 Joining us to talk about your health is Dr. Andrea Bafford, Chief of Colon and Rectal Surgery at the University of Maryland Medical Center and Associate Professor of Surgery at the University of Maryland School of Medicine. Doctor, good to see you in person again. Yes, thank you so much for having me. Thank you for being here. A couple of troubling trends in the world of colon cancer. You're seeing younger patients and you're seeing people with more advanced cases. You're seeing that in your practice. That's right. Definitely, it's noticeable. And recently, we've seen a doubling of the likelihood of cancer in young patients. So people under the age of 55, it's almost doubled since the 90s. What on earth could be behind that? Yeah, unfortunately, we don't really know. It's likely related to some diet and lifestyle factors. So we know, for example, obesity is something that is associated with colorectal cancer and there are higher rates of obesity. Lifestyle factors could be playing a role like diets high in processed meats and red meats. But really, we're not sure and we don't know what this trend is from so that really points to the need for more research aimed at figuring out what the causes are. Risk factors for colon cancer. Family history genetics can be part of it? Yes, definitely. So family history is probably the number one risk factor. Other things, having certain GI diseases. So patients with Crohn's disease and ulcerative colitis, we know, have a higher risk of colorectal cancer. And then there are some, again, lifestyle factors. So smoking, alcohol use, sedentary lifestyle, diets higher in processed meats and lower in fresh fruits and vegetables. Patients with diabetes, these are all risk factors. We think of it as a disease that affects older people. So even within the medical profession, when a younger person maybe sees a primary care provider complaining of GI symptoms, they're not thinking cancer at that age. Yeah, that's exactly right. So if someone in their 20s, 30s have GI symptoms, most of the time you'll think it's something, maybe a viral illness or diet related and it's not the first thing that comes into your mind. And colorectal cancers we know are most commonly found with screening. Well, we're not screening patients under the age of 45, previously 50. So yeah, it's something that we're finding, now that we know that more people that are younger are having the disease, it's shifted the age at which we start screening. When you talk about screening for colon cancer, everybody watching knows the gold standard is colonoscopy. That's right, yeah. Is there anything else? Is there anything less invasive that's gaining widespread use? Yeah, there are other non-invasive tests, but definitely, as you mentioned, a colonoscopy really is the gold standard. So the big change is that in the past, colonoscopy was recommended for patients starting at the age of 50, and now the screening has dropped so that we start screening at the age of 45. So between the ages 45 and 75 routine colonoscopies really is the best way to screen for colorectal cancers, but there are some non-invasive stool tests that are either looking for blood or looking for DNA changes that are present in precancers and cancers. So these stool tests are definitely better than not screening, but they do have their limitations. For example, false positives, they might show that you have a cancer when you don't, and also false negatives. So the other thing about them is that colonoscopies, the purpose really is to remove these precancerous lesions. So when you get a stool test, if it's positive you still have to follow that up with a colonoscopy, but there are, and if that's the way to get more people to do it, I think that that's effective screening, knowing that a actual colonoscopy is the gold standard. Let me remind our viewers if you have a question about colon cancer, screening for colon cancer, give us a call at the number on the screen or send an email to livequestionsatmpt.org. Talk about polyps for a second. Every time somebody gets a polyp in their colon, is that on a path to becoming cancerous at some point? No, not all polyps are gonna become cancers, but there are some polyps that will, and those are called adenomas. So adenomas are the precancerous types of polyps, but a fraction of those polyps will become a cancer, not all. But the problem is you don't know which ones will. So we do need to remove them so that the ones that will won't have a chance to become a cancer. And once somebody's been examined and polyps have been found and removed, does that change the screening going forward? Right, it does. So if you have adenomas, then you're gonna end up having colonoscopies at more frequent intervals than if you had no polyps. But it's just, it's still very effective. It's just that you're always gonna make sure that you're getting those removed before they can become a cancer. All right, so we've talked about more cases showing up in younger patients. You're also seeing more advanced cases showing up. What's the theory for why? I think that advanced cancer, we don't, again, we don't know for sure, but some of that is gonna be the higher incidence in younger people, because again... So if it's starting earlier, it has a longer time to become a cancer. Right, because you haven't found them because we're not screening for them. So that's gonna account for some of that difference. And then we also think there may be a plateauing in screening. So for many years, screening was improving every year and we saw nice decreases in the incidence, but that rate of screening is probably plateauing, accounting for the more advanced stages. It's possible there's a pandemic effect, the long period of time where people didn't go to the doctor for routine care, because that's where all the sick people were. These most recent, the data is from pre-pandemic, but I expect that change is definitely gonna be seen post-pandemic, because even in my practice, I saw patients who were found to have cancers that said, we didn't get our colonoscopy when I was supposed to, because of the pandemic. I got it a year later, or after I had some bleeding. So I do unfortunately think we're gonna see some of that. Let's take a phone call. Let's wait on the phone call and I'll ask you about the dreaded colonoscopy prep. In simple terms, before the scope is used, you sort of need to empty out, which means historically drinking something icky. Has it changed? It's changed to some degree. There's more different types of preps. Like no matter what, we have to clean out the colon so that we could see the walls clearly. So there's no getting around, having to go to the bathroom a lot. But the prep itself, there's different ones. There are some very low volume preps, so instead of drinking the four liters or gallon, you could just do shot. It wasn't four gallons. I've done this, it was not, it seemed like four liters. Four liters? Four liters, yeah, or a gallon. But now there's very low volume preps, and then there's also preps that you could just mix with your regular drinks, like mixing with Gatorade or mixing with water. A viewer wants to know, is the norm still to not recommend colonoscopies for people over 80 years old? That's a great question, thank you for that. So the recommendation for patients for colonoscopies between the age of 75 and 85, we still recommend them and select people. So obviously if you've had a history of adenomas, if you have a personal history of colon cancer, you're gonna be at higher risk, so we'll continue colonoscopies. If you're a super healthy 80-year-old, you still benefit from removing pre-cancerous lesions. So they are selectively done between 75 and 85, so no, there's not like a abrupt cutoff. Let's take a phone call from Montgomery County. This is Joyce. Joyce, thank you for the call, go ahead. Yes, hi. I'm wondering, you alluded to the DNA tests, like colon guard and those that are non-invasive. Could you speak to the efficacy of those please? Thanks for the call. So colon guard is effective in diagnosing both pre-cancerous polyps in cancers. Again, I think the main limitations is that we know colon guard has false positives, meaning they will show you have cancer when you don't, you don't get that with a colonoscopy, and there are times where they don't pick up polyps in cancers, especially polyps. So colon guard is most commonly used in combination with fit tests, which is looking for blood, and then routine colonoscopies are the best way to find colorectal cancers, not just to find them, but also remove the pre-cancerous lesion. So I think the biggest drawback of colon guard is the fact that they're not therapeutic. Speaking of therapeutic, if a polyp is found and it can be taken care of at colonoscopy, that's it. If it can't be, they come see you. That's right, yeah. So colonoscopy removing of polyps, we've even gotten much better at that. So there's some advanced endoscopic or colonoscopy techniques to remove larger polyps or flatter polyps, but if you have a polyp that can't be removed with a colonoscopy, or if you found to have a cancer, then typically surgery is needed. Recent advancements in the surgical field, how has it changed in the last decade or two? I think the biggest thing with surgery is that we're getting better at doing it with less invasive techniques. So the same exact surgeries with no compromise as far as cancer outcome, we're able to achieve with many incisions with laparoscopy and robotic surgery. And so those techniques allow patients to have less pain after surgery, quicker return to work. So the recovery is a little bit easier with these less invasive techniques. I mentioned the idea earlier that somebody with GI complaints might go to a doctor and especially if it's a young person, they might not think cancer. What are the symptoms that should make somebody think about colon cancer? Yeah, so I think one thing to know is most of the time it's found when it's asymptomatic. So that is why screening is so important. Some symptoms you may have are blood in the stools or black stools, anemia, especially iron deficiency anemia, changes in the bowel habits. So increasing constipation, for example, or noticing that the stools look different, like maybe thinner than before, these are all things that may indicate colon cancer. Just in a sentence, the takeaway here is to take any of those symptoms seriously and get screened if you're in the right age group. Yeah, definitely live a healthy lifestyle. So exercise, eat healthy, and get your colonoscopies. Dr. Andrea Bafford, Chief of Colon and Rectal Surgery at the University of Maryland Medical Center. Doctor, we appreciate your time. Thank you very much. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.