Exploring Trends of Colorectal Cancer in Younger Adults

[00:00:00] Speaker A: From Riverside Health system. This is the Healthy you podcast, where we talk about a range of health related topics focused on improving your physical and mental health. We chat with our providers, team members, patients, and caregivers to learn more about how to maintain a healthy lifestyle and improve overall physical and mental health. So let's dive in to learn more about becoming a healthier you. [00:00:28] Speaker B: All righty. [00:00:28] Speaker A: I'm really excited to have in the healthy you studio today with me, Dr. Jamila Winter, fellowship trained gastroenderologist with Riverside gastroinderology specialist. Welcome. [00:00:43] Speaker B: Thank you so much for having me, Frankie. I'm excited to join you and to talk about a very important topic of colon cancer, especially in the younger population. [00:00:51] Speaker A: Absolutely. Well, thank you for taking time out of your busy schedule to talk with us a little bit today. [00:00:56] Speaker B: Of course. [00:00:57] Speaker A: So this episode, we're going to be diving into exploring trends of colon cancer in younger adults. Okay, so a little background. Over the past couple of years, we have, unfortunately heard more about younger adults. [00:01:12] Speaker B: That's right. [00:01:12] Speaker A: Those in the being diagnosed with colon cancer. And in 2020, actor Chad Boosmith. Did I say his name right? [00:01:21] Speaker B: Yeah, I think that's. [00:01:23] Speaker A: Died at the age of 42. After a four year battle with colon cancer. The incident of colorectal cancer in young adults is on the rise. So we will be chatting with you about that and look forward to hearing just around symptoms and disease prevention and absolutely, health promotion. So tell me why you decided to pursue a career in this particular specialty. [00:01:49] Speaker B: Absolutely. And so, for those of you who don't know, gastroenterology is a field of basically taking care of digestive and intestinal problems. More common causes for you to see GI include acid reflux disease, Crohn's, ulcerative colitis, just to name a few. The reason why I decided to go into the field of gastroenterology is actually a very exciting field, and every single day is very different. So it's mostly office based. So I have the fortune of talking with patients and basically following them throughout their life. Like, there's a lot of continuity of care. Oftentimes I feel like I'm patient's primary care provider. [00:02:33] Speaker A: Right. [00:02:34] Speaker B: Look at the whole picture. Looking at the whole picture. There's a lot of chronic diseases in GI. But then another day, I can just be doing routine endoscopy and colonoscopy, where I feel like it's one of the most important parts of the field, which is prevention of colon cancer. [00:02:48] Speaker A: Okay. [00:02:48] Speaker B: And then another day, I can be in the hospital doing life saving procedures on patients who are coming in with gastrointestinal bleed, for example. So I chose the field because it's just very exciting, and the day to day can be very different. And the most important thing is that prevention of colon cancer is the mainstay of the field. [00:03:08] Speaker A: Okay, very good. [00:03:11] Speaker B: Yeah. [00:03:11] Speaker A: So you get all of that excitement. [00:03:13] Speaker B: Exactly. [00:03:14] Speaker A: All aspects. [00:03:15] Speaker B: Yeah. [00:03:15] Speaker A: So what is colon cancer? [00:03:18] Speaker B: Right, so colon cancer, the name suggests it's cancer in the large intestines or colon. Right. So the large intestine makes up the colon and the rectum. And so that basically is just when abnormal cell growth occurs in that location. And unfortunately, it can lead to really bad and poor outcomes similar to other cancers of the body. [00:03:40] Speaker A: Okay. Is family history associated with. Is it gender? [00:03:47] Speaker B: Yeah, no. That's a great question. I know we're going to delve a lot into this, but we do have an understanding of the risk factors for colon cancer. And I would say about maybe 50% of patients who are diagnosed with colon cancer, it's due to an identifiable risk factor, and those include male gender. So men are slightly increased risk than their female counterparts. Older patients are again at slight increased risk and lifestyle. So people who smoke cigarettes, very high alcohol consumption. [00:04:26] Speaker A: Okay. [00:04:27] Speaker B: And then diet is a big piece of this as well. So a diet that's high in red meat and processed foods. So those patients are at an increased risk of colon cancer than the general population. And there are other chronic diseases that I won't get too much into, but like inflammatory bowel disease, you may have seen that on commercial. So, like Crohn's ulcerative colitis. And then there is a genetic component which can be a little bit complicated to understand. [00:04:54] Speaker A: Okay. [00:04:55] Speaker B: I'll say less than 5% of cases are linked to a genetic cause that we understand as it is today. [00:05:04] Speaker A: Okay. [00:05:05] Speaker B: There are some genetic components, like lynch syndrome and Fap, which is familial adnomatus polyposis. But outside of that, we don't really fully understand the genetic piece, but we do think it does increase one's risk as well. There's more studies. Exactly. [00:05:24] Speaker A: Okay. So we always hear about high fiber diet. [00:05:28] Speaker B: Yes. Very important. [00:05:30] Speaker A: How important is that? [00:05:32] Speaker B: Again, it's not fully elucidated, but the assumption is when you have a high fiber diet, you're more likely to have normal bowel movements, and it regulates your bowels, and it probably decreases the amount of toxins that occur in the gastrointestinal tract. So we said a diet that's high in fiber also reduces the risk of colon cancer. And fiber. You can find that in natural foods. Veggies, fruits, oatmeal. Very important for one, grains, for different grains. Whole grain foods. Yeah. Very important for, again, colon health. [00:06:12] Speaker A: Absolutely. And water intake. [00:06:14] Speaker B: And water intake. Everything. Absolutely. And that's the case for everything. [00:06:17] Speaker A: Right. You like red meat and you're eating those foods. The more that you can keep that. [00:06:23] Speaker B: Keep going, keep moving, keep moving, the better. [00:06:26] Speaker A: Okay, so talk a little bit about, more about the digestive tract and specifically polyps. [00:06:33] Speaker B: Yes. [00:06:34] Speaker A: Because I know people in my family that have had polyps, and they've been detected early. [00:06:39] Speaker B: Perfect. [00:06:40] Speaker A: To the screenings. What is the significance of early detection of polyps? [00:06:45] Speaker B: That's a great question, and that's actually the most important question, to be honest with you. The reason why procedures like colonoscopy are so important, because it's not only diagnostic. Right. So it helps diagnose something like colon cancer. It's actually a preventative measure. And the reason for that is because there are these things called polyps. So polyps are a precursor to colon cancer. So they are benign, meaning non cancerous, but they are precancerous. So they have the potential, it's just abnormal tissue that grow in the colon that have the potential to grow into cancer over decades, years of life. And so a colonoscopy is a tool where we go into the rectum and the colon with a camera, but we're able to remove polyps at the time of the exam. And so then if we take that tissue out, that means that if it's no longer there, that means that that won't grow into colon cancer down the road. So that is the importance of a screening test like colonoscopies is because it prevents the growth of polyps. [00:07:58] Speaker A: Right. That's really great information because sometimes people think, well, they're benign, they're not an issue. [00:08:06] Speaker B: Right. [00:08:06] Speaker A: I had a colonoscopy. I'm not going to do the next one. But to your point, it can become. And you don't want to be a percentage. [00:08:14] Speaker B: Exactly. [00:08:14] Speaker A: It becomes cancer. [00:08:16] Speaker B: An important note is that if you do have a history of polyps, that means you, unfortunately have a risk of developing more polyps. So that's why it's important to get that follow up colonoscopy and probably more frequent than the usual ten year gap that we would recommend for someone with no polyps or no family history. So even if we remove polyps that you have at that exam, you may have other polyps that grow in different areas kind of later down the road. [00:08:48] Speaker A: Okay. [00:08:48] Speaker B: So that's important to mention. [00:08:50] Speaker A: So I know over the years, the screening times have changed. And why is. I think that's great, because as we're talking about the earlier, the younger generation, now we're seeing a presentation earlier. [00:09:04] Speaker B: Yes. So prior to 2021, the United States Preventative Task Force, which is like the governing body of guidelines, recommended that we get colon cancer screening at age 50 if you are an average risk person, meaning no family history and no other kind of symptoms. Right. Unfortunately, we've seen a trend since 1995 that every year the risk or the incidence of colon cancer increases about 3% in patients who were actually younger than 50. [00:09:42] Speaker A: Wow. [00:09:43] Speaker B: So early onset colon cancer has significantly increased over the years. We think it's probably tied to the risk factors I'd mentioned earlier. But because of those numbers, that governing body, the United States primitive task force, suggests that we should be screening earlier. Right. So now the screening age is 45 years old, and that's important to discuss because a lot of people in the community still think the age is 50, but it's actually 45 now. But the reason for that change is that we've seen an increase in incidence in the younger population, unfortunately. [00:10:23] Speaker A: And it's so important to have that relationship with your primary care. [00:10:27] Speaker B: Absolutely. [00:10:28] Speaker A: I know that for me, it really keeps me on track with those screenings and the changes in the time frame. And I have had a baseline colonoscopy, and I think there's huge misconceptions around how it being painful, I don't remember a thing. [00:10:43] Speaker B: Right. [00:10:44] Speaker A: So the medications are wonderful, and I lost a couple of pounds in preparation, so it was a win win. What are some of the signs and symptoms, in an effort to educate our viewers. [00:11:00] Speaker B: Absolutely. [00:11:00] Speaker A: That they should be looking for as it relates to this disease. [00:11:05] Speaker B: Right. So the most important thing that if anyone gets from this talk is if you see a change in your body that is abnormal or not normal to you, please seek medical care. Right. And so early onset colon cancer, when it's diagnosed, unfortunately, it's diagnosed at a very late stage, and that's because younger people, they're less likely to seek medical care if there are changes that they've noted in their body compared to maybe older folks. Okay. And so specifically to colon cancer, actually, there was a study that came out that the four signs that are present when patients are diagnosed with early onset include rectal bleeding. So bleeding coming from the rectum, especially when you're having a bowel movement. A lot of young folks say, oh, this is likely benign. It's from constipation. It's from hemorrhoids. And I'm going to be honest with you, majority of the time it is. But you don't want to be that percentage of a patient that ultimately becomes something more concerning. So I always say, if you have rectal bleeding, do not assume that it's something benign. Unless you get a full evaluation from either your primary care doctor or a specialist, like a gastroenterologist, it's very important. The second sign is a change in bowel habits. Right. And so there are people who have always been constipated all their life or always had diarrhea, but this is like a change that's different, right? Oh, I've had a normal bowel movement all my life and all of a sudden I feel blocked up. That is something to get evaluated. Okay. And then anemia is the third. So iron deficiency anemia, that is unexplained. Right. So it's common for young women to be anemic for other reasons, like our menstrual cycles or pregnancy fibroids. Other reasons. Right. But if you are having anemia on your routine blood tests that are otherwise not explained by anything else, you need to get evaluated. And then I would say, lastly, abdominal pain. So stomach pain, that again, is out of the ordinary for you. These can be signs of something else going on for you to seek care. [00:13:30] Speaker A: Okay. Are there specific markers that are explored in confirming cancer? [00:13:40] Speaker B: Yeah. [00:13:40] Speaker A: No, colon cancer. [00:13:41] Speaker B: Yes, there are. So the gold standard of, again, therapeutic, or so I should say, preventative and diagnostic of colon cancer, is the colonoscopy. So what we do is when we go in, let's say someone comes in and they are having these symptoms that I mentioned, I perform a colonoscopy. It is an abnormal growth, physically in the colon. So what I do is I take a sample or a biopsy, and then we go and send that off to the pathology lab. [00:14:13] Speaker A: You're able to do this at the. [00:14:14] Speaker B: Time of the exam? At the time of the exam, oftentimes we'll know. [00:14:19] Speaker A: Okay. [00:14:20] Speaker B: Just by direct visualization of what's going on. [00:14:22] Speaker A: Okay. [00:14:23] Speaker B: But the conformatory process may take anywhere from three to five days where we send that tissue off to a pathology lab, they look at it under the microscope, and based on the findings there, they can confirm that the cells are malignant or cancerous. [00:14:39] Speaker A: Right. Are there cells that are more aggressive? I know individuals who unfortunately are no longer with us, and I know others who have had better outcomes. [00:14:53] Speaker B: Right. [00:14:53] Speaker A: What determines that? [00:14:56] Speaker B: Right. I think there's two pieces to that. [00:15:01] Speaker A: Okay. [00:15:02] Speaker B: The first is just going back to polyps, which again, remember, as I mentioned, are benign. [00:15:08] Speaker A: Right. [00:15:08] Speaker B: But precancerous. Okay. Not all polyps are made the same. There are polyps that are benign. Benign, meaning they actually don't have any propensity of developing into cancer. There are adenomas that are at risk of potentially developing into cancer. And then there's another type of polyps called this is a little technical, but adenominous or villas type, that is a slightly increased risk of developing to cancer. So it's important. Pathology is very important. [00:15:41] Speaker A: Okay. [00:15:41] Speaker B: So when we see these under the microscope, it kind of signals to us how frequent people need to get their screening or surveillance colonoscopies. So that's one piece. [00:15:51] Speaker A: Okay. [00:15:52] Speaker B: But when you are unfortunately diagnosed with colon cancer, there are stages to that. [00:15:58] Speaker A: Okay? [00:15:59] Speaker B: And that, unfortunately, is usually based on the time in which a patient presents. And oftentimes they present too late and they're at a stage three or stage four, which is pretty advanced. And so I would say timing is important. And I will say, I would be remiss to say patients who are of different racial ethnic backgrounds, when they present, are at a risk of having a higher stage or advanced colon cancer. So patients of african american descent, african descent, unfortunately, do present at a later stage. And I think that has more to do with environment than genetics. So, unfortunately, having less access to health care or maybe screening. Exactly. Or like knowledge of the disease process. So things that I'm particularly interested in as well is understanding that difference. [00:17:00] Speaker A: Yes, absolutely. Well, this is going to help. [00:17:04] Speaker B: Yeah, absolutely. [00:17:04] Speaker A: I hope so. Those gaps as it relates to information and understanding. So get your screenings important. [00:17:12] Speaker B: Get screened. Absolutely. [00:17:14] Speaker A: What are some lifestyle changes that we can encourage our younger adults to participate in to help prevent choline? [00:17:25] Speaker B: Absolutely. So just going back to those risk factors, minimizing those risk factors. So quitting smoking, reducing alcohol consumption, very important. Making sure you have a well balanced diet that's high in fiber, minimizing the amount of red meat you eat, minimizing the amount of processed foods, increasing more natural foods, foods that come from the earth. I don't think I mentioned this earlier, but living a sedentary lifestyle or being inactive increases your risk of colon cancer and other cancers. So being physically active is exceptionally important. [00:18:05] Speaker A: Okay. [00:18:07] Speaker B: And I think overall, if you're having symptoms, getting evaluated, yes. [00:18:13] Speaker A: Thank you so much. This has really been great information. Is there anything that you feel is important to leave with our viewers before we conclude today? [00:18:24] Speaker B: Again, the colonoscopy, it's such a vital part of the screening process. About 25% of colon cancer cases are preventable, meaning if we had known about them years prior and done a colonoscopy and taking out a polyp, that would never have led to a colon cancer down the road. So I'll tell the audience, make sure you get screened at age 45. If you're an average risk, meaning no family history of colon cancer and you're asymptomatic having those symptoms, it's very important. But then the last piece is if you are having symptoms of those symptoms I mentioned rectal bleeding, weight loss, anemia, changing bowel, please make sure you get evaluated and talk with your primary care doctor because you may need to see a specialist like a gastroenterologist. [00:19:16] Speaker A: Absolutely. Dr. Winter, if somebody wants to reach out to you directly, please tell them how they can get in contact with you. [00:19:25] Speaker B: So I'm a physician at the Riverside health systems. You can find my bio on the Riverside website and contact our GI office in the portwork location. I also have social media. You can find me on, I guess used to be known as Twitter now. X. Yes, at Dr. Jam Winter. And I'm also on Instagram at that same handle. Dr. Jam Winter. [00:19:55] Speaker A: Well, I am two years new to this area, and I will be looking for you to do my next colonoscopy and screening and then also looking at partnering with you in the future as it relates to how do we get out in the community, especially in those areas that we know are high risk, to further educate in our community efforts. So thank you so much for your time. [00:20:17] Speaker B: Thank you so much for having me. [00:20:19] Speaker A: Passion around the work that you're doing. [00:20:21] Speaker B: And the difference you're making. Thank you so much. [00:20:24] Speaker A: Thank you. Thank you for listening to this episode of healthy you. We're so glad you were able to join us today and learn more about this topic. If you would like to explore more, go to riversideonline.com.