Breaking down barriers: A candid discussion on colorectal cancer screening with Dr. Dana Sloane

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>> Debra: 0:36

Comprehensive, relevant, and insightful conversations about Health and medicine happen here on MedStar Health doc talk. Two and a half years after Chadwick Boseman walked the red carpet at the Hollywood premiere of Black Panther, the Marvel super hero was dead. He had lost his private four year battle with colon cancer at the age of 43. While Bozeman's death shocked the world, the industry, and his fans, it also spotlighted a growing trend. More and more people under the age of 55 are getting diagnosed with colorectal cancer. Today on MedStar Health doc talk, we'll talk with gastroenterologist Dr. Dana Sloan about the latest developments in screening for colorectal cancer and what you need to know about signs, symptoms, and treatment. I'm your host, Debra Schindler. Dr. Sloan, thank you for being our guest on MedStar Health doc talk.

>> Dana Sloane, MD: 1:36

Thank you for having me. I appreciate it.

>> Debra: 1:39

The term colorectal cancer is one we hear often, especially in March, the designated awareness month. It really is a term that umbrellas multiple cancers. It can't really be viewed as one disease, can it?

>> Dane Sloane, MD: 1:53

It can't. the umbrella term is useful in terms of just having a phrase to which everyone can apply, the disease. But we do think about colon cancer and rectal cancer a bit differently in terms of diagnosis and treatment. Gastroenterologists, oncologists, surgeons, will often, sometimes also treat left sided cancers and right sided cancer of the colon a little bit differently. There is some thought, process that left sided colon cancers are, in fact, genetically and clinically different than those from the right side of the colon. so there's definitely distinct disease processes that are encompassed by the term colorectal cancer.

>> Debra: 2:36

Let's go through those. What the colorectal cancers include.

>> Dane Sloane, MD: 2:39

So rectal cancer is considered to be a cancer of the left side of the colon. of course, the rectum is the last ten or 20 part that holds the stool before it's passed out, but it is considered to be part of the left side of the colon. The reason that we will sometimes differentiate it in the medical community is that the signs of rectal cancer can be different than cancers higher up in the colon. And certainly the treatment of rectal cancer is very different. Rectal cancer is actually, more treatable in some ways, more responsive to treatment in some ways than cancers of the, rest of the colon. But again, for your listeners, colorectal cancer can still be treated as one entity when it comes to screening.

>> Debra: 3:27

Is bowel cancer the same thing as colon cancer?

>> Dane Sloane, MD: 3:30

Essentially, I think about bowel when I hear the term bowel, it really can encompass anything from the stomach, the small intestines, to the colon. So it's a bit less specific of a term, but certainly those terms have been used interchangeably.

>> Debra: 3:44

What about sigmoid cancer?

>> Dane Sloane, MD: 3:46

So, sigmoid. The sigmoid portion of the colon is the s shaped with a curvy part of the left colon. It's still encompassed by the term left sided colon cancer.

>> Debra: 3:54

What causes colorectal cancer? Since Chadwick Boseman's brother later revealed that he has also been battling cancer, can we say that genetics is a big factor?

>> Dane Sloane, MD: 4:03

Unquestionably, genetics plays a role, and when, folks hear the term average risk for colorectal cancer, high risk for colorectal cancer. One of the main known or well established risk factors for colorectal cancer is family history. So we know that genetics plays a very strong part, but by no means is that the only risk factor. knowing that colorectal cancer has a genetic component is the reason why we tell our patients. Understand your family history. Talk to your parents, talk to your siblings, talk to your children. because there's unquestionably a genetic component. but there are identical twins where one person will have colon cancer, the other twin will never even have a polyp. So we know that genetics doesn't tell the whole story.

>> Debra: 4:45

So when is a good time for someone to see a genetic counselor, then? Does the patient, the one who has the diagnosis, go see the counselor, or do their family members?

>> Dane Sloane, MD: 4:54

So, fortunately, your doctor would be able to give you guidance in that regard at a center, a multidisciplinary center like MedStar Franklin Square, or the MedStar entities in general. When a person comes in and is diagnosed with a colorectal cancer, it is the diagnosing and treating physician who will make that recommendation to Deb. you have colon cancer, and based on your results, based on the analysis of your tumor, we do recommend that you and your family be seen by genetic counselors. So, that's not something that the patient themselves has to navigate and negotiate. Your doctor can give you recommendations about that.

>> Debra: 5:28

In the spirit of prevention, let's go through the list of some other possible causes.

>> Dane Sloane, MD: 5:33

So, beyond genetics, and again, family history is very, very important, we do think that there are other modifiable risk factors, such as obesity, such as diet, thinking that, a diet that's higher in fiber and lower in fat can be protective against colon polyps and cancer. smoking can certainly be a risk factor for colon polyps, which are the precursors to colorectal cancer. Having other underlying colon diseases, like inflammatory bowel disease, can be another risk. what can a patient do to reduce those risks? Well, they work on those risk factors. So, again, beyond understanding their own family history to look at the rest of their Health am I a smoker? Am I getting a diet that's very high in saturated fats and low in fiber? Am I getting my fruits and my veggies? Have I been diagnosed with a condition like Crohn's disease or ulcerative colitis? And I should talk to my doctor about higher risk screening? These are some of the badges that a patient can look at when thinking about their own personal risk of colon cancer.

>> Debra: 6:28

You mentioned cigarette smoking, and the longer I do these podcasts, the more I realize that there is almost no part of your Health that isn't impacted by cigarette smoking.

>> Dane Sloane, MD: 6:39

Absolutely.

>> Debra: 6:40

Now, you mentioned that depending on where the cancer grows and when we are saying colorectal cancer could be in the colon, in the rectum, in the sigmoid.

>> Dane Sloane, MD: 6:48

So there's really four main sections of the colon, if we can think about it that way. There's the right side of the colon, the transverse part of the colon, which is kind of the upper portion, and then the left side of the colon, which includes the sigmoid, as you're mentioning, and the descending colon and the rectum. And those are kind of in order of how the stool passes through the colon. So, again, there is, evolving evidence that suggests that cancer that develops on the right side of the colon is genetically and distinctly different from cancer that develops on the left side of the colon. Are there different genes that are involved? Are there different cancer evolution in terms of how the cells develop? That happens on the right side versus the left side? These are things that are not yet well understood, but there's certainly evidence that suggests that is, unfortunately, we're seeing this changing landscape of colorectal cancer, as you alluded to earlier, seeing it in younger people and seeing in younger people at more advanced stages, and that can't be accounted for by just delayed screening alone. So we do think that there is significant physiologic changes that are happening in terms of colorectal cancer development.

>> Debra: 7:48

Could it be environmental? Could it be the food that we are eating?

>> Dane Sloane, MD: 7:51

Could absolutely be a factor. my mother loves to say food was just different back in the days when I was a girl. And the truth of it is, I think that we probably underestimate the impact of diet and how much our food is processed. To your point earlier, point about smoking and how there's not a single system that smoking does not impact. Our diet is very, very powerful. And so there's probably a lot of factors that right now may be intangible, that in the future may be better understood in terms of its risk, in terms of colon cancer development.

>> Debra: 8:21

So I thought it was interesting that you said, depending on where the cancer is, the symptoms could be different. What typically are the symptoms? What should people be wary of if they have, say, cancer in the sigmoid? Because 70%, I read, 70% of colorectal cancers are in that area of the.

>> Dane Sloane, MD: 8:39

Colon, and that number may be changing, depending upon which patient population we look at. there are, again, certain populations in whom we're seeing more right sided colon cancers, and that can be truer, for example, for some of our younger patients. But, I think the most important thing for our listeners to understand is that the most common symptom of colon cancer is no symptom at all. So the fact that we have to be intentional about screening is the most important, really, the key thing. most patients who have colon cancer or colorectal cancer are never going to have any symptoms, and this is why we have to go screening, go looking for this disease much in the way of a mammogram. So many women won't feel a lump, right, but they go in for the mammogram, and that's when they find the cancer. So, having all of our patients understand that we have to go screening for colorectal cancer is really critical. Yes. Some patients will have symptoms, such as rectal bleeding. What does that mean? Blood in the stool, blood in the toilet bowl. they may have abdominal pain. They may have some change in their bowel habits, such as new constipation or just a change in the caliber and the size of their stools. Some people will have weight loss at more advanced stages of the disease. for some of my younger patients who've come with colon cancer, they've had no symptoms, but their primary care provider has found, oh, they're becoming more anemic, their red blood cells are low, and that's how they end up getting to their color and cancer diagnosis. I think that the intimidating thing about colorectal cancer is that it typically does not have symptoms. And this is why we urge patients to get screened and be intentional about it.

>> Debra: 10:11

That's a really scary thought when you consider that, and we haven't gotten to this part yet, but that the screenings, really routine screenings, really aren't available until you're 45.

>> Dane Sloane, MD: 10:20

Well, it's interesting the screening age was lowered in the US from 50 to 45 several years ago. And truth be told, we're probably not, capturing many patients who probably should be screened earlier. But this is why, again, it's important for patients to talk with their families and understand their own history, their own family history, and to pay attention to their bodies, because a recommendation is just that. It's a general recommendation for the overall population when it comes down to the individual. I think all of our patients need to pay attention to their bodies and their symptoms, because you may fall outside of that recommendation parameter. but colorectal cancer screening is indeed widely available. I think that patients need to understand what some of their options are, but, there should be nothing standing between a patient and getting effective screening for colon cancer.

>> Debra: 11:11

So let's talk about some of those options. First off, what's an early diagnosis, would you say, what's an early diagnosis of colorectal cancer? Are they staged? 1234?

>> Dane Sloane, MD: 11:20

Yes, they are staged in that way. I would defer to my oncology colleagues to give more of the details about that. But in general, stage one colon cancer is localized to the colon, meaning it hasn't spread beyond that. stage two can imply that the colon cancer is spread into, the lymph nodes nearby the colon. So, a bit more advanced. Stage three disease is where there's more regional disease. So perhaps somewhere in the pelvis, again, near the colon, adjacent to the colon. And stage four disease, again implies widespread disease, cancer that's throughout the body. And one of the more common places for colon cancer to metastasize or spread is the liver. so in general, stage one is the earliest stage, but I think it's important for your listeners to know that colon cancer can also be prevented in some cases, by effective, high quality colonoscopy, because in that case, we're able to find a polyp before it can become a colon cancer, or find colon cancer when it's confined to a polyp, in which case a polypectomy or polyp removal can be curative. So, those are really our success stories when gastroenterologists think about, how do I prevent someone from developing colon cancer? I want to catch a cancer before it's really even a cancer. I want to catch those precancerous lesions.

>> Debra: 12:30

I've read about a new stool test that appears to detect colorectal cancer precursors better than a current fit test.

>> Dane Sloane, MD: 12:38

So you're probably talking about cologuard which is, kind of the newer generation fit test, if you will. So it's going beyond just screening for blood in the stool, which is really kind of the basis by which fit, detects colon cancer and advanced colon polyps. But cologuard is actually detecting dna or genetic abnormalities in the colon. So, the idea is that it can be more specific for colon, cancers and advanced colon polyps increasingly available. I remember when it was first introduced years ago, it was, I won't say impossible, but very, very difficult to get cologuard approved by a person's insurance company. But now it is an approved method of modality for screening. A general perception that stool based colon cancer screening is gross. I don't want to touch my poop. But the truth of the matter is, none of these tests require you to go and play in the toilet bowl. There is a very streamlined way of collecting a stool sample, much in the way as someone will collect a urine sample when they go to their primary care doctor's office. So different, bodily fluid, yes, but it actually is a very clean, very straightforward way of getting to a colon cancer screening option. And unlike the older generation occult blood for stool and fit tests that had to be done annually, the cologuards, the newer generation stool tests only have to be done every three years or so. So, there's an advantage there as well.

>> Debra: 13:55

Here's the options that I've listed. We have the high sensitivity guaic fecal occult blood test or fecal immunochemical test.

>> Dane Sloane, MD: 14:04

It's a mouthful and you're supposed to.

>> Debra: 14:06

Do that every year.

>> Dane Sloane, MD: 14:07

Right? So, the guayak tests, which, is. I know, all these crazy.

>> Debra: 14:12

Check with you before we hit record.

>> Dane Sloane, MD: 14:16

The guayak tests are kind of the old school, ah, culplate tests. So these are the tests that would sometimes require three different stool samples in a year. not the most convenient, testing for many patients. there are some dietary restrictions associated with that. If you can't have red meat, for example, during the testing period, it was really looking for blood in the stool. And those tests would even pick up on again if you had a rare steak. Dietary or ingested blood. the newer generation, yes, is the fecal immunochemical test, which is going to be more specific for colonic blood. only one stool sample required. And yes, that would have to be done annually as well.

>> Debra: 14:51

Okay, the next one is the stool dna fit, which is supposedly done one to three years.

>> Dane Sloane, MD: 14:57

Right. So that's the cologuard test we were talking about earlier. Does, require a slightly larger stool sample than the fit test and, the occult aquiac. But, that can be done every three years.

>> Debra: 15:07

Then the computed tomography. Colonography.

>> Dane Sloane, MD: 15:10

So, CT colonography is virtual colonoscopy. Your listeners may have heard about that. That, is a test wherein a, ah, CAT scan is done of the lining of the colon. So, a patient would still have to complete a laxative to cleanse the colon. Then, a CAT scan is done to look at the lining of the colon. It is sensitive to detect polyps as small as 5 size. so it's a very sensitive test. The downside there is that you've gone through the laxative preparation and they can detect polyps, but nothing can be done at the time of the exam. So if a polyp is found on that study, the follow up colonoscopy is still needed because it's just a visual test. Correct.

>> Debra: 15:49

And that's every five years. Why would people maybe opt for that over doing the colonoscopy? Is there an advantage?

>> Dane Sloane, MD: 15:56

So, as a gastroenterologist, I can tell you there's two main pools of patients for whom I'll recommend that. One is the patient who has a history of colon polyps, but for whatever reason is too sick to undergo a colonoscopy in terms of getting the sedation or going through the laxative, process. Ah, so, a good option for them, not a fit test wouldn't be appropriate in that situation because we know that they've had polyps. We want to go and look for more. but the second category of patients who might get a virtual colonoscopy are the patients who had a failed colonoscopy. So the patient came in and for whatever reason, they have a very large hernia. For example, the colonoscope, can't be safely passed through their colon. They might be in a more appropriate candidate for virtual colonoscopy. Virtual colonoscopy, again, is CAT scan based, so there is some radiation involved. So, it's really not, a testing modality that we think of as first line for most patients to get screened.

>> Debra: 16:44

Okay, next, the flexible sigmoidoscopy every five years and the same test every ten years, plus an annual fit test. I assume that's somebody who's doing both the collar guard and the.

>> Dane Sloane, MD: 16:56

Yeah. So, knowing that the incidence of right sided colorectal cancers is increasing, over the years, and we talked about that a little bit earlier, the relying on flexible sigmoidoscopy, which is a look only at the left side of the colon, is really falling out of favor, because we know that we are leaving out 50% of the colon where there's a fairly high incidence of colorectal cancer. So, again, with this changing landscape of colorectal cancer and where these tumors arise in the colon, flexible sigmoidoscopy, with or without a fit test, is really falling out of favor.

>> Debra: 17:28

Okay, but that brings us to colonoscopy. So let's go there.

>> Dane Sloane, MD: 17:32

Let's go there.

>> Debra: 17:33

Give us a brief description of the screening, who should get it, and if someone hasn't had one in ten years or is concerned about getting one because of the hype that they've heard for years, can you give them any hope of there being improvements to the process?

>> Dane Sloane, MD: 17:48

Colonoscopy is an outpatient procedure. So you come in, you have it done, you go home. it is a test done under sedation. So, there is a burden on the patient and that they can't work that day, and they do need someone to drive them home afterwards. I tell all my patients, the colonoscopy is not the hard part. A colonoscopy is difficult because of the day beforehand. The day beforehand is the person's prep day. So they do follow a clear liquid diet for 24 hours, and they drink a laxative. If there's any improvement over the past two decades is that there are newer, generation laxative preparations that are not quite as hateful, as what we had 20 and 30 years ago. we can use things like Miralax based preps that don't have any taste or grit or texture. It's a, lot to drink, and it's a lot to poop, and there's really no getting around that. But I tell my patients that just like mammography, pap smears, prostate checks, there is no such thing as a perfect screening test. Colonoscopy, has the advantage of being a high quality screening test and also a preventative test, again, in terms of looking for polyps and taking those out. And the quality of the colonoscopy really is tightly correlated with how well you're cleaned out. So the prep, while it's the most difficult part of the process, is the most important part of the process. the good news is that for our average risk patients who don't have any family history of colon cancer, don't have any personal history of polyps themselves, you have a high quality colonoscopy and you are rid of us for ten years. It's only an every ten year exam.

>> Debra: 19:16

This is going to sound silly, but I think there is also an aversion by some people, including myself, years ago, before I knew how the process actually happens, how the procedure plays out, that you're on a table, butt up in the air, like on your knees with your butt up in the air, and I think that people are really, afraid of that.

>> Dane Sloane, MD: 19:38

and I'm smiling at you, but I understand what you're saying. I have a brother who's 57 this year, and when it was time for his colonoscopy, he was horrified. He just didn't want to have it. And I think that there's some natural fearfulness. Right. So there's some natural anxiety surrounding a procedure that involves a camera going in your rear end, of course. Right. but I would have our listeners understand that colonoscopy is done with a person laying on their left side, kind of knees slightly bent towards their chest. No butt in the air. there is no open back gown for sure, but your butt stays firmly on the table and they are covered. Absolutely. Before and after, and minimally uncovered during the procedure. I will say immediately before the procedure, they're meeting with their gastrologist and their anesthesiologist again. They get some twilight sedation during the procedure. It's actually not a painful procedure, to be honest with you. I have actually done unsedated colonoscopies, in the past.

>> Debra: 20:33

I didn't know that was an option.

>> Dane Sloane, MD: 20:35

There are some patients who, unfortunately, don't have social support, so they don't have someone to drive them home. They don't have the ability to, make those arrangements. And in those cases, yeah, we can do an unsedated colonoscopy. Now, I will say it's like being very gassy, very bloated, so it's not comfortable in that regard, and that's why we recommend sedation for most patients. But even though a patient has to relinquish some control in that situation and be under sedation for those 15 or 20 minutes, they're completely comfortable. And then when you wake up, you wake up fully, covered and recovered in the, post procedure area.

>> Debra: 21:09

How long is the procedure?

>> Dane Sloane, MD: 21:11

About 15 to 20 minutes. It's very short.

>> Debra: 21:14

When you said that, I thought I, must have misheard you. No, 15 to 20 minutes.

>> Dane Sloane, MD: 21:18

Yeah, absolutely. It's a very short procedure. So again, I tried to emphasize, maybe overemphasize the fact that the colonoscopy is the relatively easy part. It's the prep day that is the biggest challenge. Having said all of that, I have a healthy respect for the fact that the best screening test is the screening test that a person is willing and able to do. So for some people, stool tests are really the best option. I think that the COVID pandemic really highlighted to us that, there are going to be times where we can't do colonoscopy for whatever reason. In 2020, it was because we shut down the procedure areas and we didn't have an option. So during that period of time, we couldn't just stop screening our patients. So we relied heavily on stool based screening options for patients. there are some patients who work hourly jobs. They can't take a day off of work, to come in and have a procedure done. They can't get a driver to bring them in. A stool based test would be perfect and perfectly appropriate, again, for the average risk individual. For other individuals, they are very laser focused on making sure that they get that preventative test done. Well, for them, a colonoscopy is going to be the most appropriate test. But I tell providers and patients we should meet each other where we are. For a patient who is very fearful about colonoscopy, does not want to have that done, we have another option for our patients who very much want us to take a direct look of the lining of their colon. We'll meet them where they are. But I wouldn't want patients to opt out of being screened because at the end of the day, getting screened, and is the most important thing, the most critical factor.

>> Debra: 22:54

How comfortable can someone feel after they've had, the color guard results come back or the fit test results come back to say that they don't have polyps, you're good for, what, another five years if you do a color guard? Or is it three years?

>> Dane Sloane, MD: 23:10

in terms of terminology there. So a, negative fit test, a negative cologuard test, tells us that you are unlikely to have colorectal cancer. Neither of those tests are polyp detection tests. That's only colonoscopy. and that's an important distinction because, again, those stool based tests are sensitive and specific for true colorectal neoplasms or large polyps or tumors in the colon. They're not there to detect polyps.

>> Debra: 23:36

Very important distinction for sure.

>> Dane Sloane, MD: 23:38

But again, if a patient has a negative fit or negative cologuard, a negative fit once a year, negative cologuard every three years. I tell them, at least we have some reassurance, especially when these are being done on a sequential basis, that you are unlikely to have a significant problem in your colon. so as long as the patient is following that regimen and getting these recommended tests done at the recommended frequency, I think they can breathe easily.

>> Debra: 24:00

Have you ever had anyone come in who had a cologuard and then later was found to have cancer?

>> Dane Sloane, MD: 24:04

Absolutely. Again, no screening test is perfect. And I tell everybody that something that, again, I keep reverting back to other forms of screening. Mammography imperfect. Can they miss breast cancers? Absolutely. can pap smears miss cervical cancer? Absolutely. but it's the reason that we get annual mammograms or biannual mammograms or annual pap smears. If we're doing these tests with the recommended cadence, we're less likely to miss a problem.

>> Debra: 24:31

So the American Cancer Society reported last year that 20% of diagnosis diagnoses in 2019 were in patients under the age of 55, which is about double the rate from 1995. Now, with the number of young people having colon cancer rising, two respected organizations, and you mentioned this, they changed the guidelines, the preventive guidelines, were once recommended to be for, what, 55 or age 50, and now they're 45. It sounds very logical, but would you like to see that get changed to an even younger age?

>> Dane Sloane, MD: 25:07

Maybe.

>> Debra: 25:08

I don't understand, because, look, Chadwick Bozeman still wouldn't have been qualified for the screening.

>> Dane Sloane, MD: 25:13

Absolutely.

>> Debra: 25:14

When he got diagnosed, he died at age 43. Got diagnosed.

>> Dane Sloane, MD: 25:17

Absolutely. Four years earlier. And any gastroenterologist sitting in this chair could tell you 2030, 5100 stories of patients who they've diagnosed at the age younger than 45. Again, these are recommended guidelines, but, those guidelines are not going to encapsulate every person who has early onset colorectal cancer. it is a heartbreaking phenomenon because it's one that we can't readily explain. It's one thing to say, well, a person has x, y, and z risk factors, and therefore they're at higher risk for getting colon cancer at age 30. We don't have a good explanation for that yet. It's something that is being very heavily scrutinized and very broadly studied, but the truth is, we don't have an answer for it yet. So, again, having patients understand that these are guidelines that for sure, they shouldn't start screening later than age 45, but if they're having symptoms, having problems before then, not to ignore them. my youngest patient to date is actually a 26 year old who had no anticipate, no known family history. her PCP noted that she was anemic on her labs, but, more anemic than he would have expected for a healthy mid 20 something female. Ah. she came in in February of 2020 and had her colonoscopy, and we found a transverse colon cancer. So, again, we could lower the age to 40 to 35. We still wouldn't capture some of these individuals. So following generic recommendations, well meaning generic recommendations for colon cancer screening is never going to be the whole story. It still falls to our team, primary care providers, patients, to escalate concerns, when they're present.

>> Debra: 27:00

So, my son in law actually got a diagnosis at the age of 22, stage four. He was a marine. He had been treated at the time for colitis and, inflammatory bowel, whatever. They probably couldn't imagine that it would be colon cancer to screen him. It was the last absolutely test, obviously, that they gave him.

>> Dane Sloane, MD: 27:19

Well, you know, it's funny, because I've been doing this 20 years this year, and when my career started not that long ago, in the grand scheme of things, if a 22 year old came in with rectal bleeding and some belly pain, I would have assumed that, well, maybe it's some colitis, maybe it's some hemorrhoids. It wouldn't have crossed my mind when I first started this that it could be a colorectal cancer. And 20 years later, that same patient comes in. I'm concerned. I really am. And again, is it our food? Are there environmental factors? Are there changes in, the genetics of our bodies? We don't have an answer for it, and it is deeply unsatisfying and worrisome. This is not to say that every person who has abdominal pain and rectal bleeding is going to have colorectal cancer. So I think that we want to avoid the other extreme as well, that every symptoms means the worst scenario. not at all. I mean, common things are still common. And then there's that old saying that we say, when you hear hooves, you think horses are not zebras. I mean, that is a classic for a reason, because common things are still common. But I think having that dialogue, the dialogue with your families, the dialogue with your primary care, the dialogue with your gastroenterologist, to say, I have these symptoms. And in the context of everything else you know about me, what should I do? I think having that dialogue is critical.

>> Debra: 28:38

Which is why we're here, for awareness. In the weeks and months since his death, an analysis of Google trends and Wikipedia page views found that the search for colorectal cancer after Chadwick Boseman died. Yeah. Jumped at nearly 600%.

>> Dane Sloane, MD: 28:54

Yeah.

>> Debra: 28:54

We'll be very interesting to see in years to come if that spike in awareness does anything to the numbers of, diagnosis.

>> Dane Sloane, MD: 29:02

It would be great if it would translate into more people getting screened. And I'll speak for my community when I say that there are a lot of african american men in particular, whose awareness of colorectal cancer, I mean, just skyrocketed after Chadwick's death. I think it hit home for a lot of young black men, but a lot of people in general. And again, I think it's important to not live life in fear. Right? Not live life alarmed at every symptom, but to understand that the landscape of colon cancer is changing. And so in that changing landscape, how can I best take care of myself so that I minimize my own risk? We definitely, in my practice, saw an upsurge in patients coming in with new concerns and new worries, and understandably so. But again, I think it's just as meaningful as it is to ensure that patients are getting screened. It's also meaningful to ensure that patients are not unnecessarily fearful. Talking to your primary care and talking to your gastroenterologist can hopefully put into a frame a person's individual symptoms and then do that risk stratification, understand what is the level of concern for this person, and then proceed accordingly.

>> Debra: 30:16

Well, since you brought up the primary care and the gastroenterologist part of it just now, how do patients come to see you? Do they come to you directly, or do they come to you through a primary care physician?

>> Dane Sloane, MD: 30:26

It's a mix. It's a mix. some patients have the option to be seen by a specialist without a referral. That's no problem. Other patients will go through their primary care provider, whatever means a patient takes whatever path they take to get to our office. really, the outcome is the same. We're going to talk with the patient about their personal history, talk with them about their family history, get laboratory values when it's necessary, like do laboratory testing when necessary. And then again, we talk about diagnostic testing and screening options as appropriate. For those patients who come to us, they have a symptom or a problem or animal screening test, and they have a colonoscopy. We find a colorectal cancer, the name of the game is expedited, multidisciplinary, integrated care. So no patient is alone after that diagnosis. and I know that the first thing on a person's mind afterwards is what next? What's going to happen to me? So the blessing of being at an integrated care center such as this is that the minute a patient has a new diagnosis of colorectal cancer, they are onto the next step. And I literally mean, when they're in that recovery area with covered up in their blanket and sipping some juice, I'm instantly talking to them about the next steps. Imaging labs, getting to see a surgeon when appropriate, seeing an oncologist, so they don't leave the hospital that day without next steps in place, which would.

>> Debra: 31:48

Be pretty frightening if they didn't have some direction.

>> Dane Sloane, MD: 31:51

Can't imagine getting absolutely well.

>> Debra: 31:53

We found three polyps, and ones do you know right away that has cancer.

>> Dane Sloane, MD: 31:57

Sometimes with enough experience, you can look at a polyp and say, this is worrisome, or you can look at the one say, this is nothing to worry about at all. And to the best of our capability, we do tell a patient on that day if we're concerned or not. But I think sometimes there's a fearfulness in terms of screening, just not knowing what will happen if the worst diagnosis does come. So I think it's important for patients understand when they're getting care through their specialists, especially when they're coming to a multidisciplinary center, they're going to leave with answers once they get a diagnosis. If it is colorectal cancer, they're going to get escalated to the next steps in an expedited fashion. And for those patients who have polyps or who have perfectly clean screening tests, they're going to get recommendations as well. In terms of what to do next. I think knowledge is power, and we want to empower our patients with understanding what is their next step.

>> Debra: 32:49

Real quick. I've been wanting to ask this question forever. Is a gastroenterologist the same as a proctologist? If not, how are they different?

>> Dane Sloane, MD: 32:58

So I don't know that there are dedicated proctologists, per se. So procto implies rectum. so that would be someone who just specializes in the rectum. I can't think of who that might be.

>> Debra: 33:09

I, didn't even know what that was.

>> Dane Sloane, MD: 33:10

So my kind of old school understanding of that is a proctologist is someone who, like a colorectal surgeon, but obviously they do a whole lot more than just proctology.

>> Debra: 33:21

It's an old term, then a little bit. I've never heard of any here at MedStar Health

>> Dane Sloane, MD: 33:28

Again, I think it's more of an outdated term these days.

>> Debra: 33:31

Interesting. Good to know. So each year, close to 2 million people around the world are diagnosed with colorectal cancer, and more than 930,000 people die from it, according to the World Health Organization. Can it be prevented?

>> Dane Sloane, MD: 33:46

Yes. Understanding that not every colorectal cancer is preventable. Many are from the standpoint of, again, understanding that family history, seeking help when there is a new symptom or a new concern such as anemia, and ensuring that you're getting the colon cancer screening that's appropriate for you. In terms of the tests that we have available for screening, the only preventative test is that colonoscopy because it's going to not only diagnose a polyp, diagnose a cancer, but it can also remove that polyp and that way be preventative against colorectal cancer.

>> Debra: 34:20

Any final thoughts on what people need to know? What's the most important thing that you hope people will take away from this podcast?

>> Dane Sloane, MD: 34:26

Get screened. Doesn't matter what you do or what test you choose or how you get there. Get screened and understand what your risk factors are. Again, we talk a lot. There's a lot of lips or risk. Eat a healthy diet and stop smoking, maintain a healthy weight, do those things, of course, but get screened. Even if you have minimal risk factors, get screened. And again, it matters less what you choose, what you choose to do, how you choose to do it. Just talk to your doctor about getting it screened.

>> Debra: 34:54

Does benefer count as fiber in your diet?

>> Dane Sloane, MD: 34:56

It sure does. Okay, good. It sure does. I tell patients fiber is kind of a triple whammy. It helps your lipids, your glucose, and it lowers your cancer risk.

>> Debra: 35:04

Terrific. It's in my coffee every morning fiber commercial right there.

>> Dane Sloane, MD: 35:09

But yeah, fiber is a good thing.

>> Debra: 35:12

Thank you, Dr. Stone.

>> Dane Sloane, MD: 35:13

Thank you for having me.

>> Debra: 35:14

I appreciate it so much for your time and your expertise here on MedStar Health doc. Talk. To learn more about colorectal cancer prevention and detection, go to medstarhealth.org backslash cancer.