Dr. Bob Underwood (Host): Welcome to UK HealthCast, a podcast presented by UK HealthCare. I'm Dr. Bob Underwood. Early detection of colon cancer can dramatically improve survival rates, but sometimes there are barriers to screening. Today, on UK HealthCast, we're talking to colorectal cancer surgeon, Dr. Avinash Bhakta, to discuss colon cancer screening and how the UK Markey Cancer Center is expanding screening capabilities and options. Dr. Bhakta, thank you for being on UK HealthCast.

Dr. Avinash Bhakta: Thank you so much for having me and thank you for spreading the news of this very important topic with colorectal cancer being one of the top five leading causes of death in the nation.

Host: Yeah. It's incredibly important. So, can you talk about kind of the current state, like trends in diagnosis, available treatments and public awareness, and understanding of cancer screening in Kentucky and the surrounding area?

Dr. Avinash Bhakta: I'm going to start with that last part of the question first because I think that will be a good transition to the current state. But historically, our commonwealth was very low in screening for our population, which back in 2002, we were trying to screen everybody at 50 unless they had a high-risk feature. We were 49th in the nation back in 2002. And so, there's a few people in Kentucky CancerLink, I kind of want to give them a huge shout out, that they really took this upon themselves and had some grassroots movements, got our eastern Kentucky population involved. And we went from 49th in the nation back in 2002. And in 2016, 2017, and 2018, we're now at 16th and going into 15th in the nation in screening all appropriate individuals that meet criteria. And that age range has gone down to 45. As you know, there's a huge early-onset colorectal cancer. And so, that age range now is 45, and we're still doing great with our screening.

Host: So, why are screenings so crucial?

Dr. Avinash Bhakta: The screenings are crucial because that's how they avoid seeing me. I always tell my patients the less of me that you see, you don't wake up and say, "I want to go see a colorectal surgeon today." That's usually not something that someone wakes up to say. And so, the screenings really are what can help prevent colon cancers from developing if we can catch the polyp or the abnormality early enough.

Host: And so, you're saying that those screenings, I mean, Kentucky has made some huge advances if they've moved from where they were to what you just described. Looking at being 15th in the nation in terms of screening, that's great advances.

Dr. Avinash Bhakta: And that's all a testament of our one commonwealth, like we're all on one page here, even though I work at Markey Cancer Center at the University of Kentucky. My goal is to make sure that everyone in this commonwealth has appropriate standard of care, has appropriate access to these screening colonoscopies to help our goal of eradicating colon cancer in my lifetime.

Host: So, for those who don't get screened, what tend to be the barriers to colon cancer screening for most people?

Dr. Avinash Bhakta: By far the biggest barrier to getting screening, especially the screening colonoscopy, is the need to usually take off a day of work to do the bowel prep beforehand. And then, the stigma of the actual colonoscopy itself, which even though we've gotten so great at it, we've gotten with moderate sedation, with anesthesia, you don't remember anything, you're usually out of it when you're getting your colonoscopy. And so, all those things are helpful, but I still think that stigmata and the need for that kind of two days of being off of what you need to do in order to survive in this world, which is your livelihood. I think that's the biggest barriers that I see in my patients.

Host: I would agree with the patients that I've taken care of as well. And so, we have something unique to talk about, and that's the new FDA-approved Shield test. And so, can you tell us a little bit about that?

Dr. Avinash Bhakta: I think the Shield test, it's very early in its onset. The ECLIPSE study found that it had a good specificity for finding colorectal cancer, but it didn't really do that great of a job at the screening for pre-cancerous lesions. So, I want to make sure our listeners are very cautious in that this is a blood test. It's pretty non-invasive, and it's a good stepping stone to what's going to hopefully come down the pipeline.

So, I think it's going to be great. I don't recommend it to a lot of my patients right now because most of the time I see the cancers already. But I want to make sure I caution all of our listeners is that it's a great initial test, but if you were having symptoms of any changes in your bowel habits, rectal bleeding that's not due to hemorrhoids in nature, and any other kind of concerning features, and especially family history, I would really say, "You know what? We should have a serious discussion about getting that colonoscopy done just to make sure we're not missing anything."

Host: So, you kind of highlighted specifically who are the patients who benefit most from this and who it's not for. And you're saying people with past medical history, family history, or aberrant rectal bleeding that they can't otherwise explain, that you can't attribute to something, that you wouldn't recommend this for them.

Dr. Avinash Bhakta: That's a great summary, Dr. Underwood. And I think if I could, I would highlight exactly what you said. That's perfect.

Host: So, who would benefit from it then?

Dr. Avinash Bhakta: Those that are average risk for colon cancer development, so those without that past medical history, those that we have a low suspicion would have any type of colorectal cancer are the ones that I would recommend for the DNA FIT testing as well as the Shield test as well.

Host: Good information to know. Dr. Bhakta, who do you think's really going to benefit from this Shield test screening?

Dr. Avinash Bhakta: I believe that the people that are going to benefit from that Shield test are the ones that we suspect with early-onset colorectal cancer. So, they don't necessarily fit into that 45-year age range where we have the current recommendations for getting a screening colonoscopy, but they're earlier, they're in their 20s to 30s, and they have some sort of rectal outlet bleeding or change in their bowel habits that we can't necessarily pinpoint a real reason for, but that they're also hesitant to maybe get that screening colonoscopy done. I think this test would benefit those patients and that population the most.

Host: Got it. This new-onset colorectal cancer is really kind of a baffling phenomenon to sort of have something, that allows us to get that level of screening done, I think, is a wonderful advancement as well.

Dr. Avinash Bhakta: It's sad, but there's not a week that goes by in my cancer clinic that I don't see a patient in their 20s or 30s that get referred to me with an advanced colon cancer. And so, I think our next hurdle is that we're doing such a great job with screening the appropriate age population. But we're still catching up now with the patients that don't meet that age criteria to see what we can do to catch them before they present with later stage cancers. And so, this blood test, I think, is going to be a huge stepping stone in that endeavor of ours.

Host: So, the UK Markey Cancer Center is the only National Cancer Institute designated comprehensive cancer center in Kentucky. So, what does that mean for the patients in Kentucky or in the surrounding area, either with colon cancer or for those who might be at risk?

Dr. Avinash Bhakta: That designation is huge for our commonwealth and for the patients that we serve in Kentucky. That allows us to ensure that we're at the cutting edge for newer treatments for all cancers, that we are allowing our patients that are afflicted with cancers the opportunities to enroll in clinical trials that they may not have previously been qualified for.

And I think from an epidemiologic perspective, it really allows us the opportunity For the outreach into our rural communities, like where you are, Dr. Underwood, New Mexico largely rural, so is Kentucky. And a lot of our patients can't necessarily make that trip all the way up to Lexington to get cancer care at Markey or one of our other sister affiliates in Lexington.

And so, this NCI designation allows us the outreach to the local hospitals to ensure that those patients are still getting the standard of care and to ensure that there's no other recommendations that we would have as their kind of support system with the NCI designation that we would recommend to them.

Host: It's about access to care in so many ways.

Dr. Avinash Bhakta: Absolutely. The access is the key and that NCI designation really allows us to break a lot of the barriers that our patients would have for the access.

Host: So for the next part, like you said, you're the surgeon, often you see these folks kind of later in the process. So, what do people need to be asking their primary care doctor if they're worried about colon cancer? And when should they start asking?

Dr. Avinash Bhakta: It's never too early to ask. And sort of like how you and I, this being conversational, I think having that relationship with your primary care doctor, who is really your point person, because your primary care doctor is the one that knows you best. And they're the ones that are going to be able to say, "Hey, you know what? There are some red flags that I see in your history, and this isn't like you. We should have a followup and make sure that we're doing that screening colonoscopy." So to answer that in short is that it's never too early to ask. It's always good to bring these things up because that's the whole relationship that we have as physician and patient, is that you got to be open with us and let us know what's going on and then trust that we're going to do what's best for you.

Host: Anything else you'd like to add kind of as we close out today?

Dr. Avinash Bhakta: The only thing I want to add is that we're all one team, this whole nation. We really want to fight colon cancer across the nation. And even though there's new hurdles that are coming up with the early-onset colorectal cancer presenting at later stages, we're all trying our best, and we can't do this without everyone being on the same team.

Host: Phenomenal. Thanks for helping us understand more about colorectal cancer screening new modalities. There's just so much out there. Thank you for educating us today.

Dr. Avinash Bhakta: Thank you for having me. And thank you once again for this wonderful podcast that you put on.

Host: And for more information, go to ukhealthcare.uky.edu and select UK Markey Cancer Center. If you found this podcast helpful, please share it on your social channels. I'm Dr. Bob Underwood. And thank you for listening to UK HealthCast, a podcast from UK Healthcare.