Transcription:
Colorectal Cancer Screening and Awareness

Gabby Cinnamon: Colorectal cancer is the third most common cancer in the United States. In 2023, the American Cancer Society estimates that more than 150,000 people will be diagnosed with a form of colorectal cancer. However, with regular screening, colorectal cancer is often preventable and, if caught early, treatable.

Joining us today to talk about colorectal cancer screening and awareness is Dr. Ahsan Basha, a medical oncologist and hematologist at Riverside's Watseka campus and the Riverside Cancer Institute in Bourbonnais. Thanks so much for coming on the podcast today, Dr. Basha.

Dr. Ahsan Basha: Thank you, Gabby.

Gabby Cinnamon: It's always a pleasure to have you here.

Dr. Ahsan Basha: Yes.

Gabby Cinnamon: So, what is colorectal cancer?

Dr. Ahsan Basha: Colorectal cancer is, basically, cancerous cells that have grown out of control essentially. And these are cells which are involved in our colon, anywhere from our large intestine all the way to the rectum, and it can grow out of control and cause lots of symptoms.

Gabby Cinnamon: How is colorectal cancer diagnosed?

Dr. Ahsan Basha: Eventually in one form or the other, it's generally diagnosed by getting a piece of tissue from the colon. Usually, this involves a colonoscopy. but we'll talk a little bit later about screening to get to that point.

Gabby Cinnamon: So, continue on that. What are the current screening recommendations for colorectal cancer?

Dr. Ahsan Basha: So, the screening recommendations have actually changed recently. Up until last year, the common recommendations from all the societies involved were people 50 and older, up to about age 75 should get a colonoscopy or other forms of screening. I'll clarify that a little bit later. But recently, as of last year, the major preventive forces have suggested that cancer screening should start at age 45 for all adults.

Gabby Cinnamon: Oh, wow.

Dr. Ahsan Basha: Yeah. Basically, it's interesting, the incidence of cancer has actually lowered in older people, but increasing in people younger than 50.

Gabby Cinnamon: Oh, that is interesting. Did they say anything like what that might be attributed to?

Dr. Ahsan Basha: Part of it is, for the older people, they actually improved diet, improved lifestyle risk. And for younger people, we're not completely sure. They think there's an environmental risk associated with things and then just general diets and habit changes. You know, obesity has increased in the US and that's one risk factor.

Gabby Cinnamon: That is very interesting. When should someone talk to their doctor about screening for colorectal cancer or are there increased risk factors where you might want to talk to your doctor about it earlier than 45?

Dr. Ahsan Basha: So for the general population, again, screening means you don't have symptoms. Screening means you're looking for something before you develop problems, right? So for the general population, once you get to about 45, if there's no other reason why, you should start talking to them about it, and getting it done. And then, the societies had different frequencies. For example, if you have normal risk about every 10 years for colonoscopy, a little bit more frequently if you decide to do other types of screening tests like the Cologuard tests and other things. Some of those are like every three years. If you just do blood testing, it's once a year. But if you have a family history that you know about, okay, say you have a parent or a relative or a sibling, first-degree relative, you should start cancer screening earlier, usually about 10 years earlier than they got cancer, and so forth.

Gabby Cinnamon: That's good to know. Speaking of Cologuard, can you talk more about that? I think overall we've been seeing a lot more promotion of Cologuard on TV, radio, what have you. And can you talk about what that is and when is that an option for people?

Dr. Ahsan Basha: Sure. That's what I did actually. So, the standard colon screening in general has been colonoscopies for colon cancer, which involves doing a prep where you have to drink a lot of fluid and clean your bowels out for a day or two before, and then have the scope put inside of you, for lack of better words. And so, that's been the standard way and it's still, to be honest, the best way overall in terms of sensitivity and being able to identify things, okay? And you don't have to do it as often.

Cologuard is a non-invasive test. Basically, it's a stool sample that you send to the company and they're not looking just for blood, like old tests we used to do that weren't as effective. Cologuard is actually able to identify DNA shed by cancer cells into the stool, and so that's what it's detecting. And so, it's fairly sensitive. Eighty-four percent of cancers that are present can be caught. Actually, no, actually, it's even higher. It's like 92% of cancer can be caught, but there is a 15% false positive risk, okay? And if you get a Cologuard test and then you have a positive test, you still end up having to do a colonoscopy.

Gabby Cinnamon: a lot of times the primary care providers will just recommend the colonoscopy because then if the Cologuard comes up that you need further screening, then your insurance doesn't cover the colonoscopy, because then it's investigative and not preventative.

Dr. Ahsan Basha: That's true. So again, if you have a positive Cologuard test, then you'd still have to have a colonoscopy. But at this point, it's not a screening colonoscopy that's covered by a lot of insurances and Medicare, it's actually a diagnostic procedure, which is then charged for.

Gabby Cinnamon: Yeah. Good to keep in mind when you're considering your options. Are there any early warning signs of colorectal cancer?

Dr. Ahsan Basha: Yeah. So basically, the most common things are blood in the stool or change in color of the stool significantly; change in the way the stool looks, such as being much smaller, thinner than usual, or you have to force yourself more. And then, there's things like abdominal bloating, abdominal pain, and loss of weight unintentionally. Usually when you get to that point, it's a little bit farther along, but those are things to look for.

Gabby Cinnamon: You kind of talked earlier about some additional risk factors for colorectal cancer, but can you remind us of those?

Dr. Ahsan Basha: So, there's risks that are involved that you can't control, okay? These are things like maybe family history of cancer, genetic predispositions to cancer, such as Lynch syndrome, it's just a genetic thing that's hereditary and increasing risk of colon cancer. Or some families have this disease called familial adenomatous polyposis, which is a long word, it means you got a lot of colon polyps, okay? And also, if you have inflammatory bowel disease like Crohn's or ulcerative colitis, those have increased risk of colon cancer. So those are things you can't change. And by the way, if you have those kind of risk factors, Cologuard is not a good test for that. It is not FDA approved for patients who have those risk factors. It's for patients who have normal risk factors.

Then, there's things you can't control, right? Obesity, hopefully you can control it. We know there's some people who have a hard time controlling it. There's medications for that. You got to talk to your primary care doctor about that. But dietary modifications such as lots of red meat, really burnt food or well done food has high risk; low fiber diets can increase risk. So, there's lots of things you can change. Smoking. Smoking, we always think of lung cancer, but there's risk associated with smoking with lots of other cancers. Alcohol, more than two drinks a day had been shown to increase your risk of colon cancer as well. So, these are all things you can modify.

Gabby Cinnamon: I've been seeing more actually about alcohol overall, kind of off topic, but also on this, that any amount, they've been saying, is not good. You know, obviously, we know that it's not good, but I've been seeing more studies come out about the links between alcohol and cancer recently.

Dr. Ahsan Basha: Yeah, there is. And we're not telling everybody to abstain, you know, but not a bad idea. But, you know, the other thing is a little bit of alcohol, there's maybe some benefit. We're not completely sure and it depends on who you talk to, I think. But a little bit of alcohol, anything in moderation, in lifestyle, diet, alcohol is all okay. As I said, in men, more than two drinks every day is a risk factor. For women, more than one drink every day is a risk factor.

Gabby Cinnamon: So yeah, kind of into my next question, which you already answered, you know, when it comes to reducing your risk, just living a healthy lifestyle overall is what's in your control.

Dr. Ahsan Basha: Moderation, right?

Gabby Cinnamon: Yeah. Yes, exactly. So if someone gets a colorectal cancer diagnosis, what treatment options are available to them at the Riverside Cancer Institute?

Dr. Ahsan Basha: So, again, hopefully, by doing screening, if you're doing screening before you have symptoms, you can catch the cancer early. If you catch cancer when it's still localized, it's about 90% curable.

Gabby Cinnamon: That's great.

Dr. Ahsan Basha: If it's spread out to like the region, the rate drops to above 75% and much lower if it's already spread to other parts of body. So again, hopefully if you catch it early, with the help of our GI physicians that work through Riverside and elsewhere, then we have excellent surgeons here at Riverside who are experts at colorectal cancer surgery, and they know how to manage things. And then, from a medical oncology point of view, we do chemotherapy, , obviously as well as some of the newer treatments, and we can talk about that later. But we have all sorts of systemic treatments that work together with the surgeon or without, if it's more further spread. And then, finally, we have an excellent radiation oncology department and, you know, working with certain types of cancers that can be very effective as well.

Gabby Cinnamon: How has treatment changed over the last 10 to 15 years? You mentioned treatment innovations, and has that helped colon cancer prognosis?

Dr. Ahsan Basha: It has. So, our chemotherapy treatments that we use alongside surgery have improved. Surgical techniques have improved. They're less invasive than they used to be. And now, the most recent stuff is immunotherapy. At present, immunotherapy is really reserved for patients with cancer that has already spread, but it's dramatically changed prognosis in a very positive way.

And as an aside, the news, I think, last year came up with, "My God, we've cured cancer," because there was a trial, which they used immunotherapy alone instead of surgery and chemotherapy and had everybody survive. And one of my cousins came up and said, "Have you guys cured it?" I'm like, "No." It's a small trial. It was 14 people. It was people with specific type of rectal cancer actually. It's very promising. It's very exciting. This may be a part of our future. And at Riverside, we have immunotherapy. So if that becomes a standard of care, we will follow it. But again, talk to your doctor, I guess, is the best thing, you know, and everything that comes on TV isn't necessarily for everybody.

Gabby Cinnamon: Yeah. I think too, kind of going off of what you said, I think you and the other providers you guys do a really good job of making things become a lot less grim in general for patients. And I think you guys do a great job of getting that across, that things have improved and new things come out every day.

Dr. Ahsan Basha: Oh, exactly. No, it's a really promising time. You know, when I first finished my training, which was too long ago, there's not much to this colon. There's very few things we can do, but our options have greatly advanced in the last 10 years and it's really amazing. And you hate to say you're excited for patients with cancer, but you are. I mean, you're excited that you can provide them with hope. That's really the main goal for you here at Riverside, provide hope and for good life.

Gabby Cinnamon: Yeah. That's incredible. Before we go, is there anything else you would like to add? Dr. Basha?

Dr. Ahsan Basha: No. I mean, I think we covered a lot here. The main thing is, one, screening, it does help. Catching things early makes a difference in people who can be around-- like I mentioned, it's the third most common cancer in the country. About 50,000 people a year die of it still, right? But we can make a difference. And so, getting your screening done, talking to your doctor, both primary care to get to the screening part and then, if you should be diagnosed, talking with a doctor about what's right for you as an individual. And again, ask questions too. We're here for answering questions.

Gabby Cinnamon: I think that's all we have for today. Thank you so much for coming on the podcast today, Dr. Basha.

Dr. Ahsan Basha: Always a pleasure.

Gabby Cinnamon: And thank you listeners for tuning into Conversations on Cancer brought to you by the Riverside Cancer Institute. Also, make sure to rate and leave a review on Apple, Spotify, or wherever you listen to the show.