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Episode #21 - Colorectal Cancer

Steve:

Well, hello everybody and welcome back to episode 21 of Cincinnati Cancer Advisors Medical Minute podcast series, sponsored by Kroger Health. Sherry, I got to tell you, I was heckled again by my wife this weekend.


Sherry:

Why'd you get heckled?


Steve:

For slouching.


Sherry:

Okay, so are you staying up straight today?


Steve:

Yeah, I'm going to try to and sit up straight.


Sherry:

Alright because we have a guest here, which is not a guest he's a colleague.


Steve:

We have very important guest actually. Making his first appearance on "Medical Minute" is Dr. Abdul Jazieh. Dr. Jazieh most recently came back from a 15 year stint overseas in Saudi Arabia. But before that he was the...bear with me here, was the Chief of Oncology, Hematology, Oncology Division, University of Cincinnati Cancer Center.


Dr. Abdul Jazieh:

Yes.


Steve:

Alright, there we go. He's got a long record in this town. He took a little break enjoyed 15 years overseas. I guess he enjoyed it.


Sherry:

Now, we're working with him now, right?


Steve:

Yeah, that's right. Now we're making him work, exactly. He's here with us today. March is colorectal awareness month and colorectal cancer awareness month. Dr. Jazieh has quite a bit of expertise in that. We wanted to get this out front today, because it's something you don't hear quite as much about. I don't know; I'd be curious to get your thoughts, Dr. Jazieh, if part of that is just something that people like talking about. I suspect it probably even factors into maybe not getting the screenings done that they need to get done, because it's a part of their body that they don't really want to talk about. I can relate to that a little bit. But we're going to benefit from his 25 years of experience diagnosing colorectal cancers today. As well as his expertise in lung cancer, which we'll talk about at some other point in time as well. Sherry, why don't you do me a favor? Why don't you take us through some of the statistics that still plague colorectal cancer because they're fairly sobering statistics.


Sherry:

Yeah. Yeah. There are a lot of statistics and Dr. Jazieh, if you'll bear with me, we want to get this information out to the folks, according to the American Cancer Society, the average lifetime risk of developing colorectal cancer for American men and women is roughly 1 in 25. That's correct, right there. It is the fourth most diagnosed cancer in the US behind lung, breast, and prostate. Second leading cause of cancer deaths in the US behind lung. And estimates for 2022, now this is very sobering. 150,000 Americans will be diagnosed with colorectal cancer and roughly 52,000 will die from the disease. From 2007 to 2016, now this is very interesting, the incidence rates for people over 65 dropped by 3.3% each year, and the incidence rates for people under the age of 50, it increased Dr. Jazieh, 2.2% each year. So Dr. Jazieh, give us a few of your observations as to why you think this might be occurring.


Dr. Abdul Jazieh:

Well, first of all, thank you, Steve and Sherry for hosting me today. It's my pleasure to be with you. Actually, colon cancer, as you mentioned, is very important cancer because of the toll that we paid by human life. If you look at the numbers actually for more than 400 patients diagnosed every day and 140 patient die every day from colon cancer. This is an important subject because actually most of these cases are preventable. If patients adhere to them screening, 70 to 80% and more probably of this cancer will be prevented to start with. So that's why it is very important to talk about the subject and we'll touch in more details about the screening. Why the discrepancy in dropping in numbers for older patients? I can say with confidence that most of the reduction in death in older patient is attributed in a great part to colonoscopy and screening.


Sherry:

So they're getting the colonoscopy


Dr. Abdul Jazieh:

Yes. because if you... And we will talk about that more, if you did colonoscopy you will discover precancerous lesions, which is the polyps. This will prevent you from having cancer to start with. That's basically what will be contributing to that. Also as we are going to mention in more details, it's lifestyle related. So there is some adoption of healthier lifestyle such as exercise and better diet for the population. However, when you see cancer increasing in the younger population, there is generally a genetic contribution to that. So now there is more prevalence of genetic risk to have colon cancer. In addition, again, to the lifestyle. The habits of eating certain food and lack of exercise and so on contribute to this risk. The biggest part of the increase in younger people have to do with inherited component and anti component.


Sherry:

Inheritance components, because we know the median age of those diagnosed in the US are between 66 and 69. That's the median age. The ethnic disparities, that's very interesting too, because the incidence rates are about 20% higher Dr. Jazieh, for African Americans. The death rates, of course, for people of color, African Americans primarily, is 40% higher than the average death rate. I think maybe like Dr. Jazieh just said, health, care, disparities, and also lifestyle, the types of foods that we're eating. play a part of that?


Dr. Abdul Jazieh:

True. So actually, this is worth pointing out that there is some kind of ethnic risk to certain groups, such as Ashkenazi Jews. They may be having higher risk of having colon cancer. However, when you look for the African American, when you compare them to the native African, they have 65 times more the risk than the African. So it's not racial or ethnic things. So it has something to do with the lifestyle.


Sherry:

The life lifestyle. And I would think the food.


Dr. Abdul Jazieh:

And access to care.


Sherry:

Yes. Access to care.


Dr. Abdul Jazieh:

We don't know for sure many people try to contemplate on that, but the most common, whenever you see a discrepancy and you could not ascertain a biological differences, is going to be access to care and lifestyle.


Steve:

I just had Chris run across the street, and get me a Payday candy bar. Right before...


Sherry:

Uh oh. not a payday, Too much sugar, too much fat.


Steve:

I know.


Sherry:

Not good.


Steve:

Meanwhile, he eats his healthy, Mediterranean diet every day. So...


Dr. Abdul Jazieh:

That's why there is actually 10 folds difference in colon cancer in this incidence, in geographical location. For example, the American resident has 8 to 10 times more risk of having colon cancer than Indian, for example, than other people. So there is this geographical disparities, which is related mainly to lifestyle and diet.


Steve:

Yep. All right. Drink more water, eat less candy bars.


Sherry:

Well, yeah, definitely eat less candy bars, eat more fruits and vegetables and eat less fat.


Steve:

All right. I'll try to work harder on that too. Okay. Dr. Jazieh, you already touched on some of those factors. So talk if you would, for a minute, because I know, there are certain things like inflammatory bowel diseases and things like that that can... where I think those folks are probably a little bit greater risk. I think... One thing though, I would be curious to get your thoughts on is, oftentimes I think it's easy... Sometimes you can convince yourself based on reading things that you might have cancer and oftentimes it may be something else right? Entirely. So some of the... My point is, I think some of the symptoms that might kind of be predictive of cancer can sometimes be associated with other, you know, IBD or IBS or something like that, right?


Dr. Abdul Jazieh:

Yes.


Steve:

Does that sometimes contribute to people not going and getting a diagnosis?


Dr. Abdul Jazieh:

Yeah, absolutely. So when we are talking about cancer in general, we talk about the general information that everybody should know. But, actually colon cancer could affect patients of any age and race and gender. I know male has 20 to 30% more likely to get cancer than colon cancer than female. But nevertheless, if you have certain symptoms that especially, especially seeing blood in the stool, changing in the bowel habits, you should seek medical help. Many times young individuals, physicians assume that this is hemorrhoids and end up being rectal cancer. So, if you are diagnosed with hemorrhoids, the physician has to make sure that to check and it's hemorrhoid and not attributed to hemorrhoid just because you saw blood and you are a young person. You see colon cancer in patients who are 20s and 30s. We see it not infrequently actually. Then we have to keep this in mind. You see blood from anywhere coming consistently more than one time, it means that you should seek medical help and make sure that you rule out colon cancer.


Steve:

Okay.


Sherry:

Dr. Jazieh, what about, I guess, constipation and also diarrhea? Those two factors.


Dr. Abdul Jazieh:

So, okay. Whenever you're talking about cancer prevention, there are two type of early detection of cancer. Detection of cancer by screening, mean a person does not have symptoms. And you go by the prescription that you are at a certain age or certain risk. You have to have a screening test, whatever it is, and that's asymptomatic patient. That will be the ideal situation.

Now, the next best thing which happened unfortunately very frequently, is called the early detection, early diagnosis of the cancer. I mean, the patient has symptoms of cancer and just take it seriously and go to the doctor and the doctor take it seriously and work up the patient to make sure that they diagnose the cancer. If the patient has, we said, blood in the stool, whether it's a fresh blood or dark blood. So dark blood, usually from upper GI tract, but any change in the stool color suggesting that there's a blood in it, number one. Number two, if there's a change in the bowel habits, you go to the bathroom more often or less often, constipation, or sometimes frequency because sometimes you may have partial obstruction and you go to the bathroom, but you don't empty your bowels. The third thing is that when there's a change and this is subtle, but when there's a change of the stool appearance, so sometimes the stool become different inconsistency, different in diameters, become thinner than usual happen. And it consistent repeatedly for days and weeks, not just one incident. So change in the consistency of the stool, the enter of the stool, and so on. This should urge the person to seek help. Abdominal cramp abdominal distinct distention.


These are all symptoms one has to take seriously, but we don't want to reach that point, right? That's right. Need to detect the cancer early. Let me back up a little bit and talk about the benefit of screening to take the advantage of that. Actually if the colon cancer start with a polyp, this polyp to develop from a polyp to a cancer, it may take 10 years. So you have an ample window of opportunity to detect the cancer. When you do the colonoscopy is one of the best screening methods, we can focus on that, and you are removing the risk of cancer totally. So it's not just detecting of cancer. You are removing the cancer, you are removing the risk of having cancer, which is the ideal situation. And that's why we have a reduction in the risk of colon cancer, because you already removed the risk from those who had colonoscopy.


One of the colonoscopy benefit is to remove the risk of cancer. And then of course, if you detect early cancer, then the treatment will be much better. For example, if you detect cancer at Stage 1, 80 to 90% would be cured. While if you detect it, when it's advanced, then you know, you're talking about 20% or less. Okay. So that's the very important thing. Another important risk of benefit. Actually, if you remove the polyps from this patient, the risk of cancer in the general population, and it will reduce by 70, 80%. So you can almost eliminate the majority of colon cancer from happening to start with.


Steve:

Okay. So you know what I think Dr. Jazieh, this has really been interesting. And I think there's a whole nother set of topics that I think we're going to want to do another episode on if you're good with that, which is people are hearing a lot about other things. Colorguard, there's some other genetic tests now that can be predictive of colorectal cancer. And so I think we're going to want to do another episode. I think, where we can really thoroughly discuss those. And my guess is that you would probably say that these are good. Still not as good as a colonoscopy. I think we'll want to talk about why that is as well.


Dr. Abdul Jazieh:

Yeah. So as I mentioned earlier, this test may detect cancer, and they are very good test by the way, they have their own indication and use. So I'm not going to write them off completely. To the contrary they have their use, however they don't detect polyps.


Steve:

Ah, okay.


Dr. Abdul Jazieh:

And you don't see visually that if they are all abnormal, if you find abnormal tests, you have to go do a colonoscopy. Colonoscopy is not just diagnostic, but it's therapeutic too because you remove the risk.


Steve:

Okay.


Dr. Abdul Jazieh:

So you are not just looking if you have a cancer, you are looking, if you have a risk for cancer and you are removing it. That's the difference between colonoscopy.


Steve:

Gotcha. Okay.


Dr. Abdul Jazieh:

And that's why most of the professional society still having colonoscopy on the top of the list of screening tests.


Steve:

Well, there you have it. He did... I mean, I was saving it for another episode. He just nailed it.


Sherry:

I know. You know what we have to say though, make sure you check your stool. I know that sounds kind of like, you know, a lot of people don't do it, but you have to look at it to make sure that at least you have that visual. So we're going to...


Steve:

Are you put it in a box and mail it?


Sherry:

No, we don't want to put it in the box, but that's what they do sometimes right, with the colorectal? Okay. Thanks everyone for joining us today for our medical minute. Don't forget to like, and also share this. Also, thank you Dr. Jazieh for being with us today.


Steve:

Thank you very much.


Sherry:

And giving us your insight. We really appreciate it.


Dr. Abdul Jazieh:

It's a pleasure to be here with you. Thank you.


Steve:

Thank you. All right thanks, everybody. We'll see you next week.


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