Scott Webb: Colorectal cancer is almost entirely preventable if we get screened early. And though colonoscopies are the gold standard, there are some at-home screening options that may work for some of us. I'm Scott Webb, and joining me today to discuss the various screening options, when we should be screened, and what we can do to help ourselves prevent colorectal cancer is Dr. John Flannery, Jr. He's a colon and rectal surgeon with Colon and Rectal Surgery of New England. This is Your Wellness Solution, a podcast by Elliot Health System and Southern New Hampshire Health, members of SolutionHealth. I'm Scott Webb.

Doctor, thanks so much for your time today. I know that colonoscopies are considered to be the gold standard for screening for colorectal cancer, but it's great to have an expert on to go through all of this, both for me and for listeners. Let's just start here. What is colorectal cancer and who does it affect the most?

Dr. John Flannery: So colorectal cancer is a cancer or malignancy of the large intestine or the rectum. It affects both men and women with almost equal frequency. In fact, it's the second leading cause of cancer deaths in the US for both men and women combined. Approximately 140,000 new cases in the US this year will be diagnosed. And unfortunately, approximately 56,000 people will die from the disease, surpassing both breast and prostate cancer. In terms of risk for colorectal cancer, the general population faces a lifetime risk of about 5% for developing the disease. And for someone who has a positive family history, meaning a first-degree relative like a sibling or parent, the risk is 10% to 15%.

Scott Webb: Yeah. And the thing about colonoscopies and what I love most about those, and I've certainly had mine, being 53, is that they both are diagnostic and preventative. It's a little bit of a one-stop shopping, and we're going to get into the options available at home as well. But I want to ask, do people actually have any symptoms if they have colorectal cancer? Is there anything we should watch out for? When should we specifically call the doctor?

Dr. John Flannery: The most common symptoms are blood in or on the stool, rectal bleeding, a change in the bowel habits, meaning constipation or diarrhea, stools that become narrower than usual, weight loss for no apparent reason, abdominal pain, and constant tiredness or new fatigue during an activity that typically was previously tolerated. Certainly, if any of those symptoms persist for more than two weeks, it warrants an evaluation.

Scott Webb: Yeah, that does seem like a good time to reach out at least to our primary or possibly if we can skip over and get right to someone like you. So, let's talk about the screening options. I've talked about colonoscopies a few times, and I know many people have heard sort of the horror stories of the prep, which I know is so much better. So I want to have you as an expert to take us through all the screening options and, if we choose an at-home screening option, how effective are they?

Dr. John Flannery: So, as you mentioned, the colonoscopy is certainly still the gold standard because if there are polyps, they can be removed at the time of the procedure. God forbid there is a cancer, it can be biopsied to document the disease. But yes, the downside is the bowel prep. But there are different preps now, and some of them are much more tolerable. And they're not nearly as bad as they were, say, 20 years ago. So, a colonoscopy is still the gold standard, but there are certain home tests that are available. The newest one that people probably see on television is the Cologuard test, which is a test for the DNA of polyps or colon cancers. And that's where a stool sample is sent and sent off to the lab. And it's actually a very good test. That's recommended every three years, whereas the colonoscopy would be every 10 years.

There was also a CT colonography, which is a CAT scan. That's fallen out of favor. A lot of insurance doesn't cover it anymore, and that is a test that requires a CAT scan. But the two other home tests are looking for fecal occult blood in the stool. One is an immunological test that uses antibodies to detect blood in the stool. And that's slightly better than the one that uses a chemical called guaiac to detect blood in the stool. And those are basically recommended yearly if you're not going to do a colonoscopy.

The last two stool tests that I mentioned, the immunological and the guaiac fecal occult blood tests, are not as sensitive as the Cologuard, the DNA test. There are some other tests that really aren't used much anymore. So, I won't go into detail on those.

Scott Webb: Yeah, let's talk about the screening guidelines, right? It used to be that 50 was kind of the marker, unless you had a family history, genetics were involved, things like that, at higher risk basically. But now, it seems like the screening guidelines have changed. People are getting screened earlier, perhaps as early as 45 or younger, and insurance, of course, is playing ball. So, maybe you can explain that. I'm sure there's a little bit of confusion.

Dr. John Flannery: The greatest significant chance for developing disease is between the ages of 40 and 50. So the American Cancer Society, the American Society of Colorectal Surgeons, and the American College of Gastroenterology are now recommending screening for the average risk person starting at age 45. Certainly, again, if there is a family history, those screening guidelines would be sooner. Typically, if there's a family history, the recommendation would be starting at age 40 or 10 years before that family member was diagnosed. The bottom line is that with regular screening starting at age 45, 80% to 90% of colorectal patients are cured if their cancer is detected and treated at an early stage. And that's the rationale for jumping up the age of screening.

Scott Webb: Yeah. It's great to hear that all the organizations are on the same page. Insurance is right there with us. And as we know, as you're saying, early screening, early diagnosis, early treatment is so key. People just don't have to die of colorectal cancer, especially if it's detected early and treated early. Is there anything we can do to prevent colorectal cancer? I know we can't get away from our family history and genetics, unfortunately, but is there anything specifically in terms of behavior and lifestyle that we can do?

Dr. John Flannery: So, the risk factors, The first one is age, as I've already mentioned. As I said, the incidence increases significantly between the ages of 40 and 50. Smoking, just like for many other cancers is a risk factor. Excessive alcohol consumption and then consuming significant amounts of red or processed meats is a risk factor. There are carcinogens generated in the cooking process, and that can lead to the development of colorectal cancer. Obesity and a sedentary lifestyle are certainly risk factors. And then in terms of ethnicity, African-Americans are at the highest risk of all ethnic groups for developing colorectal cancer, but it's not clear whether that's a biological factor or if it's due to lower screening rates in that population. But those, in general, are the major risk factors for colorectal cancer.

Scott Webb: Yeah. And we, as patients and, of course, doctors and nurses, are patients too; it's always good to know that there are things that we can do. There are things within our control. As I said, we can't get away from our family history, but knowing our family history and sort of respecting that and acting accordingly and then making the best choices we can in terms of behavior, lifestyle, weight, drinking, smoking, all of that stuff. Good to know that some of this stuff is within our control. And, doctor, really educational today. As we wrap up, what would be your takeaways for folks who maybe didn't get screened during COVID for fear of going to the hospital or whatever the reasons might be? In your words, why do we all need to be screened? And why is it so important that we be screened early?

Dr. John Flannery: If screened early, the cancer is detected early. Again, 80% to 90% of those patients can be cured. And that translates to probably 40,000 or more lives that could be saved annually through screening and early detection. When cancers are detected late, stage III or stage IV, the cure rate drops to 50% or less. So those preventative measures, again, don't smoke, consume alcohol and red meat in moderation, exercise regularly, and get your screening done, so if, you know, there is a cancer that's detected early, it's curable.

Scott Webb: Yeah, great advice from an expert today. Thank you so much for your time and you stay well.

Dr. John Flannery: Okay, thank you very much.

Scott Webb: 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.