Transcription:
Colorectal Cancer Screening

Host:    Riverside Healthcare, puts the health and wellness information you need well within reach.

Today, we're going to be talking to Dr. Bushra Alam, who is an internal medicine provider at our Frankfurt Campus. Dr. Alam, thank you so much for joining me today.

Dr. Bushra Alam: Thank you for having me.

Host: So let's start off by sharing a little bit with our audience a little bit about you, your background, how did you get into medicine?

Dr. Bushra Alam: Sure. So I am a recent graduate of Riverside Medical Center's Internal Medicine Residency Program, completed my three years there in June. And since then, I've been working here at the Frankfurt office as an internist primary care physician. I did my medical school training at Midwestern University in Downers Grove. And prior to that, I did my undergrad at Loyola University.

I've been in interested in medicine actually for a really long time. I always enjoyed studying biology and anatomy. And I also really enjoyed working with people. I kind of wanted to find a career where I felt I'd be able to develop relationships with people and sort of see them over a long time and also work on making them feel better. And that's sort of how I ended up here.

Host: Very cool. And so locally, you've done a lot of your schooling around here. Are you originally from this area?

Dr. Bushra Alam: Yes, I grew up in Aurora. That's where my family is now. So I've been kind of in the same area for awhile.

Host: Okay. Very cool. Well, so glad to have you.

Dr. Bushra Alam: Thank you.

Host: So today, our topic focuses on colorectal cancer screenings and more specifically on the racial disparities in diagnosis and treatment of colon cancer. So let's start with what is a colorectal cancer screening?

Dr. Bushra Alam: Sure. So just a quick overview of colorectal cancer in general, so colorectal cancer is a disease in which cancer cells or malignant cells develop in the tissues or the lining of the colon or the rectum. Oftentimes these cells originate from benign growths called polyps. They can develop slowly and, based on the development process, we generally recommend that colon cancer screening starts in an average-risk person around the age of 50.

So in terms of what colon cancer is and what the risk is, it is the third most common cancer affecting both males and females in the United States. And patients who are diagnosed at an early or localized stage tend to have a much higher survival rate than those who are diagnosed once the disease has metastasized.

Colon cancer can be asymptomatic, meaning that you might not know that there's something going on or it can present with symptoms such as changes in bowel habits, blood in the stool, chronic diarrhea or constipation or unexplained weight loss.

Host: So there are screenings that we can perform to see if somebody has this. And I think there are two different ones that I know of, colonoscopy and Cologuard. Can you kind of go through those two types and what the differences are between those two?

Dr. Bushra Alam: Sure. So there are a variety of different ways to test for colon cancer. Two of the more common ones are the ones you mentioned, colonoscopy or Cologuard. There are a number of other tests as well that can be done based on the discretion of the gastroenterologist. Some of that depends on a patient's anatomy or their family history or genetic makeup. But the more common ones are the colonoscopy and the Cologuard.

So basically, these two tests look for either direct visualization of the colon to look for abnormalities or they involve genetic testing for any mutations or blood in the stool. And I think we'll probably go into more detail about who qualifies for which ones and what the differences are there.

Host: Okay. Is one preferred over the other between those two or the types of screens I guess you mentioned?

Dr. Bushra Alam: Yeah. So like I mentioned, for an average-risk individual, which is generally anyone between the age of 50 to 75 who has no personal or family history of colon cancer, who does not have a history of inflammatory bowel disease or some other conditions such as familial adenomatous polyposis syndrome or other rare diseases, we do recommend starting at the age of 50. Based on different recommendations, some groups actually recommend starting at 45.

For an average-risk individual, I kind of give them the option between a colonoscopy or a Cologuard. So as I mentioned, the Cologuard is basically a stool study test that can be done from home. It involves sending in a stool sample to the company who then does genetic testing to look for any sort of DNA mutations that could predispose the patient to a colorectal cancer. And it also looks for hemoglobin which is a product of blood in the stool because sometimes some of these polyps or lesions can bleed.

The benefits of the Cologuard is as I mentioned it's convenient, it can be done from home. If that test is positive, that means that there is something going on in the colon that needs to be evaluated further. And the next step would be to get a colonoscopy. However, if that test is negative, that means that at this time it's less likely there's anything concerning and we can hold off for another three years and repeat the test at that time.

The other option is colonoscopy, which is basically a scope that allows for direct visualization of the colon to look for any polyps, masses, lesions anything like that the benefit of that test is that it's both diagnostic and treating or treatment-involved. Because it's a direct visualization, if there are polyps, they can actually be removed right then and there and then sent for tissue sampling to determine what they might be.

One kind of consideration with the colonoscopy is that it is a procedure that does involve some small risk and also requires scheduling usually at least a day for the procedure, if not two days, to allow for prep. So those are sort of considerations that patients should keep in mind when choosing between the two options.

Host: Are both of these options covered under insurance? I mean I know there's some people who maybe prefer to utilize their insurance. There's some who may not have the right type of insurance, but these tests are so important. Are they covered?

Dr. Bushra Alam: Generally, these are always covered by most private insurance companies as well as Medicare. We do come into some issues occasionally with patients who may not have access to health insurance. But generally, what we will do is try to find financial assistance programs. I know Cologuard does have one or we will try to work with gastroenterologists who maybe have financial assistance programs or other programs for patients who have limited accessibility so that we're able to get these tests done

Host: Okay. If someone is diagnosed with colon cancer, what is your next step?

Dr. Bushra Alam: So the most important thing is that we are staging the cancer appropriately. That can be done by a tissue sample and sometimes also requires additional imaging to see if the cancer has traveled anywhere else. Based on that, there would then be followup with most likely an oncologist to determine the next steps for treatment. That could vary anywhere from surgical removal of the mass to surgery plus chemo or radiation and there are a number of different treatments involved there and new technology coming out. So that would sort of be a conversation we would have with a number of different specialists as a team.

Host: Okay. And so there's, I mean, a lot of option out there for possible treatments. If somebody is unable to get to this treatment, are we able to work with people who maybe don't have the insurance or the way of getting the treatment that they need?

Dr. Bushra Alam: Yeah. So there are lots of different organizations that help us with this, either like I mentioned with financial assistance or there are even cases where we can get our patients involved in studies, clinical trials to see if there are new and upcoming technologies that they may be candidates for. A lot of times those trials actually involve a financial incentive for the patient or it's covered by the university that's conducting the trial.

So there are a number of different options It really depends on, you know, what the patient has, what stage they are and where they're coming from in terms of their financial background. We do our best to work with them so that they get the appropriate treatment.

Host: If somebody does meet these requirements for the testing, the next step is they can schedule through a primary care or how would you schedule a colon cancer screening?

Dr. Bushra Alam: Yeah. So I basically recommend anyone really to schedule an annual physical exam with a primary care provider. And during that exam, we have conversations about any sort of age-appropriate cancer screening or any specific screening that is for that patient due to their risk. So if they have a family history or some sort of genetic mutation or other chronic conditions that make them increased risk for colon cancer, then we would talk about that and I would discuss the various options with them based on their risk profile and kind of help them to set up an appointment either to have a conversation with the gastroenterologist or have the Cologuard set up if that's appropriate for them.

Host: Well and if you are looking to schedule an appointment with your primary care, Riverside has several options. You can call your doctor's office directly. If you don't have a primary care provider, Riverside does have a referral line that is (855) 204-DOCS (3627). And they will be able to find a primary care provider who maybe in a location that you're closest to and one that fits what you're looking for. You could also schedule online at RiversideHealthcare.org or schedule through your MyRiverside MyChart account.

So Dr. Alam, is there anything else that you would like to add or anything that we missed?

Dr. Bushra Alam: Yeah. So I just want to touch a little bit on any studies or recent evidence that we've found on racial disparities within the diagnosis and treatment of colon cancer. This is an area that I've always been kind of interested in in terms of accessibility and some of the social determinants that lead to inequality in healthcare.

When it comes to colorectal cancer, colorectal cancer disproportionately affects individuals from low socioeconomic backgrounds. In fact studies have shown that these individuals have up to 31% higher risk of developing colorectal cancer. We also find that African-Americans, both men and women, have the highest incidence and mortality rate with colorectal cancer.

There are a number of different reasons that this could be. A lot of that is based on lack of education or lack of access to education about what colon cancer is or how to get it treated or screened for. But there are also some new studies that have shown genetic variability. They actually have found that there is an incidence in proximal adenomas in African-Americans, which basically means the location of some of these polyps or cancerous cells can be a little bit different in African-Americans, which can actually make it more difficult to detect them.

Studies have also shown that diet and gut bacteria can play a big role in this as well. Certain alterations in gut bacteria such as a more inflammatory diet or certain conditions that increase inflammation in the body such as certain auto-immune diseases can increase the likelihood of developing certain types of cancer.

Some studies show that there was an increased amount of inflammatory bacteria in tissue samples done during colonoscopies in African-Americans versus non-Hispanic white individuals. So the importance here is that there are a lot of risk factors that need to be considered and there's ways that as a community we can work on modifying that.

For me as a physician, my goal is always to consider the patient as a whole to think about social determinants that may be sort of impacting their health care whether it's where they live, what resources they have, how they eat what their stressors are. And I think all of those are important things to consider in how we treat and how we screen.

So because of that, because of the increased risk of colorectal cancer in African-American individuals, some societies actually recommend that we start screening earlier at age 45 just so that we are less likely to miss anything. It's also important when dealing with populations that maybe have lower socioeconomic status or access that, as we talked about, we are giving them the best resources for financial assistance education and doing kind of close followup to make sure that if there is something concerning diagnosed that we are following closely and working together as a team to treat the condition.

Host: Well, thank you so much for sharing that and that additional information. Your health is your greatest asset, so make sure you are taking care of yourself. If you have any questions at all, make sure you're talking to your primary care provider as they are looking at you as a whole and treating you for you and making sure that they are giving you your best life and things like that.

So if you have any questions at all, of course, visit our website at RiversideHealthcare.org. Thank you so much for joining me today, Dr. Alam. And thank you for tuning into the Well Within Reach podcast. To learn more about the colorectal cancer screenings, visit RiversideHealthcare.org.