MedLink Health Connections Podcast

Colorectal Cancer: What You Need to Know with Dr. Nicole Powell

• MedLink Georgia • Season 1 • Episode 7

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Colorectal cancer is one of the most preventable yet deadly cancers if left undetected. Dr. Nicole Powell, DNP, a family nurse practitioner at MedLink Winder, shares key facts about this common condition.

She explains how colorectal cancer develops from small polyps that can become cancerous and highlights a critical update: screening now starts at age 45 instead of 50 due to rising cases in younger adults.

Dr. Powell breaks down screening options, from at-home tests like FIT (yearly) and Cologuard (every three years) to the gold-standard colonoscopy, which detects and removes polyps. She also addresses common barriers to screening and highlights free Cologuard testing for qualifying MedLink patients.

Early detection saves lives—when caught early, survival rates are significantly higher. Don’t let fear or embarrassment stop you. Talk to your provider about the best screening option for you and take charge of your health today.

Tangela:

Welcome to this special episode for Colorectal Cancer Awareness Month. Today we're joined by Dr Nicole Powell, a family nurse practitioner with a Doctor of Nursing Practice degree. She's part of our MedLink Winder team and is here to break down everything you need to know about colon cancer what it is, why screening matters and the different ways to get tested. Let's dive in. To kick things off, I'd like to welcome Nicole. Nicole, can you also start off by explaining what colon cancer is and how it develops?

Dr. Nicole Powell:

Thank, you so much, tangela, for having me. Yes, colon cancer, also known as colorectal cancer. You may see it as CRC screening on some documents. It's a colon. It's a cancer that occurs in the colon or rectum, which are parts of the digestive system. It usually starts from small little clumps or cells called polyps, and over time, these polyps can become cancerous. It's one of the most common types of cancer worldwide and that is why we like to make sure that we're screening for it.

Tangela:

Okay, and can you kind of explain exactly why this screening is so important?

Dr. Nicole Powell:

Yes, so its prevalence varies by region. There are influential factors such as age, genetics, diet, lifestyle. However, it is generally more common in our developed countries. So early detection is key, because if we detect something early, it's easier to treat. So if we detect pre-cancerous polyps or early stage cancer before symptoms develop, it greatly increases the chances of successful treatment and cure increases the chances of successful treatment and cure.

Tangela:

Okay, and you kind of mentioned age a little bit. So what age should individuals start getting screened for colon cancer, and are there any exceptions?

Dr. Nicole Powell:

Yes, so there's a couple of different ages that you'll hear out there. The US Preventative Task Force and the CDC have a couple of different ages, but the age that we've started using now is 45, recommended for everybody. There are some exceptions, like you said, which are you have a very high incidence of colon cancer in your family or someone in your family at an early age had colon cancer. We would want to screen you sooner. Someone in your family at an early age had colon cancer. We would want to screen you sooner.

Dr. Nicole Powell:

If you were to come into the office with certain complaints, like you had a change in your bowel habits or your stool all of a sudden was a very different consistency and there wasn't a reason for it like a diet change or certain medications that can cause that, we would be concerned and we may do some screening. Or if, like, the size of your stool has changed so all of a sudden it's very skinny and it comes out like a ribbon almost, those are things that would make us want to send you to a specialist to be screened. And at that time it's not really screening. We're looking more for a reason, so it's more of diagnostic testing at that point.

Tangela:

Okay, and some of these screening methods that are available for colon cancer, and what are their pros and cons?

Dr. Nicole Powell:

So I don't. Personally, I don't think there's any cons, but there are some that you know patients prefer over others. Of course, patients prefer the less invasive ways of screening. So those are like our fit kit that we do a lot at our offices here, and when you have polyps it can cause bleeding in the colon. So when we see blood in the stool we may be able to quote, unquote, kind of assume that they're polyps. But it could be other things. So the screening does not mean that you have polyps. The screening does not mean that you have cancer. It just means that we detected blood. Blood can also come from other things, such as you were constipated and had a little bleeding with hemorrhoids or something like that. So it may not be at all related to cancer. So we do use that test as a screening method, but it is not something that directly means oh my gosh, this person now has cancer. We just want to make sure that then we look further to see why are we having this bleeding?

Dr. Nicole Powell:

Another test that we do is the Cologuard test, which that screens. That one is a little more specific and that is looking for the DNA. It's like a DNA-based screening kit and that one is a lot more specific, so it's not just looking for blood like the Fit Kit. If that one comes back positive, we would then send somebody to get a colonoscopy because again, we want to know why is it positive. And with these tests we have found that when they do get the colonoscopy the person doing the colonoscopy most of the time looks even more carefully because they're knowing there's a reason why this test was positive and they're trying to find the reason why it was positive. So those tests are really good.

Dr. Nicole Powell:

With the FIT kit, you have to do that one every year. If it's negative, those tests are really good. With the Fit Kit, you have to do that one every year if it's negative. With the Cologuard, if it's negative, we screen you every three years, unless something comes up in between that time. With the colonoscopy, that is still considered the gold standard because they actually go inside with a camera and they can see everything. If they see polyps at that time, they can remove polyps at that time. So that is considered preventative. Even they can remove a polyp before it becomes cancerous. And then we prevented that from proceeding to anything worse With the colonoscopy. It depends on what they see. That will kind of give you the time that you need to come back. So if they see several polyps or something concerning, they may tell you three or five years. If they see nothing at all and you have a very low risk of colon cancer, you may get seven to 10 years before you need to come back.

Tangela:

So how does regular screening improve survival rates and reduce mortality associated with colon cancer?

Dr. Nicole Powell:

So when we detect colon cancer early, the five-year survival rate is significantly higher than those that we diagnose in later stages. So if we find cancer that's stage one, it's way easier to treat than cancer that is at stage four or cancer that is now spread to surrounding parts of the body. So screening helps us catch things earlier because we're just checking for stuff. There isn't any issues, you're not having any symptoms, so it gives us the best likelihood of finding something at a lower stage if we find something, and being able to treat it sooner.

Tangela:

What are some common barriers that you find to colon cancer screening and how can they be overcome?

Dr. Nicole Powell:

With our Fit Kit and our Cologuard. The biggest barriers that I've seen, even most recently with patients, is they don't want to have to mess with their stool at home. Both of those require them to use a little device that kind of touches the stool. And we provide the patients with gloves and all of those things, but it's still just. They really don't want to be at home playing in their poo so to speak.

Dr. Nicole Powell:

So those are hard sometimes to get people to complete. Also, when you come back with the fit kit you're walking back into the office and you're dropping off stool and anybody else who has done that. They kind of know what you're at the office for. So there may be a little embarrassment attached to that. For that reason sometimes we can get patients to buy into the Cologuard because they still have to do the kit at home but the Cologuard is picked up from your house so you're not having to go out in public with a big box kind of showing off to the world that you had colon cancer screening. So those are the barriers for that.

Dr. Nicole Powell:

I see in my patients just me personally that I have more barriers trying to get people to get their colonoscopy because they don't want the invasive procedure, they're afraid to go to sleep. They heard from a friend that the prep is really difficult to take on and very uncomfortable. I myself have not had a colonoscopy but my sister, she recently had a colonoscopy and she told me that the prep was not uncomfortable. She just did not enjoy drinking that much Gatorade flavored drink. That was her most, that was her biggest complaint about it. But the actual prep was not very uncomfortable, but it's necessary because they want to make sure that your colon is as clean as possible so that they can see everything. So those are the biggest barriers that we see.

Dr. Nicole Powell:

Some of them are also financial aid. So if somebody comes back, if somebody comes to us and they've received a fit kit and they're sliding fee and the fit kit comes back positive and we say, oh gosh, we need you to go get a colonoscopy. That is a big charge for them to take on if they're a cash paying patient and we do have some financial aid resources. Right now, at the time of this podcast, we do have free Cologuard for our cash pay and sliding fee patients and that is a huge discount that Exact Sciences and Cologuard has been very, very gracious to give us. And that is more. It is a more specific test. So hopefully we're able to capture people more accurately that way and not have to send so many people to get a colonoscopy. But when that one comes back positive, we still want them to get that colonoscopy and that can be quite expensive for some patients, especially if they're cash paid.

Tangela:

Well, that's awesome. I did not know that. You mentioned a little bit of the prep process. Can we go a little bit more in depth? I'm just curious. Maybe talking about it maybe alleviate some of that worry. So what is the preparation process look like? I know you mentioned the big drink, which I've seen people talk about all the time, but what is a little bit more? What else is that? What else is there to that?

Dr. Nicole Powell:

Yeah, so it really depends on who's doing the procedure. But most recently what I've seen for most of my patients for their prep has been a solution of Miralax mixed with yellow Gatorade, because they don't want you to have like a red drink or a purple drink or something that may skew the results or skew what they're looking at, and they have you drink large, large amounts of this for several hours. Most of the time it's a whole day prior to your procedure. So most people are wanting to have their colonoscopies done early in the morning because they've been doing this prep. Some I've seen 12 hours, some I've seen 24 hours. So it really varies, probably per person and per that for the surgeon or the person doing their procedure, per their preference. But again, like for the patients, I see it's 12 to 24 hours.

Dr. Nicole Powell:

Lots of this Miralax mixed in with Gatorade, which Miralax is a stool softener. It helps bring more water into the gut to soften your stool, so it's really just trying to clean you out. It's not intended to cause explosive diarrhea or any of those things, but I'm certain at times it can, depending on how you react to the solution or if they give you one of the other solutions that is a little more aggressive, so I can see how people would not look forward to that. However, it's so necessary and so needed for us to make sure that we give them the best view of everything, so that we get the most accurate results.

Tangela:

Do you know if there are any specific recommendations from organizations like the CDC or USPSTF regarding colon cancer?

Dr. Nicole Powell:

screening. So the CDC is recommending adults ages 45 to 75 get screened regularly, and regularly kind of is like we talked about earlier, which is the Fit Kit every one year or the Cologuard every three years or whatever is preferred or recommended by your gastroenterologist for your colonoscopy. The US, the USPSTF has is the one who is still saying age 50. However, the American Cancer Society has also adopted the age of 45. No-transcript no-transcript.

Dr. Nicole Powell:

Nothing specific other than making sure that we're always for providers.

Dr. Nicole Powell:

Make sure that you educate your patients, listen to them about their concerns and the things that are holding them back, Because sometimes it's just a misinformation or miseducation from something they've heard from friends or family members, and we really want to dispel those myths so that we can get them screened.

Dr. Nicole Powell:

But also, for patients, just making sure that they're educated and helping them, you know, linking them to resources like the Cologuard that we have available right now for patients. Use that as much as possible and really drill into the patient that this is an awesome opportunity to save you a lot of money to get a really great screening test. I've used that a lot. I tell people this test is usually over $500 and we're able to give it to you for free. So please take advantage of it and just helping them. You know, leaning in to what is important to them staying healthy for their family, so that they can be around to enjoy their life and making sure that we keep educating them and hopefully they'll spread that on to their friends and family and we'll see more people coming in to get screened. Yeah, that's the Cologuard.

Tangela:

That's amazing that we can offer that for free, you know, because that's awesome. Thank you so much for everything educating our audience and patients and anybody listening. A little bit more on colorectal cancer. It's very important and you know, you gave us some statistics. We talked a little bit more on colorectal cancer. It's very important and you know, you gave us some statistics. We talked a little bit about all the things. So thank you so much for being on the podcast.

Tangela:

Thank you for tuning in to the MedLink Health Connections podcast. We hope you found today's episode informative and inspiring. If you enjoyed the show, please subscribe, rate and leave a review on your favorite podcast platform. Remember the information shared in this podcast is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for any medical concerns. Medical advice Always consult with your health care provider for any medical concerns. Stay connected with us on social media and visit our website at medlinkgaorg for more resources and updates. Until next time, stay healthy and take care.