What you need to know about colon health and colon cancer

Transcript

Joey Wahler (Host): Well, colon cancer is one of the leading causes of cancer deaths in the United States. When actor Chadwick Boseman died in 2020 from colon cancer at age 43, it made the public realize that the disease is increasingly affecting young people.

So we’re discussing colon health and colon cancer. Welcome to Flourish, a podcast brought to you by Prisma Health. Thanks for joining us. I’m Joey Wahler. Our guests are Dr. Andre Eaddy, a gastroenterologist at Prisma Health, and Dr. Robert Kneece, an internal medicine provider at Prisma Health. Gentlemen, appreciate your time.

Robert Kneece, MD (Guest): Thank you for being here and having us on.

Andre Eaddy, MD (Guest): Thanks for having me.

Joey Wahler (Host): So Dr. Eaddy, because of attention from stories like Chadwick Bozeman’s, how much more public awareness do you sense there is regarding colon health and colon cancer?

Dr. Eaddy: I think it’s been very helpful to provide more public awareness. And I also think that it’s our responsibility to know just how important colon cancer is. So, the second most common cause of cancer in both males and females, third leading overall, and I think many individuals may not be aware of that. And that awareness has helped. It’s also important to realize that we’re seeing colon cancer at a younger age, and it tends to be even more aggressive at younger ages as well. And so that’s changed the way we think about colon cancer and changed the way that we think about screening. So, it is always helpful when there is media attention to such an important cause.

Host: Dr. Kneece, for those unfamiliar, let’s backtrack for a moment. What does the colon, simply put, actually do in the body?

Dr. Kneece: Well, the colon’s job is to dehydrate what’s left of the food that you have in it. It forms it into the stool. It slowly absorbs water and also some electrolytes and it kind of moves this waste along. You know, you have bacteria living in your colon and it feeds on the waste, breaks it down. Some of it is symbiotic, meaning that it makes certain nutrients such as vitamin K and stuff. But the main job of the colon is actually to absorb water and form it into the stool.

Host: So, Dr. Eaddy, generally speaking, whether it be diet or other factors, what are the things, either pro or con, that affect colon health in most people?

Dr. Eaddy: Yes. So, our diet is very important to colon health. So things like fiber and increasing the fiber in your diet with green leafy vegetables, fruits, things high in fiber tend to be very helpful. And so, the things that tend to hurt the colon, may be antibiotics, certain antibiotics that are not used appropriately, heavy amounts of alcohol, excess sugars and fats have also been thought to poorly affect the colon. Often, we talk about oxidative stress or injury to the colon, and we know that greater injury to the colon can lead to colon cancer over time. So it’s important – diet, exercise, and avoiding injury to the colon.

Dr. Kneece: Yeah, I want to add onto that. Colon cancer and a lot of cancers or whatever, there’s a strong correlation between being overweight and getting cancer, both in the colon and the other places in your body. And a lot of certain foods, they, especially red meat, fried foods, having too much sugar, carbohydrates, alcohol, all lead to inflammation, and those can increase the risk of colon cancer as well as many other cancers. So, estimated 50, 70% of colorectal cancer and other cancers can just be avoided by lifestyle changes, such as healthy eating, exercise, getting your weight, basically having a more plant-based diet than a red meat diet.

Host: Interesting, now also for you, Dr. Kneece, a colonoscopy is key in assessing someone’s colon. And so for those that haven’t had one, what exactly does that entail? Because it’s really a lot simpler than most people realize, right?

Dr. Kneece: Yeah. And a lot of people don’t want to do it because they’ve heard about the prep and everything and the prep’s not as bad as everybody thinks it is. A good prep leads to successful colonoscopy. And you want to make sure that when you talk to your gastroenterologist or your primary doctor who’s ever given the preps to get it, that you, basically do all the prep because you don’t want to have to go back and have it a second time because they couldn’t see what they were looking for.

And there’s ways to prep for the prep or whatever, a few days before cut back on the fiber, making sure that you’re decreasing, go into a smaller meals, clear liquid, such as broth right before. They’re going to give you, either Golytely, some of these different preps, Gatorade mixed with Miralax, Dulcolax or Miralax, or Dr. Eaddy can tell a little bit more of the different kinds of preps. There’s many things, but basically, you want to make sure that you have a good prep before it, and it’s not as bad as it was. So when you go to the gastroenterologist and they do the colonoscopy, they usually put an IV in you, give you some medicine to relax and put you to sleep. And then, the next thing you do is you wake up and it’s over with.

Dr. Eaddy: And I think it’s important for individuals to realize that my job as a gastroenterologist is to make sure you are as comfortable as possible. And so there has been advancements in the bowel preparation where they taste better. Some of them are lesser in volume, so they’re easier to tolerate. And then during the procedure itself, I use medicines to make you comfortable. And so oftentimes you’ll be asleep for the procedure or in a sort of twilight where you’re not uncomfortable at all. It’s essentially falling asleep and waking up, for the procedure. And so many people will say the worst part was just drinking a large volume associated with the prep. And we hear that time and time again. And even the prep itself has become easier. So the process is meant to be straightforward.

And it’s also important to know that there are other forms of colorectal cancer screening. Most importantly, stool tests with Cologuard or what’s called FIT testing. And so that’s something also to talk to your primary care doctor about –what options there are for colon cancer screening.

Host: Gotcha. So continuing with you, Dr. Eaddy, what age do you recommend most people get their first colonoscopy?

Dr. Eaddy: So the recommended age for colonoscopy is 45 years old or sooner if you have a family history of colon cancer, if you’re having symptoms. So if you’re having symptoms such as blood in your stool, abdominal pain, weight loss, you should be talking to your primary care doctor immediately about whether a screening colonoscopy is needed for you.

Family history also increases your risk. People of different ethnicity. So African Americans tend to be at higher risk of colon cancer at an earlier age. So it’s important to talk to primary care doctors about what is my risk, what are the factors that influence my risk for colon cancer. And making sure to get started at the right interval that’s individualized for you. But the standard age tends to be 45, unless you have other risk factors.

Host: And speaking of which, Dr. Kneece, insurance companies have recently started covering patients younger in terms of a minimum age at which they’ll pay toward a colonoscopy. How helpful has that been?

Dr. Kneece: That has been very helpful in everything and whatever a lot of that came through, they’ve been talking about it for the last couple years because of diet and everything you’ve seen, more people, younger millennials down to 40, 45 and stuff getting colon cancer. So, therefore, the United States Preventative Health Service actually decreased the age for recommendation down to 45.

And that’s the reason why a lot of people had been avoiding because they were worried that the insurance companies weren’t going to pay for it. But yes, that’s been very helpful with the insurance companies now on board with paying for the colonoscopy.

Dr. Eaddy: We’re also really glad that insurance companies are covering colonoscopies at this younger age, because what we’ve noticed is that underserved populations, minorities, particularly African Americans, often are not being screened at the same level, as the general population. They tend to be affected at a greater extent and even earlier with colon cancer. And so, hopefully we’re able to increase awareness in this population. And also, provide access to care, which is really important. And I think that’s one of the strategies of Prisma is to provide access to these populations that were previously underserved.

Host: And Dr. Eaddy, speaking of care, if colon cancer does develop, how is that addressed?

Dr. Eaddy: Yes. So, the purpose of screening first, and I like to reinforce this with my patients. When we do a colonoscopy to look for cancer, we’re not just looking for cancer. We’re also looking for polyps that prevent cancer. So, we want to remove those polyps before they become a problem. And it’s the same with the stool test. The stool tests are to identify large polyps or cancer at an early stage so that we may do something about it. And sometimes we’re able to do that during your procedure, removing the polyps. And for you, it’s no different than a standard colonoscopy, but when we do find colon cancer, then often there are additional steps that need to be taken to remove that cancer.

First, we have to figure out in what areas it’s involving of the colon to make sure it hasn’t left the colon and gone to other areas. And it’s those factors that influence whether you may need a surgery or whether you may need chemotherapy. And so normally we will refer you to a surgeon to talk about options. You may even need a cancer specialist to talk about whether, chemotherapy is needed. But the most important thing to note is that when you find colon cancer at an early stage, that it is very much curable. It’s not a death sentence and it will increase the length of time you’re able to live a very comfortable life. And that’s our goal.

Host: And, Dr. Kneece, following up on that, when we talk about early prevention here, when we’re discussing colon and things involving rectal issues, I mean, we all know most people don’t want to discuss these things. Often people are uncomfortable, they are embarrassed, but I guess the message you two want to get across is that early intervention and prevention can literally save your life. Because if this gets out of hand, by putting it off, ignoring it, that type of thing, it really can become life-threatening, right?

Dr. Kneece: Yes. Most definitely, you want to be sure that you’re not eating too much red meat. You want to make sure you’re exercising, not having too much sugar in your diet, having plenty of fiber in your diet. Eating foods, a lot of people don’t know what has fiber in the diet and everything else. So, beans, whole grains, nuts. If you eat a baked potato, eat the skin of the baked potato, eat berries, bran cereal, oatmeal, vegetables, the crunchier, the better, the darker, the color usually is higher fiber. So carrots, beets, broccoli, are fiber rich, collard greens, swiss chard, artichokes, those kinds of things. Make sure that you’re doing the right things for your health. And that not only helps prevent colon cancer, but it also prevents a lot of other things. If you’re doing that, that prevents heart disease and other types of cancers.

Dr. Eaddy: It’s also important to identify those warning signs. And so I just want to reinforce, so blood in your stool, weight loss, abdominal pain, or if you get a blood test and there are low blood counts. So we know that women can be at greater risk of overlooking the warning signs of colon cancer because they may have more frequent blood in their stool, after giving birth to children, they may be anemic, after having menstrual cycles. So sometimes those keys or warning signs may be overlooked. So it’s even more important to be diligent about looking for those warning signs, to know whether to talk to your primary care physician about screening.

Dr. Kneece: Yeah. Get your normal, regular, physical every year. And if you have unexplained fatigue, shortness of breath, bloating, unexplained weight loss, loss of appetite, and diarrhea alternating with constipation, unexplained sizes of the stool, whatever, where the stool’s getting smaller, in other words, get regular checkups. And if something’s abnormal, go see your doctor.

Host: Yeah, I’m glad you both mentioned there some of the specific things people can look for that they shouldn’t ignore that I was referring to in general. Great information. Folks, we hope you now know better what colon health and colon cancer, looking for the signs of trouble and how to prevent it. We hope you now know better understand what that’s all about. Doctors Andre Eaddy, and Robert Kneece. Thanks so much again.

Dr. Eaddy: Thanks for having us.

Host: And for more information, please visit PrismaHealth.org/Flourish. If you found this podcast helpful, please do share it on your social media. And thanks again for listening to Flourish, a podcast brought to you by Prisma Health. Hoping your health is good health. I am Joey Wahler.