Joey Wahler (Host): March is Colon Cancer Awareness Month, so we're discussing the importance of screening for early detection. Our guest is Dr. Daniel Berger. He's a Gastroenterologist, also Director of Endoscopy, Division of Gastroenterology and Hepatology for Sinai Chicago. This is the Sinai Chicago Health and Hope podcast, where caregivers from Sinai, Chicago share insights, updates, and important advice on the health topics impacting our communities.

From the latest in medical research to practical tips for improving wellness; doctors, nurses and health professionals are here to help you and your families take control of your health. Thanks so much for joining us. I'm Joey Wahler. Hi there, Dr. Berger. Welcome.

Daniel Berger, MD: Hi Joey. Thank you for having me.

Host: Great to have you board. So first, we know that colon cancer has a very high survival rate if detected early, right?

Daniel Berger, MD: That's right. You hit the nail on the head. So, colon cancer is a disease that really is silent, for most cases. Usually it doesn't cause symptoms, until the very end. So March is Colon Cancer Awareness month and we're able to really shine a spotlight on colon cancer, what it is and why it's so important to screen early for colon cancer.

And like you mentioned, if we catch colon cancer early, there's really a high survival rate, actually greater than 90% five year survival if caught early. That's really one of the great things about colon cancer screening; the ability to catch colon cancer at an early stage, which allows it to be treated and then also to detect pre-cancerous lesions that allow us to actually prevent colon cancer and really stop it in its tracks.

Joey Wahler (Host): And to pick up on one thing you mentioned there, the fact that it's often symptom free colon cancer, right? And so, especially in those earlier stages, people might be headed down the wrong, so to speak, without even realizing.

Daniel Berger, MD: Right, exactly. So, colon cancer actually starts off as these little polyps, that occur in the colon that don't cause any symptoms. They're usually very small. And over the course of time, those polyps can actually transform into colon cancer. What allows us to stop colon cancer in its tracks is to check for those early pre-cancerous lesions, find them, remove them during a colonoscopy test. And that allows us to really prevent colon cancer from occurring.

Host: So that being said, at what age should most people start getting screened and how does that differ depending upon family history or other risk factors they may have?

Daniel Berger, MD: Great question. So, the current guidelines recommend colon cancer screening for everybody over age 45. What's interesting is that, that guideline was revised in 2021. So up until 2021, the recommendations were age 50. But now we're seeing more and more younger people in their forties and early fifties, sometimes even younger coming in with colon cancer, and we're finding that in younger patients. So the studies were finding this trend and subsequently the guidelines were changed to screen patients at age 45. Aside from that, there are some possible variations in screening age.

So, for example, if a person has a family history of colon cancer, let's say it's a first degree relative, such as a parent or a sibling that had a history of colon cancer; we typically screen those patients at an earlier age, starting at age 40 or 10 years younger than their relative who had it. So if the relative had colon cancer at age, 40, we would screen them 10 years younger at age 30. So whichever one of those two comes first. But those are currently the guidelines for colon cancer screening.

Host: Gotcha. And so when we talk about screening here, the most common screening is of course, a colonoscopy. For those unfamiliar, what's involved in that procedure?

Daniel Berger, MD: So colonoscopy is the gold standard test for colon cancer screening. It's what I recommend to all my patients at age 45 for regular risk patients. Colonoscopy is a procedure. It takes usually on average about 20 minutes. We do it in the GI. Lab office. It's not a surgery, there's no open cutting or anything like that.

It's a procedure where we use a thin camera, that goes through the colon and checks the colon for polyps, which again, are the pre-cancerous growths. If we find those, we can easily remove them right there and then, typically stopping colon cancer in its tracks again. The procedure is very safe. It's done under some sedation, so there's virtually no pain for the patient. We watch patients for about 20 to 30 minutes after the test, and then usually they can go home the same day. We just ask that they have someone that can drive them home. So the test itself is easy, safe, quick, you know, not too long.

A lot of patients may have heard about the bowel prep, which is the day before. So for the colonoscopy procedure, the day before the test, they do have to do a preparation, where they have to prepare themselves for the test. What that involves is essentially changing their diet for the day before and being on a liquid diet really. They can have any clear liquids, just no solid food for the day before. And then in the afternoon or and evening, they do have to drink a laxative that will help flush out the colon to allow us to really look closely and find those polyps that sometimes are very small and hard to see. But that's really, for most patients, a little bit of the challenging part as opposed to the procedure itself, which is, like I mentioned, quick, easy, painless, and really a life-saving procedure, in a lot of cases. So, that's a little bit about the procedure in a nutshell.

Host: And Doc to punctuate one thing you said there, I can attest personally having had multiple colonoscopies to the fact that that prep the day and night before to clean out your system; that's the hard part compared to the procedure itself. Once you're at the facility ready for part two, it's easy street from there comparatively, right.

Daniel Berger, MD: Yeah, definitely. You kind of hit the nail on the head there. LIke I mentioned earlier, the hardest part really for most patients, I would say is doing kind of the preparation the day before. There's a lot of misconceptions, myths, and, rumors about the procedure itself.

But like I mentioned earlier, the colonoscopy test itself is very easy, usually quick, painless, and, that's really, for most patients, the easy part. The day before, it is a little bit of a change from your routine. You know, you do have to change your diet and be on a liquid diet, and then drink a laxative that will help flush everything through.

You know, so it's a, a change from the normal routine. But I would say, you know, for a lifesaving test such as colonoscopy, I a hundred percent think that it's worth it. Because like I've said, you know, this is a lifesaving procedure. Colon cancer is the very common cancer. It's the second deadliest cancer in the country, third most common cancer.

So, the reason why it's still so deadly and so common is because people just are not getting screened for it early enough. So that's why this month we really raise awareness to colon cancer, the importance of doing screening for it. Just like any multiple other conditions, for example, breast cancer. 

We recommend mammograms for that to screen and prevent breast cancer. This is a similar test. To prevent another very common and deadly cancer if it's not caught early. So going back to your original question, I think the test itself, like I said, extremely safe, easy, painless. The day before is a little bit of a change from the routine, but a hundred percent worth it to improve your health and prevent a common and potentially deadly cancer, if not caught early.

Host: A couple of other things here. First, you mentioned earlier that precancerous polyps can also be discovered on a colonoscopy, but you might also, during the course of that procedure, discover some less serious conditions that can be addressed as well as a result of taking a look right.

Daniel Berger, MD: Yeah, exactly. For colon cancer screening, again, the most important thing is checking for those early pre-cancerous polyps and being able to remove them and that stops colon cancer right in its tracks. So that's really what we really kind of emphasize the importance of. But like you mentioned, there are other conditions that we could discover on colonoscopy that could be important to one's health.

For example, the presence of something like diverticular disease, which are common findings that happen usually with time as people get older, people can develop diverticulosis, which are basically little potholes or pockets in the colon. And, discovering that will alert someone to the fact that potentially down the road they could be at risk for diverticulitis, which is when one of those pockets gets infected, and inflamed.

So, there are some lifestyle and dietary things that we can address if we find that. Other things such as inflammatory bowel disease like Crohn's or ulcerative colitis are potentially findings that we can find on colonoscopy. But the big thing that I, again, stress for all our viewers and patients is just having it done for colon cancer screening and preventing colon cancer at the right time. If you're 45, or older and have not had a colonoscopy, I would just urge our viewers to talk to their doctor about it. Because again, it's very important. It's life saving potentially and the, the benefits greatly, greatly outweigh the risks and potential, a little bit of a discomfort or change in the routine the day before.

So, you know, that's what Colon Cancer Awareness Month in March is really all about. Just want to continue to emphasize that.

Host: So in summary here, doctor, you mentioned lifestyle adjustments, diet, exercise is always included in that, of course. So in a nutshell, what's your best advice for any changes people can make in their everyday approach to help try to prevent getting colon cancer in the first place?

Daniel Berger, MD: So lifestyle choices definitely do play a role in our digestive health as well as colon cancer risk. So I like to tell my patients that having a diet high in fiber, so think about whole grains, fruits, vegetables, things that are high in fiber. Those are or have been shown to be healthy for the digestive tract as well as potentially decrease the risk for colon cancer.

On the flip side, red meat, too much red meat has been shown to increase risk for colon cancer, especially red meat, such as processed bacon and sausage. Those are processed red meats that have been linked to an increased risk in colon cancer. Other lifestyle things, you know, smoking and alcohol have been linked to increased risks of cancer in general. So I always tell patients to if, they can, to quit smoking and quit alcohol, because those two are independently, have been linked to increased risk for cancer. And then just having a healthy, active lifestyle. So making sure to stay active. Try to exercise several times a week, increase daily steps with a goal of 10,000 steps per day, just being active, and not, sitting around all day and just keeping your body active.

Those have been shown to again, potentially, allow for decreased risk for developing cancer.

Host: Great advice indeed. Folks, we trust you are now more familiar with the importance of colon cancer screening. Dr. Daniel Berger, thanks so much again.

Daniel Berger, MD: Great. Thank you for having me. 

Host: To schedule your colonoscopy, you can visit sinaichicago.org. Now, if you found this podcast helpful, please do share it on your social media. And thanks so much again for being part of the Sinai Chicago Health and Hope podcast.