the gold standard, there are some at-home screening options that may work for some of us. Welcome to Right Beside You, a Reid Health podcast. I'm Scott Webb and joining me today to discuss the various screening options, when we should be screened and what we can do to prevent colorectal cancer is Dr. Naeem Raza. He's a Gastroenterologist with Reid Health. Dr. Raza, thanks so much for your time today. We're talking about colorectal cancer and colonoscopies and screening and all that good stuff today, as we get rolling here, what is colorectal cancer and what signs and symptoms should we be on the lookout for?

Naeem Raza, MD (Guest): Colorectal cancer is a common and lethal cancer. It is one of the leading causes of cancer death in the United States. We like to discuss about the risk factors about colorectal cancer and the most important risk factor is age, followed by family history. Colorectal cancer comes from the colon polyps, which continue to grow and over the period of time, change into cancer. Most common signs and symptoms are bleeding in the stool, which is mostly undetected, unless it reaches to the cancer stage. Like any other cancer, the most important symptom we get from the patient is they are asymptomatic, which means those cancers when they're in the early-stages, do not give any obvious warning to the patients. That is why as a physician, our goal is to educate our patients and communities, that we need to stay in the early detection and prevention of this cancer. There are simple tools available, which we like to discuss further in detail.

Host: Yeah, and we're definitely going to do that. And you mentioned risk factors or who's at risk, and of course none of us can outrun our family history and genetics. Does it affect males more than females? Is it fairly equal?

Dr. Raza: It is fairly equal. And the number one risk factor we have seen is the age. We used to start screening in average population, age 50, but we have seen the cancer is on the hunt for the early ages. And know we have across the board colorectal cancer screening starting at the age of 45. There is not much difference in the gender. But there is some difference in certain races, such as African American race, we have seen earlier start of those cancers. Patients with the family history, as you mentioned, also tend to have higher risk. And then there are some genetic disorders which runs in the family and those patients need early screening for these cancers to, too.

Host: Yeah. And I'm glad that you mentioned that the screening guidelines changing, because I think there's some confusion out there. Right, it used to be 50, if you were average risk and now it's 45 and sort of alarming, there's higher incidence of colorectal cancer in even younger patients, maybe you could speak to that a little bit.

Dr. Raza: Yes, we have seen. That we continue to emphasize start screening at age 50 and above. But lately we have seen that patients start getting these cancers and precancerous lesions at younger age than 50. So with multiple studies, United States Preventative Task Force and American Cancer Society and other organizations came up with these guidelines that we should start screening in an average person, means across the board without having any high risk factors screening for cancer at age 45. This helps to diagnose and prevent this cancer at the earliest stages.

Host: Yeah. And you mentioned there, that's really, I think why colonoscopies are the gold standard? Sure. There are other options, Cologuard, things like that at home options, if you will. But the reason colonoscopies are the gold standard is because they are both diagnostic and preventation. It's sort of a one-stop shopping if you will.

So let's talk about, since we know that screening and diagnosis early is key. Let's talk about the early detection methods like colonoscopies, what are polyps? And so on.

Dr. Raza: That are different methods available in prevention and early detection of these cancers. Some are noninvasive methods, which means they can be done by simple stool studies. Then there are some radiological methods such as CT scans and other, and then there is invasive procedure colonoscopy. Colonoscopy procedure includes by direct visualization with the help of the scope, which has camera and light.

This procedure helps to prevent and early detect the polyps. Colon polyps are small growth of the tissue, which is abnormal. And if they continue to grow, they become cancers. By doing this procedure at the right time and regular intervals, we are not only able to find those polyps, or growths, we can remove those, at the same time in the procedure. So that is why, as you mentioned, we can take care of the whole situation in one stop. By removing those polyps, we prevent them to continue to grow and prevent the cancer to happen. Let's look at simply most of the other tests like detection for the cancer, breast cancer, mammogram, and pap smear, or CT scan for the lung cancers.

They help to detect the cancer at the at earliest stages. But with the help of colonoscopy, we can not only detect the cancer, at earliest stages, we can remove the polyp which will become a cancer so we can prevent the cancer to happen. This is an excellent method which can be done safely, comfortably, and prevent the cancer to happen, which means these patients can avoid not only chemotherapy or surgery because they have avoided the cancer to happen.

Host: There's so many good reasons, right as we're establishing here and have your expertise today, it's diagnostic. It prevents, it's a safe and comfortable and so on. So I think the natural followup Doctor is why do so many people avoid being screened. Are they scared off by the prep? Is it the unknown? Maybe you have a sense of why people who, you know, are even average risk who get to 50, why they continue to put it off. It wasn't just COVID maybe there was some of that during COVID, but even, you know, removing COVID from the equation, why do people sort of drag their feet on this?

Dr. Raza: There could be many reasons, but I always want to take responsibility as a provider period. I like to educate patients from my end and I feel like this is the first thing we need to focus. As a provider, we should educate our patients and then try to understand why they are reluctant. We know these colonoscopy procedures, if we consider for screening reasons, all the insurances and Medicare approved. So it is not the expense at that time. There are confusions in the mind of the patient about the bowel prep. We have come across many simple bowel prep formulations which are much easier to tolerate. There are also misunderstanding in regard to the complications and the side effects. Most of these procedures are done with either very light conscious sedation or with the help of anesthesia. Either of those two procedures involves complete comfortability and tolerance in the procedures. So the pain is not an issue in these procedures. The complication risks involve bleeding or perforation. Those are also extremely rare. In the studies, the risks of those complications occur in around one in 4,000 to 5,000 cases like that. So, overall my experience is that we may have to do a better job in communication and educating our communities and our patients.

Host: I think you're so right. And that's, what's so encouraging about doing things like this, is we're communicating, we're educating, and I really appreciate your perspective. That some of the responsibility for folks may be dragging their feet a little bit, or their confusion really, you know, is from their doctors being able to communicate and explain, and you know, having had my own colonoscopy, I think best part about it for me was I knew that provided everything was normal that I wouldn't need one most likely for 10 years. Right. And I think that that's also maybe some good information to get out there is that if you're normal, if you're at normal risk, right. And everything is fine, it's not like you have to go back every year. Right?

Dr. Raza: That is correct. Normal colonoscopy without family history of colon cancer in the first degree relative, you don't need to do the repeat till 10 years. Also, if you choose other screening methods, and those methods are positive or abnormal, then your indication of colonoscopy becomes from screening to diagnostic, which means then it becomes more of your financial responsibility to pay part of that procedure.

I strongly recommend colonoscopy procedure. Because first you can not only detect or find, you can also remove those polyps. Number two, it is a screening if you go straight for colonoscopy, as part of the guidelines across the board.

Host: Yeah. As we've established here today, it is the gold standard. It is safe, comfortable, the only real complication is you have to have a ride, right?

So you can't drive yourself home. So that's one minor complication, but most of us have a friend or family member who can drive us home. So Doctor, we wrap up, and great information today, tell listeners, how easy it is to contact you your office to get this scheduled. Insurance pays for the colonoscopies and just encourage them one last time to get their colonoscopies, get screened.

Dr. Raza: I am a strong, passionate supporter for colonoscopy to prevent the cancers. Since I started practicing as a GI physician, I have seen the benefits all the time. My chief department of gastroenterology, where I trained during my fellowship, Dr. Michael Kumar used to say, anytime he see the colon cancer, it hurts his feeling.

That is a missed opportunity where colonoscopy procedure could have prevented that to happen. This is a simple procedure. Again, screening colonoscopy is approved by all the insurances. Scheduling is very easy. You can talk to your own providers and they can call to schedule this procedure through the Reid Gastroenterology.

There are easy process. So the computer, by the phone to schedule this procedure. The bowel prep's available both in liquid form, much smaller quantity in comparison to the past, and also in the pill forms, which are easy to swallow, comparing to the large amount of liquids. The procedures are done with the sedation. So there is no discomfort in the procedure. There is need for a ride because of the medicines given to make you comfortable. And that is the requirement by the state and it is for your safety and other people's safety. Otherwise, everybody, after the procedure is awake and comfortable able to eat and they can rest and do the routine light activities, with the company of the other person.

Host: And that's perfect doctor, you know, communication and education is so key. Thanks so much for your time today, Doctor you stay well.

Dr. Raza: Thank you. Thank you.

Host: And to learn more. Call 765-935-8923. And if you found this podcast helpful, please do share it on your social media. And thanks for listening to Right Beside You, a Reid Health podcast.

I'm Scott Webb.