Bill Klaproth (Host): Of all cancers affecting both men and women, colorectal cancer, cancer of the colon or rectum, is the second leading cause of death from cancer in the United States. Fortunately, the death rate for colorectal cancer is declining and one reason for this decline is an increase in preventive screening. Here to talk with us about colon cancer screening, the benefits and newest guidelines is Dr. Christopher Bach, a gastroenterologist at Tidelands Health. Thank you so much for your time today. First off, can you tell us about colon cancer? Who is at most risk?

Dr. Christopher Bach (Guest): That's a great question. In the general population, about one in ten people are at risk of developing colon cancer. We know that with increasing age, our risk increases, so we usually begin screening at around 50 years old because that's when we start to see the first signs of colon cancer in the form of colon polyps.

Bill: You mentioned age. Does genetics play a big part in this as well?

Dr. Bach: Yes. In the general population, it's one in ten, but if you have a family history of colon cancer in your family, your risk for colon cancer is increased, depending on how many family members are affected, but certainly, genetics do play a role in the development of colon cancer.

Bill: If someone does have colon cancer in their family and is at increased risk, at what age do you start screening them?

Dr. Bach: We usually recommend that a family member begin screening for colon cancer 10 years before that affected family member with colon cancer was diagnosed. For instance, if your father was diagnosed at the age of 55 with colon cancer, you would begin screening at 45 years old.

Bill: What are the overall benefits of getting a colonoscopy?

Dr. Bach: I would say in the holiday season is nice because you lose a little weight. The benefit overall long-term is actually preventing colon cancer. In the ideal state, a colonoscopy can actually remove pre-cancers, so remove polyps before they have the chance to become cancer, or even worse, become cancer and spread to other organs.

Bill: You just mentioned polyps. Can you tell us what that is and what that means if one is found?

Dr. Bach: If you think about normal colon mucosa, if there's a genetic mutation in that tissue, whether it be from environmental exposures like smoking like a lot of red meat or just from a history of colon cancer, that genetic risk increase, you get a mutation in the DNA of that tissue and that will form an abnormal growth of tissue and that abnormal growth is called a polyp. We know that polyps are an increased risk that tissue is at an increased risk to become cancer, which is defined as a spread of that growth past the lining of the colon.

Bill: Just because you find a polyp, that doesn't automatically mean it’s cancer, right?

Dr. Bach: Absolutely, that’s correct.

Bill: Then if you find a polyp, you go in and you do a biopsy of that polyp to see if it is cancer or not?

Dr. Bach: Absolutely. When we find polyps, we remove them. We remove it in its entirety, therefore removing the risk.

Bill: Are there other screening options besides colonoscopy?

Dr. Bach: Yes. There are a bunch of different tests that we have available. Probably the least invasive, there are stool tests, which tests for either DNA mutations that are found in colon cancers, and that's called a Cologuard. The other tests available tests for just blood in the stool, so a more sensitive test but not very specific to colon cancer or colon polyps. Those are our stool tests, and there are also radiographic tests like the barium enema, which uses contrast dye that is put into the colon to see whether or not there is colon cancers or colon polyps. Finally, CT colonography, which uses a CAT scan, what we would call a virtual colonoscopy, to determine whether or not there are any polyps or cancers within the colon. I should note that all these tests that I mentioned, they're less invasive, but if they're positive in any way, the next test is a colonoscopy to go ahead and either biopsy or remove what is found to be abnormal during that test.

Bill: Why would you choose to do one of these other screening methods instead of going right to the colonoscopy, which is the gold standard, right?

Dr. Bach: Absolutely. I think patients with a lot of other illnesses who have an extensive history of heart disease, have had a lot of heart attacks, poorly controlled diabetes or COPD, the risk of undergoing a colonoscopy is higher than the general population – it’s something to consider in terms of a less invasive test. In fact, if you are positive on the less invasive tests, a colonoscopy can be considered, but as you pointed out, the colonoscopy is the gold standard.

Bill: I get a lot of gnashing of teeth when I hear people talk about ‘I've got to go get a colonoscopy, I can't believe I've got to do this thing.’ Can you tell us exactly what it involves, and then prep, which seems to be the big thing that people don’t want to go through? Tell us about the actual procedure and the prep because it’s not that bad.

Dr. Bach: A lot has changed over the years and at the end of the day, it’s still going to require you going to the bathroom a number of times. It is a laxative prep, but the amount of fluid or the amount of medication laxatives that you need to take is actually decreased to just about a point of fluid, so about 16 ounces on average – that’s improved on the gallon it used to be. Once you’ve prepped for the colonoscopy, which is usually the day before the colonoscopy, the day of is just nothing to eat until the time of procedure, and the procedure itself only takes about 20 minutes. Everyone is completely asleep. We use a medication called Propofol, which is full sedation so no one wakes up during the procedure, and you wake up pretty quickly after the procedure once we've stopped giving you the medication. During the procedure, we're just taking a look throughout your colon and looking for these abnormalities and it's completely painless. As an added benefit, people wake up well rested, so that’s one of Propofol anesthesia. It's really not that bad.

Bill: I've had one done. It was easy, and you're right. They put a nice blanket over you, the doctor starts talking to you, but also you wake up and it's done and over. Just get it done. This disease is so preventable with a colonoscopy. I've said this to my friends before. You're not allowed to get colon cancer because the testing is so good – just go get it done. Lastly, can you tell us about nutrition and diet? Are there any tips for keeping our colons healthy?

Dr. Bach: We know from a lot of studies that we've done in terms of nutrition and colon health that the best thing to keep your colon healthy in terms of being regular as well as decreasing the risk of developing polyps and cancers within the colon would be a high fiber diet. At least two to three servings of either fruits or vegetables per day. Probably the worst thing for the colon are two things, smoking which is bad for a lot of things, and then red meat, and that would be eating red meat more than two times per week as being excessive, but we do know that red meat itself increases the risk for colon cancer and colon polyps.

Bill: Lay off the burgers. Why should someone choose Tidelands Health for their gastroenterology needs?

Dr. Bach: I think that we have put a lot of time and effort into having a very comprehensive approach to everyone’s digestive health, whether it be liver disease or trouble swallowing, acid reflux, belly pain and of course colon health in the form of colonoscopies. From our nurse practitioners to our doctors to all our staff, we really do care about our patients and want to do the best job for them.

Bill: Thank you again for your time today. For more information about Tidelands Health physicians, services and facilities, visit tidelandshealth.org. That’s tidelandshealth.org. This is Better Health Radio with Tidelands Health. I'm Bill Klaproth. Thanks for listening.