Hi everybody and hi Dr. Vanessa Shami. We are super excited to have you here today for those that may not know Dr. Shami, she's a professor of medicine at the University of Virginia. Dr. can you tell us a little bit about what you do? Absolutely. I'm interventional gastroenterologist, and so I do a lot of advanced procedures such as endoscopic ultrasound where I biopsy tumors. I also do a lot of resections, such as if somebody has a precancerous lesion in their colon and that's particularly large or advanced, that's my specialty. I do a little bit of all of that. It's such important work, it is so critical. Personally, colon cancer came into my life when my brother passed away from it. You're here today to help our listeners understand a little bit more about colon cancer, and I was wondering if you could share how common colon cancer is. Absolutely Bill. It's really common. It's actually the second leading cause of cancer death in men and women in the U.S. By the end of the month, there'll be about 53,000 people in this country who die of the disease. The scary thing is that we're seeing an uptake in younger individuals, so 10.5 percent of new cases are actually occurring in individuals that are younger than 50 years of age, a little bit worrisome. Really worrisome because I don't know what the recommendation is from insurance companies on first colonoscopies, what is that age? Now it's interesting you asked that. The new recommended age by the U.S Preventive Services Task Force is 45, and unfortunately, the word needs to be out there. People, many patients still think it's 50, and we all know that people will cheat. We're all human, and so we'll wait even longer than that. It's really important that people now know that the screening age is 45, so we can capture these individuals whose incidence of colon cancer is actually going up. Do we have a clue as to why? That's a good question. I think we're thinking it's the Western diets, obesity, lack of exercise. Just like your mother used to always tell you, lots of fruits and vegetables, lots of fiber, and decreased animal fats. But we think it's probably multi-factorial. I'd had this conversation a few years ago about colon cancer with another physician, and they were talking about the hereditary piece. My question was, isn't the hereditary piece of colon cancer actually the polyps, the grow. That if doesn't polyps isn't bad, but actually tends to run in families. If you're a young person with polyps, in my experience, they've asked you to share it with other family members in case they too are below the age. Can you explain a little bit about that? I'm certainly not an expert in it, but I did find that interesting. Absolutely. First of all, polyps are, I think of them as what moles are to melanoma. Polyps are precancerous growths. They look almost like mushrooms. They have different shapes in the colon. Usually it's individuals 50 and above who will form most of the polyps. But if you have a hereditary component, you will develop these polyps at a younger age. In fact, there are some hereditary diseases where people will get colon cancer by the time they're in their 20s. It's extremely important that if you have colon cancer or a history of polyps, that you do let your family members know, so that the physicians can then appropriately recommend screening for those individuals. That was my next question, is when we discover that siblings or other family members may have polyps at an early age. What does that do you say during the screening recommendations for a colonoscopy? Does that mean we remove the colonoscopy up then from 45-35. What's that look like? The real big thing is colon cancer. If you have a family member who's had colon cancer and just say the age of 40, we usually recommend your first screening of somebody who's a first-degree relative 10 years before that. Just say I had colon cancer at the age of 40, then we will start thinking of screening my children, my offspring 10 years earlier than that. So it will be children of that would be looking at. Absolutely. Also, if I had a sibling who did not get tested and I had colon cancer, you absolutely want to encourage your siblings to get screened. Sure. I myself have gone down that road. It critical as we know. While we're talking about colonoscopy, what makes that the great task? It sounds so scary to so many people, but can you shed some light on that? Absolutely. The good thing about colonoscopy is you're actually directly in there, and we as gastroenterologists are looking at the inner lining of the colon. It is the best test that we have right now to detect polyps, and it's particularly good in flat polyps. Not only do we detect them, the nice thing about colonoscopy is then Bill, you can actually remove them at the same time. So you don't have to have a test which detects possibility of having polyps and then undergoing a colonoscopy to remove them. It's almost like a one-stop shop if that makes any sense. But visualization with colonoscopy is the best. I'm sure because you don't do a layman like myself, it does sound like a daunting experience. Can you share with our listeners the safety of that process and procedure? Can you shed some light on that? Absolutely. The colonoscopy itself, people are very concerned about the procedure. I've had a recent colonoscopy and I've got to say the procedure itself as a patient you do not feel because usually you're getting sedation. It's actually the preparation that I think can be a little bit challenging. But keep in mind, you are trying to save your life potentially, so anybody can get through the preparation. But in terms of the colonoscopy, very rarely will there be risks or adverse events from the colonoscopy. We tell individuals those include we say infection, no need for antibiotics. I always tell people your chances of getting infected is so low we don't even recommend them. You can get bleeding, and bleeding can occur after you remove polyp. It can occur up to three weeks later, but it's extremely unlikely, and if you have a large polyp now, we have ways as gastroenterologists to clip up the site where we resect the polyp, and actually decrease the chance of bleeding. There's a risk of the sedation, but it's extraordinarily rare, and the most severe adverse event is tearing a hole in the colon or a perforation. Again, add up all those things I mentioned that is the least likely to occur. If it does occur, we now have tools where we can actually patch up the majority of the time that hole internally so people would not need surgery. There are adverse events, but they're very unlikely, especially if you go to somebody who's trained in endoscopy. Super rare, pretty rare. Very rare. People can feel comfortable about it. I know I do I always think of it as a great [inaudible]. I was comfortable enough to get it done, and I will continue to have it done. It just popped into my head? Are there younger people, are you doing more and more colonoscopies on younger people, and what would that age range be? You're finding where there's more of not that rare 20-year-old, but where are you starting to see this come into play? We're seeing it at 45 and above. Again, I think that's why the guidelines are now starting to switch to that age group. That's the age group where we used to not see people. We didn't screen them, but it's interesting to me that that's the age group where we're seeing the incidence increasing. Well, I know my first colonoscopy was almost 30 years ago, and I was very young and did have polyps at that time, and it was very rare for me to be getting that at that age at that time. There was something I wanted to ask you about alcohol and smoking. Do you have any information on how colon cancer and drinking are connected possibly? We know smoking for sure, but now we're hearing more and more about alcohol, and the relationship to alcohol over several kinds of cancer, and with colon cancer, can you share a little bit about that? Absolutely. It's moderate. If you don't want to have high amounts of alcohol consumption or moderate. They say that in women having more than one drink a day and in men having more than two drinks a day will actually increase your chance of colon cancer. Again, I think if we drink in moderation or less, one drink a day in a woman is not a ton of alcohol, so as long as you keep that in mind and go below that threshold, you should be okay. It is definitely at risk, but I'm also thinking the layered effects of alcohol, smoking, diet, and do we see an increase when we say this person's a big drinker and by the way they eat a lot of something; do you notice that? I do notice that it's more like this patient has colon cancer, what were their risk factors? For me I recommend screening for everyone, and it's more they have colon cancer, in hindsight what were their risk factors? We don't practice so much right now prospectively looking like you need a colonoscopy because you smoke, you drink. It's more everybody should get screened, but who are those individuals that are particularly at a high risk? I always think when we talk about smoking and aspartic exposure, there are synergistic impacts. Absolutely. There are these layered effect. If we're going to prevent the suffering that comes with colon cancer, what is the best way that we can do? We know we're going to get screened, we know about fruits and vegetables, what else do we now? We know about family history that that can also increase it. We know that any type of screening is going to decrease your chances. I think one important thing, Bill, is if you're not going to get a colonoscopy, there are other ways to also screen. So I don't want individuals not to get screened at all. There are tool-based tests such as fecal called blood testing that you can get annually. You can also get a fecal immunochemical test or a FIT test. There are also DNA tests that you can get. Combination of DNA changes that occur in colon cancer and polyps can be detected in the stool combined with blood. Then there are the visual test. So if you're not going to get a colonoscopy, you can get a shorter scope, the flexible sigmoidoscopy, you can also get a CT colonography or we call it a virtual colonoscopy. Please keep in mind for individuals who are really scared of colonoscopy for some reason that there are other. Modalities. Now it's good to know their options. It's good to know while they're not maybe as specific or as accurate as a colonoscopy, people can still be proactive. I was actually telling a cyclist I met the other day that I was going to be speaking. He was talking to me about colon cancer. I was like, "I'm speaking to the best person." He said, "I just had my colonoscopy." He was from Algeria and he said, I don't understand why people can't deal with a human dignity for a moment to go through. I was like, it is like I get through it but it's stuff. Some people cannot wrap their heads around it and there are options. I think this is a discussion a lot of people are having and especially people my age are concerned about, what it's going to be like, or what may be happen or it becomes very personal and inward. Well, it is personal and inward, but what people lose sight of its life saving, and while people say, "Well, it's just a screening. How do we prevent it before you even get to the screening?" Screenings prevent lots of cancer and this screening in particular, correct me if I'm wrong, is really one of the few screenings that actually you can stop cancer before it starts with a colonoscopy. Am I correct in saying that? Absolutely, Bill because like we talked about, you're getting rid of the precancerous lesions, which are the polyps. By taking them off, you're eliminating the possibility of that polyp from developing into cancer. It is up there with cervical cancer screening or mammograms with breast cancer. These are extremely important tests and I wish more people like Katie Couric, how she advertised her, then taped her colonoscopy. We need more people to do that, to encourage people to go out there. Because again, it saves lives and it's so much easier. I tell patients to go through a colonoscopy and take out your polyps than it is for you to get a port and chemotherapy and radiation and surgery. Katie was so smart, I don't know her but, she was so smart with bringing cameras into her procedure because she made it part of an everyday conversation and because of her, I believe colonoscopies have become a part of everybody's landscape. They know about, they are considering, and probably more people now are getting them than ever before. I love it when people can take science and make it, everybody's. Absolutely, I agree. Great. Before we close out here or there anything, is there anything you'd like to share or things that are on your mind about what patients can do next? No, if you're at, in the least bit intrigued about learning more about colonoscopy. See your primary care physician, and talk to him or her or go to have them refer you to a gastroenterologist and talk about the different options in clinic. Because I think it's extremely important, and again, it saves lives. Colonoscopy saves lives. We have the data and it is so worth it, and I can tell you, if this makes any difference, I don't know if one gastroenterologist today that's screening age who hasn't gotten a colonoscopy. I'm sure there are out there, but so that can tell you how important we actually truly feel it is. Good point. People will say that when they've talked to me about prevention, I always believe that, even if something were cancer, we can treat it and cure it. It prevents other cancers from around the corner from spreading or occurring, and the one exam that I personally have experienced is a colonoscopy. When polyps are removed, it's lifesaving. Absolutely. [inaudible] For your heroic work, you're doing amazing work and we're super grateful to you for joining us. I do want to share with the audience that you are a Less Cancer board member and we're so grateful for your work in helping in the work to prevent cancer. Thanks so much. Thank you Bill, it's an honor to be here. I appreciate it.
