Carl Maronich (Host): Welcome to the Wellness First Podcast, the St. Joseph Hospital Podcast, where we hear and learn directly from the experts on all things health and wellness. I'm Carl Moronich and today's topic is colon cancer, which is one of the most preventable and treatable forms of cancer, yet, far too many people skip the screening that could save their lives.

Today we'll be talking with Dr. Annette Tobar, our gastrointestinal specialist with St. Joseph Hospital, to talk candidly about the risks, the signs, myths, and must knows surrounding colon cancer, from understanding when to get a colonoscopy to the truth about rising cases in younger adults. This conversation is all about empowering you with the facts and removing fear because when it comes to your health, knowledge is power.

Doctor, welcome to the podcast.

Annette Tobar, MD: Thank you.

Host: We're going to be talking about colon cancer, so maybe we'll start with defining exactly what is colon cancer and how does it develop?

Annette Tobar, MD: So colon cancer is a cancer of the colon, which is the large intestine. It is one of the leading causes of death in the United States in both men and women, with over 150,000 cases diagnosed per year. It's a malignancy. It starts as what we call polyps in the colon, which are abnormal growths in the colon that progress through cellular changes to turn into a malignancy.

So the development is from, typically it's from different types of polyps. There's certain genetic syndromes that are can predispose patients to the development of colon cancer.

Host: Yeah. And what would some of the common symptoms be that someone should be looking for and let them know there could be an issue?

Annette Tobar, MD: So that is a great question and that is the reason we recommend colonoscopy, is the majority of colon cancers are asymptomatic. For patients who do develop symptoms, we can consider things like bleeding, abdominal pain, weight loss, a loss of appetite, or even anemia. Those are some of the more common symptoms, but typically by the time we see symptoms, we worry that the cancer may be further advanced, which is why we feel strongly about screening colonoscopy and starting at ages determined knowing the natural history of the disease.

Host: Yeah. So talk about age a little bit. When generally should folks get their first colonoscopy? And as we mentioned in the intro, we're hearing that there are rising cases among younger adults. So maybe talk a little about the age factor and when folks should really start considering a colonoscopy.

Annette Tobar, MD: More recently, the age of screening for colon cancer has been lowered to 45. I think the more well known age is 50. We are seeing colon cancers in younger patient population, which is why this was lowered. The definition of average risk means not having a family history of colon cancer or polyps, or having a personal history of colon cancer or polyps.

So that patient population we recommend at the age of 45. If there are any known genetic syndromes within the family or family history of colon cancer or polyps, then it's a discussion to be had with your doctor because it could lower the age at which we would recommend starting screening.

Host: We've mentioned colonoscopies. Are there other forms of screening that folks may be able to take and that, that you might recommend or would have a little conversation about?

Annette Tobar, MD: There are. I'm biased because I do colonoscopy day in and day out. I know what I see. Colonoscopy is the gold standard for examining and screening for colon cancer, examining the colon and screening for colon cancer. There are other tests. These are stool-based tests that look for blood or even DNA that you would see in patients who would've polyps or malignancy. These tests are an alternative. Like I said, I feel colonoscopy is the gold standard. It's forward view of the lumen within the colon. You're going to be able to see in real time what is happening. If there are any polyps they can be removed at that time. And that is part of the prevention of colon cancer is moving, removing these polyps before they advance.

Host: Now if you were to not get a colonoscopy, go with the other type, it seems like oftentimes you're going to say, well, there may be something, get a colonoscopy. So it's going to come back to that oftentimes. So, it seems like that might be the logical place to start with a colonoscopy.

Annette Tobar, MD: That is my recommendation. If patients feel truly adamant about not doing colonoscopy, and we can understand why, it's a more invasive exam. It requires a prep, then the other alternatives should be offered. But it's with the caveat that they're not as sensitive at detecting polyps, so they're not as good for preventative.

And I think they provoke a little bit of anxiety if these tests come back positive and they have to then proceed with the colonoscopy. Which could be avoided, but I would, again, I would understand why different folks choose to approach this differently.

Host: How effective are screenings in preventing colon cancer and catching it early?

Annette Tobar, MD: They're very effective, which is why the societies, have come together and made these recommendations knowing the natural history of colon cancer, preventing it I mean, it lowers mortality associated with colon cancer. And that is why insurance companies will cover it. It just, it's seems more cost effective even for patient care.

Host: As you mentioned, you do these a lot. You're involved, this is your line of work. What common myths or misconceptions do you run into with patients around colon health and colonoscopies?

Annette Tobar, MD: So with everything else, we're about our natural or daily lives. If we feel well, we don't think anything is wrong. And I think that's some major misconception. Patients find it hard to believe that they would even have polyps or advanced polyps or even colon cancer because they're feeling well. And like I said, they're asymptomatic.

So that's the biggest misconception or myth that I would present to a patient because we would hate to miss something. The other thing is not having a family history, you know, it doesn't run in my family and that's something that patients might rely on and have a missed opportunity of having screening for colon cancer.

Host: Yeah. Now if someone is getting 45 older and thinking about, I need to get a colonoscopy, do they need to get a referral from their primary care provider first or can they directly call the office and schedule themselves?

Annette Tobar, MD: Typically it's by referral from the primary care. If patients are established with us for other reasons, we can also follow up on that and place a referral ourselves. But typically it's through the primary care.

Host: Very good. So, which people should be doing regularly, they should be seeing their primary care doctor, as you said, a lot of things are asymptomatic, so they should be seeing their doctor regularly to try to avoid those things. Lifestyle. Are there any things folks can do from a lifestyle perspective that might reduce their risk or at least better, their chances of when it comes to colon cancer and colon health?

Annette Tobar, MD: Yes, absolutely. So genetics play a big part in colon cancer and you can't change that. That's not with the expectation, but I do recommend my patients not smoke. Smoking across the line is associated with malignancy, many malignancies. I recommend my patients avoid being sedentary, remain active, avoid obesity.

 Other things that could be avoided are alcohol. But those are the major ones. And then you could argue processed and red meats.

Host: So a lot of those are just common sense healthy endeavors that we should all be following, but, oftentimes they get away from us, so good reminder of all those things. Fear, you mentioned earlier, some folks don't get a colonoscopy because they're concerned, they're fearful what it might find. And how do you speak to patients regarding their fear when it comes to colonoscopy?

Annette Tobar, MD: Patients will often come and try to meet us before having a colonoscopy. I think they appreciate meeting with a physician before. They get a lay of the land of the hospital. They can meet with us and have all their questions answered which is really great.

It's not uncommon that day of, we're in the room, we're ready to go, and the patient says, I'm nervous and my line has been for a while, I say, well, I'm not nervous. And it makes them laugh. It calms them down a little bit. I'm very conservative and I tell the patients this is what the plan is going to be.

The goal is to do this safely, get around the colon, take a look on the way out. If I meet any resistance, we stop. There's a way to do this and get through it effectively and safely. And I try to reassure my patients that's what we're going to do. And I think that does calm them down or make them feel more at ease.

As far as the prep, that's anxiety provoking for many patients. And understandably they can become dehydrated, but it's something that we can talk through particularly if they come see us before the procedure.

Host: Being reassuring always helps be it a colonoscopy or doing a podcast. And doctor, you did a great job with this podcast. Any, anything we didn't mention that you want to make sure we do?

Annette Tobar, MD: I think a big part of it is establishing care with primary to not only talk about this, but overall health. I think it's not uncommon that patients, the family history is not teased out well and it's a missed opportunity for potentially starting sooner in some patients that may need to have colonoscopy sooner.

Host: Very good. Well, doctor, you mentioned you do a lot of colonoscopies. I do a lot of podcasts, and you were a tremendous guest today. You did a great job.

Dr. Annette Tobar, gastrointestinal specialist with St. Joseph Hospital. Thank you so much for being with us.

Annette Tobar, MD: Thank you.

Host: For more information, visit the St. Joseph Hospital website@stjosephhospital.com.

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