 Joining us for our Your Health segment is Dr. Andrea Bafford, assistant professor and chief of colorectal surgery at the University of Maryland School of Medicine and University of Maryland Medical Center. Dr., thank you for being with us. Thanks for having me. It's great to be here. Good to have you. We're here to talk about colorectal cancer, which I understand has been declining overall, but increasing in people under age 50. What's going on? Right, that's right. That's exactly why it's increasing. And still, cancer patients less than 50 account for 10% at most of colorectal cancers, but it has been doubling in rate as opposed to declining, like you said, in everybody else. Probably something to do with dietary habits, lifestyle, rising rates of obesity. These are some reasons we think it may be rising, but it's something that definitely is being seen and has even changed our guidelines as to how to screen people for colorectal cancer. I was going to ask if it's gotten to that point yet. How have the recommendations changed? It's starting to shift to 45 for the age of a first screening colonoscopy as opposed to 50, which it was in the past. And that's in the case of somebody without a family history. That's right. That's right. So, people with family members who have had colorectal cancer are at higher risk. And those people should have colonoscopies 10 years before their family member had colorectal cancer, even if it's before 50. But this is the general population. Some of the societies, like the American Cancer Society, recommends 45 now. What's the process? We'll talk about polyps. Is that how it always gets started? Polyps are the growths that are there before the cancer. So, yes, the cancers do start as polyps. And we think it takes a while for those polyps to become cancer, maybe about 8 to 10 years. So, the whole point in doing your colonoscopy is to find these lesions and remove them before they have a chance to become cancer. Okay. And this is obviously, it's a major cancer. It affects one of the top cancer killers. Right. Third most common cancer in men and women. And the third most common cause of cancer related death in men and women. And if everybody got a colonoscopy when the recommendations say to do it, as a surgeon, you would be far less busy, right? That's right. Yeah. So, there's an opportunity, but the procedure itself has a bad reputation, you can say. Yes, it's not, mostly the prep ahead of time isn't the most pleasant. You have to clean out the bowels to be able to see things, okay? There are some other screening tests now available that rely on DNA changes in the stool, for example. There's virtual colonoscopies. So in certain cases, there's other options to the standard colonoscopy and that may help in some cases. What are the pros and cons there? If you're able to get somebody, you can't talk somebody into the colonoscopy, but you can get one of these other screening tests. What's good? What's bad about that? So, the other screening tests certainly have less prep involved and then the procedure can be done without any sedation, for example, without anesthesia. The con definitely in why I think a colonoscopy is always going to be gold standard is a colonoscopy allows you to intervene. So if you find a polyp, you remove it right away, as opposed to having a second study or procedure done in order to do your preventative test. And then also, if you could see something in biopsy, you diagnose it. Cancer is earlier. Let's get to the phones of Prince George's County. This is Nadia. Nadia, thank you for calling. Go ahead. Yes. Hello. You're on? Yes. I was going to ask Dr. Bedford that recently I did do colicard and it did come back positive. My question was how reliable is colicard and how do I prepare myself for the procedure having diabetes? Interesting. Thank you very much. Best of luck to you. Sure. So colicard test is quite sensitive. It's less able to be specific. So you may find a change, but it doesn't always mean that there's something there. But it's a good entry so that it allows us to screen people who would benefit then from the more invasive procedure, the colonoscopy. And as far as how to prepare with diabetes, we do keep patients on liquid diets for the most part, the day before the procedure. So I think that helps to maintain the blood sugar levels, not at a more normal level as you're doing your prep. And then if you have your procedure earlier in the day, for example, the next day, then there'll be less chance of having a low sugar level in the morning. But definitely ask your doctor about that because it depends on, like for example, if you're on insulin, we tend to halve the dose of the insulin. So they'll have very specific recommendations for you. They'll review your medications and let you know what to do. But it's definitely something that we're very familiar with and adjust accordingly. Any advances in the prep itself? You mentioned that's an objection for a lot of people. Has it changed at all? Yeah. There's preps available now that are very, very low volume, so you're almost doing a couple shots as opposed to having that jug of solution. So that helps a lot. There's ones you can mix with Gatorade, for example, and that's a lot easier to tolerate as well. So there's definitely improvements. Let's take a phone call from Howard County. This is Steve. Steve, thank you for calling. Go ahead. Hi. I've had regular screening since I was 50. I'm 72 now. My mother had colon cancer back in the 1970s. And this last one that I had, had the next one when I'm 75, and my doctor has said that that will be my last one, that they don't screen after your age 75. So I'd like to find out why and why not, and why can't I get one? Steve, thanks for the phone call. You mentioned there's a long period of time between when a polyp proceeds to become cancer. Is that it? So that's a great question. And a lot of our guidelines do recommend stopping screening at the age of 75 because you're benefiting less from a prevention standpoint because, again, it takes maybe a decade for a cancer to develop. However, between the ages of 75 and 85, and even older than 85, you really decide based on a specific person. So if you're in great health, you have very little medical problems, you know, very active, I still would continue screening patients over the age of 75 because you're in such great health, you'll still benefit from finding a cancer early and treating and expect to do well afterwards with treatment. So a caller can probably talk a gastroenterologist into doing a colonoscopy. Can he talk the insurance company or Medicare into paying for it? Yeah, I think there's a lot of different reasons to continue to do colonoscopies, and it may be that you have, you know, a family member or some symptoms like blood and the stool, for example, that if you have those things, we do, especially in that over 75 to 85, are a little more selective with colonoscopies, but reviewing any symptoms that may trigger a lower threshold to do the study. A call from Western Maryland, this is Lisa. Lisa, thank you for the call. Go ahead. Yes, I think you may have just answered my question, but it was more of a case of how is the insurance companies taking advantage or lack thereof at a 45-year rule for colonoscopy and going forward? Thanks very much. Probably not something you deal with directly that much. Yeah, I'm less familiar with insurance coverage, and right now some societies recommend the 45-age screening initiation, and others don't. So I'm not, as far as insurance companies, I think there is definitely enough data and having the American Cancer Society recommend the age of 45 should allow for insurance companies to cover. Is there anything people can do to prevent colon cancer or lessen their potential for developing it, particularly if there's family history? Yeah, so we've been talking about screening, so definitely getting adequate screening, but other things you could do are dietary changes, a healthy diet high in fiber, lower in animal proteins and red meats. That is shown to increase, those things are shown to increase colorectal cancer, so if you're able to control those things, it's helpful. Regular exercise of physical and activity has some association with colon cancer, maintaining a healthy weight, avoiding excess alcohol intakes. So for men it's considered two drinks, more than two drinks a day is excess, and for women one a day some moderate alcohol intake are none, and then not smoking. So these are all lifestyle things that everyone can do to decrease their risk. What's happening on the treatment side? You do surgery, you do with robots sometimes. Yeah, so with surgery we are able to do the same surgeries with less and less invasive means, so robotic surgery, laparoscopic surgery, those are surgeries with minimal incisions, so you're able to do the adequate cancer surgery, but decrease the time off of work, the amount of pain after surgery, improve recovery. We're trying to preserve organs more, so maybe doing less surgery in a way, period. And then from the chemotherapy standpoint, more of the therapies are now targeted, so we're looking at specific cancer genes or the proteins they make or the environment they're in, and targeting those specific things so you can individualize treatment. And even with radiation therapy, which we use for rectal cancer for example, there's improvement, proton therapy, something we offer that decreases. Dr. Bafford, we're going to have to leave it there. We appreciate the visit, thank you so much for joining us. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.