This is “Healthy Conversations,” a podcast presented by Adventist Health Central Coast.

Prakash Chandran (Host): According to the American Cancer Society, colorectal cancer is the second most common cause of cancer death in the United States. However, colon cancer screenings are saving thousands of lives each year by catching cancer before it's too late. Today we're going to talk about colon cancer screening and prevention from a patient's point of view, and here with us to discuss is Douglas Roewer, Clinical Nurse Manager of Endoscopy Services. 

I'm your host, Prakash Chandran. So, Doug, thank you so much for joining us today. I really appreciate your time. In preparation for our conversation, I watched a colon cancer awareness video that you recorded for your then five-year-old son that was incredibly unique and touching.

And while I have a lot of questions about colon cancer screening and your journey, I just wanted to start by asking why was it so important for you to make this video, especially in the way that you did?

Douglas Roewer, BSN, RN: Well, Prakash, first off, thank you so much for having me. It means a lot. To answer your question specifically, one thing that I take very seriously as a person, is prevention. And I find that a lot of people when I talk to them, they don't want to be spoken to, but I also find that a lot of people seem to be more receptive when they aren't spoken to.

So instead of addressing what I feel is an important topic to me, which is not just colon cancer awareness and screening, but what you can do in preventive medicine, I decided to make it a message to my son, and I feel that people are more receptive to hearing my message when they aren't the ones being spoken to.

And plus, I wanted a little message for my son because he did have a fear of going to the doctor. So I figured I can kill two birds with one stone, if you know what I mean.

Host: Absolutely. I thought it was beautifully done and I'll make sure that it gets included in the show notes so everyone can watch it. It kind of reminded me a lot of the importance of just being proactive with my health and we'll cover that a little bit today. Before I get into that, I just want to cover the basics of colon cancer and colon cancer screening. Can you talk to us a little bit about why you should get screened and who should get screened?

Douglas Roewer, BSN, RN: Yes. One thing that's really wonderful about a colonoscopy is it's one of the very few procedures that exists in current medicine where we get almost 100 percent visualization of the body part that we're examining. For a colonoscopy, we use something called a colonoscope, and then once we insert it and then we start looking at the colon, we have high definition imaging of everything we're looking.

And because the imagery is so crisp and so, so defined, we can find the smallest lesions by the millimeter, and even something called flat lesions, and those can potentially be precancerous, and that's what we're trying to detect, precancerous polyps. Precancer, meaning these have the potential to eventually become cancerous or cancer.

Let's take another procedure, a mammogram, for example. The thing about a mammogram is we do not have 100 percent visualization. It's more or less an x-ray. And we have to hope that what we get in the x-ray, we can see as much as we can. That's why I'm such a big advocate of colon cancer screenings, because we get such great visualizations and we can detect things at its earliest stages.

In terms of when you should go see a physician for an exam, first you got to consult with your primary care physician, and then they will give you a recommendation. According to the national guidelines, you should start at the age of 45. In my case, I started at the age of 40 because I do have a family history of precancerous polyps.

Host: Yeah, I wanted to talk to you a little bit about your personal journey. I mean, I think we are lucky enough to be having this conversation with you because you work in the field, you can describe it in a very clear and accurate way. But talk to us a little bit about why 40? What in your family history made you go in earlier than even this now lowered age? Because I think I believe it was 50 and it was lowered to 45. Is that correct?

Douglas Roewer, BSN, RN: Yes, sir, it was only changed within the last few years, this guideline, the lowering of the age by five years. What made me come in sooner rather than later was my dad does have a family, or a personal history of pre cancerous polyps, and there were a bunch of them in his colon at the time, and he was in his early 50s when he had his first colonoscopy.

Because of that, his physician at the time, told him to tell me my first colonoscopy will be at age 40. And my brother, he's going to be turning 40 in the next few years himself, so he already knows he has to get his procedure done as well.

Host: Okay. And, I was reading in the description of the video that you kind of mentioned like, you know, prior to your procedure, you couldn't help but think, look, I'm low risk. Do I really need to do this? But this really shifted your perspective because you went in at 40 and they actually found something. Is that correct?

Douglas Roewer, BSN, RN: That is correct. It was an incidental finding and myself, as well as my gastroenterologist, Dr. Neal Moeller, who performed my procedure, we thought there will be nothing there, low risk, what are the chances? And I have no family history of cancer, just the family history of precancerous polyps. The finding was very revealing.

I was surprised, not only to see the polyp, but also ended up being a C rated C cell adenoma, which is a precancerous polyp. I don't know how long I would have had to wait before that pre cancerous polyp turned to cancer, but you don't want to wait. I mean, you want to get out as early as you can because if, A, you know, even if it's an early cancer, you still have to go through chemo, you have to go through radiation in order to shrink it, then you have to go through surgery, and then it's just a very life altering thing, and then part of your colon is removed.

Doing this, you just go in, if there is a polyp, and it's either benign or precancerous, very easily we can just remove it within a minute or so with almost no complication and then you're done and then you come back whether it's three years, five years, ten years, whatever is recommended by your gastroenterologist.

At the time I was on the three year plan. As of a few weeks ago, I had my follow up since my three years has already passed and I was, I had two small diminutive polyps, but completely benign, so I'm now on the five year plan.

Host: Yeah, and just to give clarity for people that may not know, a polyp is just kind of, it's like a bump or it's a growth. Is that fair?

Douglas Roewer, BSN, RN: Yes a polyp is a growth within your colon that has the potential to turn cancerous. And since us, when we're visualizing that bump in the colon, we don't know what's technically benign or precancerous or cancerous, rule of thumb, we see a bump, we remove it, collect it, send it to pathology for analysis so they can put it under a microscope and based on their findings of the cellular structure, they'll tell us on what the identification was of that lesion that we removed.

And then from there, once we get our analysis, we would then give our recommendation to the patient, when they would come back for their follow up procedure.

Host: It's recommended, and I'm sure also covered by insurance at 45, but who should be thinking about potentially getting it done earlier? You mentioned the family history. I also know that, I believe, Chadwick Boseman, the Black Panther actor; he was diagnosed earlier and died colon cancer. So, there is reason to go in earlier. Do you have a sense of when people should be evaluating whether they should go in before 45 years old?

Douglas Roewer, BSN, RN: Yes, anyone who has a family history or a personal history of cancer. It doesn't have to be colon cancer. It can just be cancer. I can get into a number of different scenarios, but if we take things a few steps back again, preventative medicine is something I take very passionately in my life.

And one thing that I think that everyone should be doing, no matter how young, or old they are, they should be going in annually to see their primary care physician or their primary care provider. So that's either going to be someone who practices family medicine or a nurse practitioner or even a physician assistant.

And by going to see them, they do all their checkups, like blood work, and then based on your age, and your personal history, and your family history, they also then give you your, their recommendation for you. It may not just be the colonoscopy, it could be the mammogram, or a pap smear, or whatnot.

And then also if there's incidental findings, let's say in your lab work, then they would recommend what the recommendation is for follow up. Also, the other thing is, depending on your insurance, as you were mentioning about insurance, some insurance companies won't cover this procedure unless you do have a referral.

So, regardless, you should always keep up with your primary because your primary will always know not only what you should get, when you should get it, and they can, they're the easiest route in terms of facilitating movement on your behalf, especially if there's urgency that's required.

Host: Yeah, that makes a lot of sense. I know, obviously, you've emphasized twice the importance of that preventative action being the best medicine. But, maybe for people who are a little older, can you speak to any sort of like symptoms or things that might tell them they might have colon cancer or they may want to get checked out?

Douglas Roewer, BSN, RN: That's the thing, the thing about colon cancer is if, there really aren't any symptoms, usually a later symptom would be rectal bleeding and hopefully, if you're seeing bleeding in the toilet and you go in timely, hopefully whatever's causing that bleeding, we're catching it at an appropriate time.

But really, it's hard to say if there's any symptoms. I can give you a big motivating factor as to why I created the video on behalf of my son and why I posted it on social media. Back in high school we all had our cliques, I mean all of us who were in high school, and there was a young man I went to school with, his name is Jeremy Bruner, and we were only about two years apart.

Everyone was exposed to COVID around the 2020 time, and during that time I was living in California, my friend's living in Chicago, and he posted on Facebook that he had just been diagnosed with colorectal cancer. A few years following that, he eventually succumbed to colon cancer as well and passed away.

His sister posted on social media that he had no symptoms. The only reason he went to the doctor was because he was his energy levels were low. And so they did blood work and just for the heck of it, they did an upper endoscopy, which is a scope where they look in their esophagus, stomach, and the beginning portion of their small intestine.

Following that, they did the colonoscopy, and during the colonoscopy, they had found the cancer. And so, it's hard to say, and as far as I know, he had no family history of colon cancer from what I understand, nothing to indicate that he needed an early screening. So, because of that, I made this video so that people not only were aware of colon cancer, but also the importance of seeing the doctor regularly and not to be afraid to go see the doctor.

So that, because the whole purpose of medicine in general is, to see the unseen.

Host: Yeah, thank you for sharing that by the way. I think that, that is really important to know that. It is important to go in to listen to your primary care physician and they're going to be able to best guide you around the best course of action, but ultimately, we're responsible for our own health. So, just making sure that we are proactive with all of these different types of screenings.

Douglas Roewer, BSN, RN: Yes.

Host: We talked just earlier about the colonoscopy being the gold standard. Are there other screening modalities that people should be aware of?

Douglas Roewer, BSN, RN: Well, outside of, well, in gastroenterology the other screening would be for an upper endoscopy, especially if you have a family history of whether it's esophageal cancer or stomach cancer. Also we do upper endoscopies for symptomatic reasons. The number one reason is reflux or heartburn symptoms, difficulty swallowing.

And from there, if we have to, we can do that procedure, take biopsies as needed so we can get a diagnosis. And the majority of the time these ailments can be treated very easily with oral medication.

Host: So, Doug, just as we start to close here, if there's one thing that you wish more people knew about colon cancer or colon cancer screening what might that be?

Douglas Roewer, BSN, RN: One thing that people who haven't had this procedure performed think is the most difficult part of the procedure is the procedure itself, which is the colonoscopy. When in fact, in my opinion, and if you ask just about anyone else who has a colonoscopy, actually the most difficult part of this procedure is the prep.

The night before, you have to take about a liter of fluid, followed by a bunch of water so that you can go to the bathroom, and then following that the morning of, you have to wake up early enough and, again, drink enough fluid and then go to the bathroom. That is the hardest part of this procedure, which is preparing for this procedure.

After that, you come to the hospital, you get admitted, you have an IV, and then once the procedure is performed, 20 minutes later, as you're waking up from your sedation, nine times out of ten, the patient is asking, are we done? Are you kidding me, that's it? Oh my God, the prep was actually more difficult than the procedure itself.

And I'm just sharing you what the majority of the patients who come to my department says. The prep was more difficult than the procedure itself. If only I had known, I would have come sooner. So, these are not my words. These are actually words of many, many patients who come to my department for their colonoscopy.

And, trust me, it's one of those things where once you get it done, you're done. I mean, there aren't very many procedures that exist in modern medicine where we can have a procedure that's this easy and where we can have very, very rewarding results, especially in the world of preventative medicine. Again, it's easier to prevent versus treat something that's already there.

Host: Well, Doug, I think that is the perfect place to end. Thank you so much for your time, for sharing your story today. We truly appreciate it. That was Douglas Roewer, a Clinical Nurse Manager of Endoscopy Services.

Douglas Roewer, BSN, RN: Oh, thank you so much for having me. I appreciate everything.

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Disclaimer: This program is a community service and is not intended to be a substitute for medical advice. Listeners having questions about their health, should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.