Scott Webb: There's been a rise in colorectal cancer over the past few years, especially in people younger than 50, which is why the guidelines for colon cancer screening have changed and many average risk people are now being screened as young as 45. Joining me today to emphasize the importance of colon cancer screening, knowing our family history, and the ease with which we can get screened is Dr. Michael Kaczanowski. He's a gastroenterologist with Foundation Gastroenterology.

This is Your Wellness Solution. The podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb.

Doctor, it's so nice to have your time today. We're talking about colonoscopies and colon cancer and screening, and diagnosis and treatment. So, we have a whole bunch of stuff to cover. Glad to have you here. And with such a growing prevalence of colon cancer cases, sort of alarming really, what are the signs and symptoms that people should be aware of? You know, like what can we look out for ourselves at home?

Dr. Michael Kaczanowski: So, colon cancer might not cause symptoms right away. In fact, many of the symptoms of colorectal cancer can also be caused by other problems like infections, hemorrhoids, irritable bowel syndrome, or inflammatory bowel disease. The general symptoms include a change in your bowel habit, such as diarrhea or constipation or narrowing of the stool that lasts for more than a few days, a feeling that you need to have a bowel movement that's not relieved by actually having one; blood with your bowel movements, which might make it look dark brown or black or even red; cramping or abdominal pain, weakness, fatigue, losing weight without trying. Those are all the big symptoms. It's important to get checked if you have any of those problems because, well, remember, in most cases, people who have these symptoms don't have cancer, but you should talk to your doctor if you experience any of them because you want to find out the cause and treat it.

Scott Webb: This is a little bit confusing one. And I think we were talking about this before we got rolling here, which is that the screening guidelines have changed. And I was telling you that even my primary still thinks it's 50, even though most organizations now agree that 45 for even average-risk people is a good age to start, and insurance is on board with that as well. So, I want to have you go through this. When should we start regular screening, whether we're at regular risk or even higher risk?

Dr. Michael Kaczanowski: You're absolutely right about that. All of our professional societies, as well as the United States Preventive Services Task Force, all agree that for average-risk people, screening should begin at age 45. People at increased or high risk for colon cancer might need to start colorectal cancer screening before 45, be screened more often, and maybe get special tests as well. This includes people with a strong family history of colon cancer or certain types of polyps, a history of inflammatory bowel diseases like Crohn's disease or ulcerative colitis, a known family history of hereditary colorectal cancer syndromes like familial adenomatous polyposis or FAP or the Lynch syndrome as well as people that have a history of radiation to the abdomen or pelvis to treat prior cancer.

Scott Webb: And doctor, are there certain segments of the population that are just naturally at higher risk, whether we really understand why they are? I believe I've heard that certain segments of the population are just naturally at higher risk. Is that right?

Dr. Michael Kaczanowski: That's absolutely true. African American people have a higher risk as do certain Jewish populations. And people with family histories that are concerning for polyps and other cancer syndromes are at higher risk.

Scott Webb: And one of the alarming things, I think we were discussing this earlier as well, is cases of people younger than 45 years old being diagnosed with colon cancer, which is pretty surprising, pretty alarming. So, do we have any sense of why that is? Maybe we can just go over the guidelines as well. Because as you say, if there is a family history of genetics or predisposition, whatever it might be, getting screened early is really key, right?

Dr. Michael Kaczanowski: In general, the risk of colorectal cancer increases as a person gets older with about 90% of cases being diagnosed in those people over age 50. That said, and to your point, the incidence of colorectal cancer in men and women under the age of 50 has steadily increased by about 2% per year since the '90s. And by 2015 or so, there was a 30% increase in colorectal cancer in the 40-year-old age group, and nobody really knows why that's happening. The exact cause of colorectal cancer isn't known. But again, certain risk factors are strongly linked to disease, like diet, tobacco smoking, and heavy alcohol use. Again, those people with certain hereditary cancer syndromes or family history of colorectal cancer have a very high risk of developing the disease.

Scott Webb: Yeah, that's what I was wondering, listening to you there. You know, we try to understand why younger people are being diagnosed with colon cancer or getting colon cancer. And I'm wondering, is it a higher incidence of obesity disease in America? Is it more smokers, drinkers, bad eaters, people just not getting enough exercise? Is it maybe just a combination of those things as we try to speculate a little bit?

Dr. Michael Kaczanowski: I think that's very much the case. It's a multifactorial problem that encompasses all of those risk factors.

Scott Webb: Definitely. And so, we're talking about the screening guidelines and how they've changed. So now, you're speaking directly to patients or prospective patients, doctor, what would be your advice to them? If they've, let's say, gone past 45, gone past 50, and they haven't been screened, or as they're approaching 45, what's your best advice to encourage them to be screened? With the understanding, of course, that we've all heard the horror stories of the prep, how it used to be, you know, really bad, and so many emergency trips to the bathroom. Having had my own colonoscopy, I know that it's not as bad as it used to be. And from an expert here, assure people that the prep is not a reason not to have your colonoscopy, that COVID is not a reason not to go to the hospital to have your colonoscopy. Let's hear it from you, doctor.

Dr. Michael Kaczanowski: Those are all absolutely true. Absolutely don't hesitate to talk to your primary care provider about your concerns and your particular risk factors. There are several different ways to be screened for colon cancer and your primary provider can help you navigate the choices and arrange one that's most appropriate for you. Remember though, colorectal cancer is preventable with screening and also more treatable when found early.

Scott Webb: Yeah, it really is. And I've used this expression before, so I'm sort of plagiarizing myself a little bit, but I sort of think of colonoscopies in particular as kind of one-stop shopping because they are both diagnostic and preventative, right? And I think that that's what people need to understand, is that no one really needs to die of colorectal cancer, but you need to be screened, you need to be diagnosed and they can take those polyps out. You can take those polyps out right at the time, that sort of one-stop shopping approach, which I realize isn't the most medical way of putting it, but maybe you can kind of explain to folks, really the value, even though there are other options, of course, as you say, there are some at-home tests and so on, but really colonoscopies are the gold standard because you're able to sort of one-stop shop, if you will, right?

Dr. Michael Kaczanowski: That's absolutely true. The primary visual test is colonoscopy, which uses a flexible, lighted tube with a camera at the end to look at the entire length of the colon and the rectum. And as you mentioned, what's unique to this test is that if a polyp is found, it can be removed during the test itself, very much potentially preventing a future cancer. In order to do a colonoscopy, your colon and rectum must be empty and clean, so the doctor doing it can see the entire lining during the test. And that's the bowel prep that you are referencing. It's challenging, but very much worth it. You'll be given medicine to relax. You'll even sleep through the procedure. You'll need a ride home afterward. But if you're of average risk and nothing abnormal is found, you won't need another colonoscopy for ten years.

Scott Webb: Yeah. That's the important takeaway. Yeah, I was a little apprehensive about the prep for me. But when you find out on the other side of it because most people don't have colorectal cancer, right? So, you find out that you're good and you don't need to be seen again for ten years, it's just this huge win. You know, you're sort of celebrating on the way out, on the way to the car. So, doctor, thanks so much for your time today. Really appreciate your expertise and your time and your compassion and you stay well.

Dr. Michael Kaczanowski: Oh, thank you so much for having me. And for more information, go to SNHhealth.org. If you enjoyed this podcast, please be sure to tell a friend and share it on social media. This is Your Wellness Solution. The podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb. Stay well, and we'll talk again next time.