Beyond the Checkup: Demystifying Colon Cancer Screening

[00:00:00] Pete Waggoner: Hello and welcome to Beyond the Checkup brought to you by Stellis Health where neighbors care for neighbors. I’m Pete Waggoner, ready to guide you to a healthier, happier life. Today we’re here to inspire, explore, and help you thrive in your health journey. So let’s dive right in with Dr. Dale Lawrence on today’s episode of Beyond the Checkup.

[00:00:26] Pete Waggoner: We’ve got a great topic and Dr. Lawrence, thanks for joining us here today during your busy times as always.

[00:00:31] Dr. Dale Lawrence: Sure. I’m happy to be here. Thanks.

[00:00:33] Pete Waggoner: As we know, March is recognized as National Colorectal Cancer Awareness Month. And if you people weren’t aware, it’s good to, to be aware of what we’re happening, is happening here.

[00:00:42] Pete Waggoner: So one of the things that I want to get into before we get into the specifics of this, is you’ve been in the practice as a family practitioner, doctor for 20 years. A primary care physician, and you’re one of a couple that handles these screenings for the colon screening. What I [00:01:00] want to do is break it down a little bit and debunk some of the myths.

[00:01:04] Pete Waggoner: Things have changed a lot over the years for those that may be a little scared of what they’re hearing.

[00:01:08] Dr. Dale Lawrence: Sure, absolutely. You know, even in the 20 years that I’ve been doing this, it’s changed a lot. But certainly in the 20 years before that, there were really significant changes. You know, It used to be that practitioners couldn’t see the whole colon. They could only see part of the colon because the equipment they had wasn’t long enough.

[00:01:30] Dr. Dale Lawrence: At the very beginning, the equipment they had was straight. And so it was very uncomfortable for patients, it was not very effective. And people didn’t like it. And out of that have grown all these stories about how miserable it is and it’s difficult.

[00:01:45] Dr. Dale Lawrence: And fortunately, every time there’s an advancement now, things get better. The scope gets more flexible. The drugs that they use for sedation work better. The [00:02:00] process is less uncomfortable. The prep continues to improve.

[00:02:03] Dr. Dale Lawrence: Now, even though It’s never going to be good. You still have to take all the medicine and you have to poop like a goose and get everything cleaned out of you.

[00:02:12] Dr. Dale Lawrence: it is better than it was 20 years ago. So, one of the things that I feel like being a primary care provider who provides these services is I’m providing them for the folks that I see day in and day out. And I think they feel more comfortable having somebody they know doing it.

[00:02:30] Pete Waggoner: I would think so.

[00:02:31] Pete Waggoner: And, you know, one of the things that is interesting, you brought up the prep and we’ll get into that a little bit later on in the podcast as well. When you talk to friends and people that are prepping now, it used to be an ordeal. It felt like almost a 2 day ordeal. Now it seems like it’s just sort of, ah, it’s not that big of a deal, even though they have to do what they have to do.

[00:02:53] Pete Waggoner: Was there a moment or a period over the past five years where things have changed in that regard too?

[00:02:58] Dr. Dale Lawrence: Well, to be honest, there are [00:03:00] lots of different preps available for this procedure. And depending on which provider you go to, you get a different prep. Even at the facilities that I work at, they use different preps for the different providers.

[00:03:13] Dr. Dale Lawrence: Dr. Martin and I, who do the most of the scopes for the clinic, for Stellis Health. We use a prep that is available over the counter, so you don’t have to have a prescription. It’s a one day prep. So, if you’re getting your colonoscopy on a Wednesday, the prep happens on Tuesday.

[00:03:28] Dr. Dale Lawrence: Then you’re usually able to sleep. Some of the preps that are available on the market have you waking up in the middle of the night, and doing things like that. Day of or the morning of your procedure and that can really be kind of undesirable. So we use the over the counter and we try to get everything done the day ahead of time.

[00:03:46] Pete Waggoner: How common is colon cancer, from what you’ve seen?

[00:03:50] Dr. Dale Lawrence: Well, it’s interesting you ask that. I mean, I did some checking, and the American Cancer Society estimates there are going to be over 100, [00:04:00] 000 new cases of colon cancer for 2024 in the United States. And worldwide, colon cancer is the third most prevalent type of cancer.

[00:04:10] Dr. Dale Lawrence: For men, it’s behind lung and prostate. And for women, it’s behind the breast and lung.

[00:04:16] Pete Waggoner: Why do you think that is?

[00:04:18] Dr. Dale Lawrence: Well, it is interesting. I do feel like despite all of our prevention and our testing to try to find polyps when they’re small, so that they can’t grow into bigger things, and become cancerous, we still seem to be finding more and more.

[00:04:38] Dr. Dale Lawrence: I wonder if that is, obviously, as the population increases, you know, there are just more cases that are going to be found.

[00:04:45] Dr. Dale Lawrence: The interesting thing seems to be that we’re finding colon cancer in folks who are younger and younger as time goes on. When I started doing this, even just 20 years ago, it was very rare to find [00:05:00] colon cancer in a 40 year old. Or someone in their forties, and that seems to be way more prevalent now.

[00:05:06] Dr. Dale Lawrence: For that reason, the cancer screening guidelines have changed. They used to start at age 50, and now for the general population, they’ve moved to the age 45. So there’s a lot more young people that need to be screened than were in the past.

[00:05:20] Pete Waggoner: What are some of the things you hear from your patients if there’s a trend? As to, let’s say they, they turn the meter over to 45 years old and now it gets to 50, 52. What are they saying to you? Why are they not doing it? Is it fear? Is it not wanting to know? What do you think it is?

[00:05:39] Dr. Dale Lawrence: I think there’s a component of fear. I think there is a “put it off” because it’s a headache and I don’t wanna do it today.

[00:05:47] Dr. Dale Lawrence: It’s certainly inconvenient, you know. Taking a day where you have to go to the hospital, and the day before you got to take all the prep. Yeah, it ends up being a large commitment. And I think people [00:06:00] just end up pushing it down the road. And I hope that if they’re fearful, visiting with their primary care provider in the office helps put them at ease.

[00:06:12] Pete Waggoner: Well, and I think that comes back to your very initial point of trust. And you brought that up with you. And it’s a lot better when people know who’s handling a procedure like this.

[00:06:21] Pete Waggoner: What are the different types of colon cancer screening tests that are available?

[00:06:26] Pete Waggoner: Do you utilize different versions?

[00:06:28] Dr. Dale Lawrence: Great question. We’ve been talking about colonoscopy up till now, but colonoscopy is just one type of colon cancer screening. What we’re talking about with colonoscopy is a patient going to a hospital or an outpatient center, getting sedated, a long tube is inserted in their rectum, and advanced all the way through their large intestine looking for polyps.

[00:06:52] Dr. Dale Lawrence: And if there are polyps, we have instruments with the device that we take them out. Because we know that [00:07:00] little polyps grow up into big polyps and big polyps turn into cancer. And if you take out the polyps when they’re small, they can’t turn into cancer.

[00:07:07] Dr. Dale Lawrence: So that’s one way of screening. And if you do a colonoscopy and everything is completely normal, we do a recheck in 10 years.

[00:07:15] Dr. Dale Lawrence: And so if you’re an average risk person, you have no polyps, there’s no family history of colon cancer, and you get it done, then you’re off the hook for 10 years. There are several other imaging type things. I mean, we’ve done virtual colonoscopies over the years. Those kind of don’t, those have fallen out of favor.

[00:07:33] Dr. Dale Lawrence: They don’t, they’re not the greatest. You still have to go through the prep. They do a cat scan, a fancy cat scan. And if they find a polyp in there, you still end up with a colonoscopy. So people kind of, those were in favor maybe 15 years ago. They’ve gone away. They’re not really a big thing.

[00:07:48] Dr. Dale Lawrence: A flexible sigmoidoscope is a shorter scope that looks at the left side of the colon. Those kind of procedures are primarily used in areas, either [00:08:00] for screening, if there’s no colonoscopy available, maybe you’re in a rural area. Or maybe there’s no practitioners that know how to do the colonoscopy.

[00:08:09] Dr. Dale Lawrence: Or if people have a problem maybe with hemorrhoids, or bleeding or something and they just need a short scope done. So that’s number two and those are done every five years.

[00:08:18] Dr. Dale Lawrence: Then there’s the ColoGuard, which everybody sees a little box on television that’s advertising colon cancer screening. ColoGuard is something that’s offered every three years. A stool sample is submitted, and it’s mailed to the company, and they check the stool for DNA and for blood.

[00:08:38] Dr. Dale Lawrence: And the DNA tells them if there is colon cancer present in the colon, or if there’s a polyp that is shedding cells that has cancerous potential. That test, if it is positive, you end up getting a colonoscopy. So that we can go in and find the polyp and [00:09:00] remove it, so that it doesn’t cause any problems. Again, if that’s normal, that’s done every three years.

[00:09:06] Dr. Dale Lawrence: And then finally, there’s a test that is called a fecal immuno test. It tests stool to see if there is blood in it. And if there is blood in it, then, patients often end up with a colonoscopy to see if there’s a source for the bleeding.

[00:09:23] Dr. Dale Lawrence: And if that’s normal, that’s something that’s done every year. So there’s lots of different options. Things that are less invasive. You don’t have to go to the hospital or the clinic or an outpatient surgery center. They can be done at your home. And they work really well.

[00:09:38] Pete Waggoner: So it sounds like all roads, if there’s something that leads to that colonoscopy though, once you have to start. But, there are ways you can stay ahead of the game and do this. And as far as accuracy of those things, do you feel pretty comfortable with the accuracy of those?

[00:09:55] Dr. Dale Lawrence: Yeah, all three tests. The colonoscopy obviously is the gold standard of colon cancer [00:10:00] screening, but even so, it is not 100%.

[00:10:03] Dr. Dale Lawrence: And the statistics show that even in the best of hands, I think it’s 95% sensitive. So, I mean, things do get missed. One thing that Buffalo Hospital has started offering, which is new, is is an artificial intelligence for colon cancer screening. So when we’re doing the colonoscopy, artificial intelligence is watching the screen as we’re doing it.

[00:10:25] Dr. Dale Lawrence: And it helps us identify polyps. Where you’re in a process of checking to see if we actually do find more polyps than we did before it was something that we implemented. So, there’s always some new things happening and it’s pretty cool stuff.

[00:10:43] Pete Waggoner: Well, I mean, I have a million questions right now. We only have a short period of time, but I’m going to ask this anyway.

[00:10:52] Pete Waggoner: When you are going through the process, typically, do you find several polyps or a couple? Does it [00:11:00] vary? What does that look like to you? How many?

[00:11:03] Dr. Dale Lawrence: Yeah, so if I’m doing, statistically, if I’m doing a good job as an endoscopist on a screening exam, I find pre cancerous type polyps 25 to 35 percent of the time.

[00:11:16] Dr. Dale Lawrence: So if I’m doing 10 scopes that morning, three of them, and they’re all screens, they’re all brand new people, three of them should have new polyps. So that tells you how kind of prevalent it is. When I’m doing a colonoscopy, many of them don’t have anything. Everything looks completely normal. and we’re talking about colonoscopy for colon cancer screening.

[00:11:38] Dr. Dale Lawrence: We also do colonoscopies to evaluate if people are having bleeding or diarrhea and there’s different. things we look for with those types of procedures.

[00:11:47] Pete Waggoner: So, in terms of risk factors for individuals, I heard you mentioned family history, maybe some genetic type things. Can you break that down as to what those factors would be?

[00:11:59] Dr. Dale Lawrence: Sure, the risks [00:12:00] for colon cancer are many, right? They will talk to you, they will talk about smoking, alcohol use diet, lack of exercise. If you’re more, have a sedentary lifestyle, you have a higher risk of colon cancer. All of those sorts of things though. They are risk factors, and they’re important, and you, for a healthy lifestyle, you should try to modify all those sorts of things.

[00:12:24] Dr. Dale Lawrence: But in the end, the biggest risk factor you have for colon cancer is genetics. It’s your family history, which is something you can’t control.

[00:12:33] Dr. Dale Lawrence: All of the controllable factors are very small when you compare it with the risk factors that go along with family history.

[00:12:42] Dr. Dale Lawrence: If you can pick your parents, that’s the best thing you can do to prevent colon cancer. For people who have a family history, when I’m saying family history, people will come in and they’ll say, well, my aunt on my mother’s side had colon cancer, does that put me at higher risk?

[00:12:57]