Simon Floss (Host): Hello, and welcome to the special podcast brought to you by the experts at Sanford Health. I’m your host Simon Floss with Sanford Health News. Today, we’re talking a serious disease that affects thousands each year, colorectal cancer. Here’s a few grim statistics about colorectal cancer before we get going. According to cancer.org, the lifetime risk of developing colorectal cancer is 1 in 23 for men and 1 in 25 for women. Colorectal cancer is the third leading cause of death in the United States. Researchers predict it will cause nearly 53,000 deaths in 2022. Joining me now is Dr. Jacob Quail, a surgeon for Sanford Health in Vermilion, South Dakota. Along with providing a wide range of surgeries, Dr. Quail offers colon cancer screenings among many other services. Thanks for joining me today.
Dr. Jacob Quail: Well, thanks for having me. It’s a really awesome topic. Those stats you just read out are real. This is something that we’re dealing with all the time. As we come on March, March is Colorectal Cancer Awareness Month. So it’s something I love to talk about. And I’m sure my family and friends are enjoying me talking about it with someone else, not with not just with them. So I’m happy to be here.
Host: Yeah. And like you said, March, very timely that we’re talking about this, very important discussion as we just said, it affects thousands of people. And just talking about that coming off of hearing those statistics, what’s kind of your reaction? I mean, these are things that you know, but what would you say to people who are listening, hearing that for the first time, not knowing how serious this is?
Dr. Jacob Quail: I would just say, start having that conversation with folks that have been screened and to be aware of the statistics. So, the big change that has happened this past year – the guidelines of when to be screened for colon cancer has changed. Now we recommend screening at age 45, not 50.
Host: Instead of 50. Yeah.
Dr. Jacob Quail: Yep. So, that’s a big deal. Because what we’ve found is that since 1994, the rate of colon cancer has increased 51%, that’s CDC data. So, in the age of less than 50, right? And so, if you’re less than 50, we found that the rates are increasing. That’s significant. So, that’s why we think it’s super important that folks start getting screened at age 45. The range, the age range is now 45 to 75, and we recommend everyone get screened. From that 75 to 85 range, you really need to have that discussion with your provider, whether the risk and benefits still make sense for you. After the age of 85, colon cancer screening is no longer recommended, but again, the big change is that we want folks to start getting screened for colon cancer answer now at age 45.
Host: And you said that we’re seeing an increase in rates. Do we know why or anything like that?
Dr. Jacob Quail: It’s still too early to tell, but it may be secondary to some lifestyle changes that are happening. Some of the risk factors that we’ll talk about for colon cancer: eating highly processed foods, smoking tobacco, drinking unhealthy amounts of alcohol, or obesity, not exercising. These are all important risk factors for colon cancer. They don’t necessarily change when you need to be screened, but they may have something to do with it. But I think time will tell.
Host: Sure. And so one thing that we want to talk about is myths versus facts. What are some typical myths that you hear and what are some facts that people should know?
Dr. Jacob Quail: So, I think one of the myths I hear is colorectal cancer screening is embarrassing.
Of course, for the folks that work at this field all the time, of course it’s not embarrassing. So, it’s a myth for us. But, I can see how some folks would say that it’s embarrassing. The bowel prep having the colonoscopy, they may think it’s embarrassing, and that’s OK. So what do we have to do about that? Well, at least I encourage folks to have a conversation with their primary care doctor, or their doctor that’s going to be doing the procedure just to have answer any questions that you may have about the process, because it’s not something we do all the time. Right? And also, there’s other ways to get screened. If you say, ‘nope, I still don’t want to get screened with the colonoscopy,’ well, there’s some stool-based test that can also be used to screen folks.
And, we say the best screening test is this test that gets done, especially in the rural setting. That’s a setting that I work with every day and we just want the screening test to get done. So, I would say that quality cancer screening is embarrassing, is a myth. Another myth versus fact that we deal with is colorectal cancer screening is expensive. Well, colorectal cancer screening is a screening test. These are tests that are covered by insurance, which we’re very thankful for because we know colon cancer screening decreases the risk of developing colon cancer. That’s the whole purpose, right? That’s why we do it. So, insurance companies cover these procedures, these screening tests. Also, with the age changing to 45, they’ll also be covering those folks as well. So, that’s super important for our patients to know.
Another myth versus fact is colorectal cancer screenings are painful and that’s a myth.
We do colonoscopies under sedation. So, what I tell folks is you’ll come to the procedure room, you’ll meet our CRNA or anesthesia provider. You’ll get some sedation, you’ll be sleepy and you won’t remember anything. And then you wake up. So, of course it’s a myth that it’s painful, but if you’re still nervous about it, there’s another option, right? We talked about there’s two options for colorectal cancer screening. One is that direct visualization with the colonoscopy and the other then is with the stool-based studies that we can talk about a little bit later.
This is the big myth versus fact: I don’t need to get screened if I don’t have symptoms. These are exactly the folks that we want to get screened. We want to get those healthy folks screened so they can stay healthy for the rest of their life. We know colorectal cancer screening works and that’s why we lower the age to 45, per guidelines. So, it’s just something that we want to get the word out that if you don’t have symptoms, we want you to be screened for colon cancer. If you meet the age requirements.
Host: And piggybacking off of that, the earlier that you detect and catch something, obviously the better. Can you maybe speak to that a little bit?
Dr. Jacob Quail: So, that’s a super important point. There is two benefits of colorectal cancer screening. One, it detects polyps that may be pre-cancerous during the colonoscopy. We can take those polyps out and prevent their progression to colon cancer. Now not every polyp leads to colon cancer, but some do. And that why we do it. That’s reason number one.
Number two (reason) why do we do colorectal cancer screening, we are able to detect colon cancer at an earlier stage, maybe when you don’t have symptoms yet. And, at this point it’s easier to treat once detected. So, there’s really those two big benefits for colorectal cancer screening.
Host: One thing that we need to talk about is risk factors and family history. So who is at risk for developing colorectal cancer? Or is it anybody?
Dr. Jacob Quail: Yeah, that’s a great question. The average risk patient needs to gets screened at 45. That’s the average risk.
Now, how about what are the risk factors that change that time when you need to get a screen for colon cancer? Well, number one, family history, right? So, that’s why it’s super important to have that discussion with your family. Around the kitchen table, I knew I grew up in a small rural farm that’s a discussion we did not have. OK, but you need to be having that discussion. So, we’re specifically talking about colon cancer or colon polyps in our first degree relatives. Now who’s the first degree relative? We’re talking about our parents, our siblings, or our children.
So, if they have a history of colon cancer or what we call advanced polyps, you need to start screening at age 40, or 10 years before they were diagnosed. So, that’s super important that family history, personal history, if you have a personal history of colon cancer or colon polyps, you have an increased risk.
Another risk factor is if you’ve ever been told you have inflammatory bowel disease. Now, what is that? That is Crohn’s disease or ulcerous colitis. If you’ve ever heard those terms around the kitchen table, that’s something maybe you have a conversation with your primary doc about.
Host: There are a lot of people that are diagnosed with that.
Dr. Jacob Quail: Yes, there’s a fair amount of folks that are diagnosed with that. So, if you have that diagnosis, you need to be screened for colorectal cancer earlier. OK. There’s other specific genetic syndromes that have an increased risk of colon (cancer). One of them is called Lynch syndrome. I was a Navy surgeon for 11 years, and my last year in service, we had a 24-year-old patient who came in with belly pain. We worked him up, he was found to have colon cancer, (at) 24. It turns out his mom had Lynch syndrome and they never had that discussion. I like to use that example. It is something that we just have to make sure we’re talking to our family members about for this preventable disease.
So those are the three big risk factors, family history, personal history and presence of inflammatory bowel disease. That changes when you need to be screened, what age you need to be screened, for colon cancer. Earlier, we talked about those other risk factors that don’t really change the age when you need to be screened again, that’s like eating highly processed food or smoking, unhealthy alcohol use, obesity, not exercising. Those are important of course, for your general health, but we know they also increase your risk of colon cancer.
Host: Now you alluded to it earlier, but talking about what screening is and what patients can expect. Like you said, there’s really nothing to be afraid of. It can seem a little bit frightening at first, but again, nothing to be afraid of. So, what can patients expect when they come to any of the Sanford facilities?
Dr. Jacob Quail: So, that’s a super important question. So, the big thing we always hear about at least if they’re getting screened with the colonoscopy, (is) the bowel prep. Yes, you have to drink this stuff to clean your bowels all out. And why is that important? That’s important because we want to make sure you’re cleaned out good so we can see if you have polyps or not. If you don’t have a good bowel prep, if we can’t see, we may have to repeat the colonoscopy sooner rather than later. And then, you have to do the bowel prep again and the whole process, right? So, you do the bowel prep in general. You start at the night before, or they’ll tell you to what time to be here in the morning of your colonoscopy date. You’ll get an IV. You’ll meet the anesthesia or CNA provider, if that facility is using those providers. I always say the procedure takes half hour, 45 minutes.
You recover for half hour, 45 minutes, and then you go home. Now, you need someone with you to drive because you get sedation, right? Remember, it’s not a painful procedure. So, you get sedation. So, always helpful to have something lined up because you can’t drive afterwards. I always say no signing any important papers. No doing anything important the rest of the day. You just recover and you go back to a normal thing the next day. That’s important to remember for colonoscopies is in general – you take the day off of work. So, you kind of expect that going into it. So, that’s the colonoscopy experience.
If you have a polyp it’s important that you get the information down the road a couple days later about what type of polyp it is, because that’s important for you to know, because they’ll tell you then when your next colonoscopy should be.
If you have a polyp, you have a colonoscopy repeated sooner than 10 years. That’s really important. Not only for yourself, but we talked about how family history is important. So, you want to let your family members know as well.
The other screening tests that we use then, is there’s some stool-based studies. If you decide to use a stool based study, maybe you heard about a Cologuard or a FIT test, that’s something you don’t do a bowel prep for, but that’s something you can do at home. What’s important about that though, is let’s say your Cologuard or your FIT test is negative. OK? Then you have to repeat the FIT test every year. Remember the colonoscopy. We said, if it’s normal, you have to repeat it every 10 years. The Cologuard, if it’s normal or negative, you get repeated in three years. So, the frequency of when you need to do those stool-based tests is more frequent than if you had to do the colonoscopy.
Now this is the kicker with the stool based test. Let’s say they’re positive. And what does positive mean? Well, they detected either some abnormal DNA or maybe some blood coming from your GI tract. And that means you have to get a colonoscopy because maybe we have a polyp or an early stage colon cancer that we really need to take a look at with the colonoscopy. At that point, it’s called a diagnostic colonoscopy, not a screening colonoscopy. So, it’s a little bit different, but you’ll still do the bowel prep. So, just be mindful of that. If you do the stool study and it’s positive, we recommend the colonoscopy to take a look. So, those are the big screening tests, the colonoscopy, which we talk about that procedure a little bit, the stool based studies, Cologuard or FIT tests and how they’re different.
Host: Lastly, you talked about it earlier, but as Midwesterners, we sometimes tend to not have the uncomfortable discussion or sweep things under the rug. But, these types of things obviously need to be talked about. There has been a lot of growth in this field in the last few years, but there’s still a ton of work to do. So, how do you encourage loved ones to get screened?
Dr. Jacob Quail: And I love that question because what I always say is first you need to have the conversation. We need to have the conversation around the community at home, around the kitchen table, because we know that colon rectal cancer screening works. It decreases the risk of developing colon cancer, colorectal cancer in the future. And if they’re still hesitant, at least talk to your primary doc or talk to the procedure list. I’ll be doing the procedure if you decide that colonoscopy is the best thing for you. And I just think it has to start with that, having the conversation because that’s not something that I know I didn’t have with my family. Now we do. And as we talk about it more, it gets easier to talk about. And I always talk to patients about now, OK, you go be an advocate out there in the community because we know it works and everybody’s important in this community. We want to make sure everyone gets screened. So, that’s what I usually tell folks.
Host: Awesome. Well Dr. Quail, anything wrapping up? I know this is a huge topic that we want to make sure that we cover, but is there anything that you think is important that, wrapping things up, people need to know about?
Dr. Jacob Quail: I think one of the other challenges that we face is some folks – ‘we’re all busy.’
Host: Yeah. Yeah.
Dr. Jacob Quail: ‘I don’t have the time.’ And I think that’s a real challenge for everybody. And one of the good things about colorectal cancer screening is that you don’t have the time, there’s other options. Maybe you, a stool-based study is the best study for you. Maybe this didn’t decide to do the colonoscopy, so there’s options. So I know you don’t have the time, but if you just get it done, I know you won’t regret it down the road because we know it works. So that’s just one of the other challenges that I, that we face that is super important. Especially as we kind of ramp up our efforts in March here with Colorectal Cancer Awareness Month is super important topic and I’m so happy we’re having it.
Host: And quickly, how do you schedule it?
Dr. Jacob Quail: Yeah. So, if you decide, ‘yes, I want to get this scheduled,’ I would touch base with the primary doctor. OK. And they can even put an order in to start the process. You’ll be contacted and you’ll get the bowel prep instructions. That’s always a really important thing. And they’ll tell you what time and where to be. Also, there’s a specific order you can place to get a stool-based test, and that’s something you can do at home. So there’s pathways out there. And they’re ready to be used. Thank you.
Host: Awesome. Thank you so much for joining us today.
Dr. Jacob Quail: Thanks.
Host: And thank you for listening. Before we wrap up, I’d like to remind you that Sanford Health’s podcasts are now available on your favorite podcast apps like Apple and Spotify, as well as our website, Sanford Health News. If you enjoyed this conversation, follow us, give us a thumbs up and share your comments. We love hearing from you and hope that you found this conversation insightful. Thanks again for listening. I’m Simon Floss with Sanford Health News.