Evo Terra (Host): Colorectal cancer is the second deadliest cancer in the United States, yet it's one of the few cancers that's preventable, thanks to screening. Let's talk about the importance of getting screened with Dr. Jason Glass, a Gastroenterologist at San Juan Health Partners Gastroenterology.

 This is Celebrate Health from San Juan Regional Medical Center. I'm Evo Terra. Dr. Glass, welcome to the program.

Jason Glass, MD: Hey, thanks for having me.

Host: Before we get to talking about screening, Dr. Glass, tell us a little bit about this specialty of yours. What types of issues does a gastroenterologist treat?

Jason Glass, MD: So we treat the gamut of things in the intestines and your guts, really, from your swallowing pipe to your stomach, your small intestines, and then your colon, so the tube that runs from your mouth to your bottom. We deal with that, and then we also deal with the organs in your abdomen, like your liver, your gallbladder, your pancreas.

So we deal with kind of the acute and chronic problems with those organ systems.

Host: I know that a lot of doctors, when they enter medical school, they know exactly what they want to treat and what they want to get into later on, but how about you? How did you choose gastroenterology as your specialty?

Jason Glass, MD: It was kind of a journey. So when I first started doing my clinical rotations in medical school, I actually really took a liking to surgery. I liked the procedural aspect of surgery, but I felt like, surgeons, I love the surgeons I work with, but, they're in the operating room most of the time and I wanted to spend time with my patients.

So I ended up doing internal medicine, which is just the big bucket for all the diseases. They kind of have to take care of everything and they're not very procedural, so I gravitated towards gastroenterology because we do get to take care of chronic diseases and we do get to do procedures.

So it kind of melded those two things together. And going into medical school, my father was actually diagnosed with colon cancer. He was diagnosed by a gastroenterologist and that kind of put that thought in my mind going into my training. So I ended up here.

Host: That makes perfect sense to me. So let's let the folks at home know, why might they need to see a gastroenterologist like yourself?

Jason Glass, MD: So there's a lot of different things. The kind of average ache and pain that you feel in your belly, maybe some of the loose stools, if those sorts of things aren't going away over several days to weeks, that's something that you might want to talk to your primary care doctor and they might send a referral to us.

Things like trouble swallowing, that's another thing. Diarrhea that is not going away, unintentional weight loss, I know that we all kind of want to lose weight but when it's kind of becoming a problem, that's when you might want to be seen by a gastroenterologist. And if you want to get your colon cancer screening with a colonoscopy, that's another big one.

Host: Right, right. Yeah, that was my first treat into seeing a gastroenterologist when it was like, hey, you're over 50, it's time to do that. But let's talk about that. This is the entire topic we want to get into right now so who should get these annual colon screenings? Don't just take my word for it people, listen to the doctor.

Jason Glass, MD: Yeah, so the gastroenterology community has been really trying to push at least this month and push screening for colon cancer for a few reasons. One is if you look at the CDC's report, they want 80 percent of the population that's eligible for screening to get screened.

Currently, we're probably around 69%. And people eligible for screening, if you're average risk, which is someone that has no family history of colon cancer, so your parents, brothers, sisters, children don't have colon cancer, the age to start screening is 45. And that is new as of a few years ago. The professional guidelines changed from 50, people have probably thought 50 is the age of screening, but now it's 45.

And the reason for that is because there's been a troubling trend where patients age 20 to 49 have an increased risk of colon cancer, and that rate is increasing.

So, a lot of these professional guidelines have decreased the age from 50 to 45 to try to catch those patients earlier.

Host: So anybody basically over the age of 45 today, but as you have noted that number may slide down further, even without a case of history of cancer in the family. It's just, if you're over 45, what the current recommendation is, and you haven't had your colonoscopy, you should get a colonoscopy. Is that fair statement?

Jason Glass, MD: That's a fair statement, but colonoscopy, as a gastroenterologist, I would say is the best screening, but others would say, and I agree with this statement, that the best screening test is the one that actually gets done. So, I mean, a lot of patients have a lot of reservations about having their colonoscopy for obvious reasons.

They have to take a day off of work. They have to drink a big gallon of laxative to clean themselves out. They have to get anesthesia. So all these things, albeit they're low risk, they are risks and they can be very inconvenient. So there are a lot of other options out there for colon cancer screening that people might not know about. The best ones that are studied are stool based tests, and historically doctors that, we're using these little cards called fecal occult blood tests, and there's a lot of good data for that, but they're a little outdated and they have a lot of false positives, so they can be positive if you have hemorrhoids, they can be positive if you're eating things that are high in iron. There's these newer tests, there's two of them that are approved right now for colon cancer screening. One's called the Cologuard, and you may have seen that on TV. It's a little box, you just apply for it, they send it to you in the mail. It's all done at home, you send it back, and if it's negative, then you're good for about two to three years.

And then there's another test, it's called the FIT test, and that one, you have to do it every year. The caveat to those is that you have to be average risk, you can't have a history of polyps. I'll talk about polyps a little bit later. And if you have a positive one of those, then the recommendation would be to get a colonoscopy.

There are a lot of other options out there too. I think those are the most common ones that we know about and at least available to us in our community, those are the most readily available.

Host: Let's talk about those polyps. I know that, when I got my colonoscopy, there were a couple of polyps found, which put me in the five year club. So, what do polyps mean? Is it a death sentence or anything horrible like that? Tell me, what are we looking for in there?

Jason Glass, MD: So, generally, polyps are completely benign and nothing to worry about. What is polyp? A polyp is a little benign growth. So our colon is lined with this wall of cells. And they're constantly doing a ton of work, these cells, you know, reabsorbing nutrients and whatnot. And so when cells do that, they turn over a lot, they have a life cycle.

So they're born, they live, they die, and then they shut off. Cancer, just getting into a little cancer biology. When cells are kind of constantly turning over, there's a lot of room for error. We have a lot of machinery in our cells that help repair those things, but over time, and if we're not treating our bodies right, or if you have genetic problems or predispositions, those cellular machinery can miss these errors and then they can start, these cells start growing kind of uncontrolled.

So a polyp is sort of like that. It's a little bit of uncontrolled growth, not completely cancer. They are pre cancerous and we know that if a polyp is kind of just left in the body for a long time, that polyp can turn into cancer and that interval that scientists have found to be around 10 years.

So if you've had your colonoscopy and you're like, oh, you're good for 10 years, that's the reason why it's a polyp, usually the life cycle from a polyp to a cancer is 10 years. So we're hoping that we can get the polyp before it does that.

Host: And the whole idea here is getting an early warning, finding out something may or may not be wrong ahead of time because that way we have time to treat it early in the stages. Am I the right path here?

Jason Glass, MD: That's absolutely right. So we see a polyp, we take it out. We know that when we take polyps out, we know that we reduce the risk of colon cancer. That's been studied and it's very well validated. Same thing with those, stool based tests. We're hoping to detect a little microscopic blood particles or little DNA particles that might be part of a polyp or a cancer

and hopefully we detect it early enough to either prevent cancer or detect a cancer that is in a lesser stage.

Host: Right, right. Early detection is the key. Transitioning possibly a bit here. I heard that your clinic now has a grant for two, what they call GI genius machines. What are those? And I'm assuming they're not AI. So how are they helping patients?

Jason Glass, MD: So, it actually is a form of artificial intelligence and machine learning, but, I applied for a grant and it was a partnership between Medtronic, which is a big medical technology company and Amazon, and they're donating these GI Genius machines to places that are generally underserved populations. And so what this machine does is during the colonoscopy, in real time, it'll put a little box around something that it thinks or sees is a polyp.

And it might find polyps that you may miss, just from the naked eye. And this technology has been shown to increase the detection of pre cancerous polyps, compared to not having this technology present. So it's a really cool and exciting piece of technology we have.

And it's nice that we have it in our community. As if you get a colonoscopy and you have this technology, which we do, you might get more bang for your buck in terms of getting the polyps out.

Host: Yeah. That extra set of eyes and artificial eyes at that, that the doctor can then look at and go, Oh, why as a matter of fact, that is interesting. That is quite fascinating. I'm sure that will have a marked impact on the community. Dr. Glass, thank you for all of the information today. It was incredibly helpful.

Jason Glass, MD: Thanks so much for having me.

Host: Once again, that was Dr. Jason Glass, a Gastroenterologist at San Juan Health Partners Gastroenterology. To learn more, visit sanjuanregional.com/gastroenterology, which is not so easy to spell. So that's San Juan J-U-A-N regional.com/G-A-S-T-R-O- E-N-T-E-R-O-L-O-G-Y. And if you found this podcast episode helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

I'm Evo Terra, and this has been Celebrate Health from San Juan Regional Medical Center. Thanks for listening.