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Butts & Guts kicks off Colorectal Cancer Awareness Month with Patricia Ajayi-Fox, MD, a gastroenterologist in Cleveland Clinic's Digestive Disease & Surgery Institute. Listen as she discusses the importance of getting screened for colorectal cancer, and the concerning disparities in the Black community regarding screening and outcomes.

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Colorectal Cancer Awareness: What to Know About Screenings

Podcast Transcript

Dr. Scott Steele: Butts & Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Hi, everybody. And welcome to another episode of Butts & Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And I'm very pleased today to have our guest, Dr. Patricia Ajayi-Fox, who's a gastroenterologist in Cleveland Clinic's Digestive Disease & Surgery Institute. And what we're going to talk about today is colorectal cancer screening, and more specifically the disparities associated with colorectal cancer outcomes that exist all across the United States today. So Dr. Fox, thank you so much for joining us here on Butts & Guts.

Dr. Patricia Ajayi-Fox: Hi, Scott. So nice to be here today. Thank you for having me.

Dr. Scott Steele: As you all may know that March is Colorectal Cancer Awareness Month. And colorectal cancer, depending on the year, is either the second or third leading of cancer related death in the United States. However, advances in early detection and treatment make it one of the most preventable and treatable forms of cancer. Think about it. We have a test that can go in, such as a colonoscopy, and identify it at a pre-malignant stage, whereas there's other cancers in the abdomen that we aren't so lucky. So we're really looking forward today to talking about screenings and more specifically addressing diversity disparities with Dr. Ajayi-Fox. So tell us a little bit about your background. Where'd you train? Where are you've from? And how did it come to the point that you're here at the Cleveland Clinic?

Dr. Patricia Ajayi-Fox: Yeah, so I did my medical training in Philadelphia, and then I trained as well in Pittsburgh. But I did my gastroenterology fellowship actually here at Cleveland Clinic. I just completed it not too long ago. I'm a general gastroenterologist, but I have an interest in ensuring that everyone has good access to medical care. And so being a gastroenterologist, I have a special interest in making sure everyone is up to date on the recommended screening, so colon cancer screening, especially here in the Cleveland area.

Dr. Scott Steele: So go 10,000 foot level. How does colorectal cancer, how does it start and how does it come to the point where it is actually a cancer?

Dr. Patricia Ajayi-Fox: Yeah. So colon cancer starts from the micro level, something called a mutation, which is basically a blip. But that can cause what's called a polyp, which can be within the colon. A polyp, over many, many years, can turn into the cancer. And the cancer, which can be located in the colon over time, if you leave it, can even travel from the GI to other parts of the body. And that's why it's very important to detect it as early as possible so we can take it out at that polyp stage.

Dr. Scott Steele: So what are some of the symptoms and warning signs that patients out there or listeners to this podcast should not ignore?

Dr. Patricia Ajayi-Fox: Yeah. So there are a couple of warning signs that people should be very aware of. One of them would be seeing blood in your stool. That's always abnormal. So you should alert your primary care doctor or any physician about that. Other signs that you should be looking for are having dark stools or changing in your frequency of bowel movement. So suddenly, you're having a lot more diarrhea or a lot more constipation. Also, having weight loss that's not intentional is something that you should keep in mind that could also be a warning sign that you should alert your physician about.

Dr. Scott Steele: And I think it's important for the listeners that are regular to this podcast, we've had other podcasts that have focused on similar topics and understanding that you might have heard some of the same type of symptoms with such thing as hemorrhoids and other ones. So just because you have these doesn't ensure that you have cancer, but it's important to understand that you don't ignore these symptoms so it can get worked up appropriately. So we talk in a little bit about screening options for colorectal cancer day. And so can you go into a little of them, colonoscopy, the stool screening test, flexible sigmoidoscopy, when they should start, and then a little bit more about some of the changes in more recently, as the guidelines have suggested decreasing from 50 to 45. And then how does family history fit into all of this?

Dr. Patricia Ajayi-Fox: So the first part of it, of what are the options that we have for screening, this is something that's very important so people feel well-informed. So the first option and the option that myself and you are very well aware of is the colonoscopy, which is a way that you can directly look into the colon. It's good because it can both screen and intervene. So if we find any of those polyps, we can take them out there and then. A colonoscopy may not be for everyone, so there's other options. There are some stool test. One of them is the FIT test that you can do every year. And then more recently, there's another stool test called a Cologuard that be done every three years. And so it's good that our patients and people out there are well aware of all their options.

And you were correct when you mentioned about how the age recommended for screening change recently. So previously, we had recommended age 50, but then it was found that these colon cancers may be presenting or being found even earlier. So now, it's actually recommended across the board that we should start screening for these cancers, whether through colonoscopies or through the stool test, starting age 45. However, if you do have a family history of colon cancer, that's important to let your physician know because the recommendation could be to screen a little bit earlier. So usually, if you have someone in your family, usually a direct family member, have colon cancer, it's usually recommended that you screen about 10 years earlier. Basically, the takeaway should be across the board, we usually recommend age 45. But have a discussion with your primary care doctor or your physician to figure out and make them aware of your family history, so you can figure out if you need to be screened a little bit earlier.

Dr. Scott Steele: Yeah. And I encourage all of the listeners of this podcast to look back into previous episodes as we've had a focus, unfortunately, on the rising incidence of early onset or young onset colorectal cancer. So we're going to delve a little bit into disparities that happen in regards to, not only colorectal cancer, but the screening process for that. And so we'll start off with a Truth or a Myth. So Truth or Myth: patients in the Black community are more likely to present with late stage colorectal cancer and experience worse outcomes.

Dr. Patricia Ajayi-Fox: Unfortunately, that is a truth.

Dr. Scott Steele: So why is this the case?

Dr. Patricia Ajayi-Fox: So I think many factors go into play, starting from the beginning, from lack of information. So unfortunately, not everyone is aware of the recommended screenings or why it is important. So I think starting from the bottom, just education, people may not be as informed as to what's so important. Why, what exactly is colon cancer screening? So I think that's very important that us as physicians try to educate them to let them know that colon cancer is real, it's out there, and it's happening to people. And I think people, if they're aware of this, then they're more likely to be open to having the procedures done. So that's it. Being educated and knowing how important it is. So far as the procedure itself goes, there are some barriers that have been identified that can make it more unlikely for them to make it for the procedures.

So for instance, barriers such as transport. People need to have a ride that comes with them for the procedure. And so that may be difficult for certain demographics, and then also missing work for a procedure. Some people may not be able to have that flexibility because most of our colonoscopies happen during the week. So missing work for a procedure may not be a possibility for everyone. And then of course, there's a very big barrier of insurance because someone needs to pay for it. So that has also been identified as a barrier. If you have not the best insurance or no insurance at all, man, these are only a few of the reasons why this is the case.

Dr. Scott Steele: So I gave you the truth or myth regarding the Black populations. But is it fair to say that this is, in general, the vast majority of the minority populations? And it's also, you mentioned a little bit about insurance and rise and everything. And is there a socioeconomic or financial status that is associated with this disparities for colorectal cancer?

Dr. Patricia Ajayi-Fox: Yes. So that is a case. It is seen in the Black community, but of course, anyone who is of lower socioeconomic status may have the exact same things that are going against them that may not enable them to be able to show up for their colonoscopies. Yes.

Dr. Scott Steele: So what steps can providers, gastroenterologists, colorectal surgeons, primary care docs, take to address these disparities?

Dr. Patricia Ajayi-Fox: So I think the first step is to try to reach out to the communities, like we're here in Cleveland, to try and reach out to a community to listen to what questions or concerns they may have, because I'm sure they have a lot. They may start from the beginning of what exactly is colon cancer? Why do we need to do this screening process? And then we can start from that, and so they know the importance of it. I think we can also partner with our primary care doctors because they may get to see our patients more frequently than we do. And they're our colleagues.

And so we can build a good relationship with our patients to ensure that everyone is giving them the same message, that these are the recommended forms of colon cancer screenings. And if you can't make it to a colonoscopy, then maybe the stool test are the best test for you and you don't have to miss work for that. So I think the steps that we can do to address these disparities is reaching out with our communities and reaching out to our primary care colleagues to try and work together to eliminate this.

Dr. Scott Steele: What research is currently being conducted to better understand why these disparities do exist in colorectal cancer diagnosis and outcomes?

Dr. Patricia Ajayi-Fox: So I think some of the things that we've tried to do and has been done is trying to, like I said, infiltrate the community more to try and understand their barriers, because the barriers that occur here in Cleveland may be different from what's occurring somewhere else. So I know here at Cleveland Clinic, the Taussig Cancer Center, they're trying to get to know the community better by having health navigators to work with the community at barber shops and churches, just to try to get to know them better and to get them a little bit more educated. So I think that's part of the research initiatives as well as community outreach to try and spread the word and try to understand the community better.

Dr. Scott Steele: Well, that's fantastic stuff, and I'm glad there's people like you out there leading these efforts into closing this gap that's out there. So it's a time for our quick hitters, when we get to know our guests a little bit closer. So first of all, to you, what's your favorite food?

Dr. Patricia Ajayi-Fox: So I'm actually a Nigerian. So my favorite food is a Nigerian food called jollof rice.

Dr. Scott Steele: Okay. You got to tell us a little bit about what that is.

Dr. Patricia Ajayi-Fox: So it's rice made with tomato sauce, and it's pretty spicy and it's pretty good.

Dr. Scott Steele: That sounds delicious. I could go for a little bit of that right now. What is your favorite sport, either to play or to watch?

Dr. Patricia Ajayi-Fox: So when I was younger, I used to play soccer, which we call football in Nigeria. And I like to watch that as well.

Dr. Scott Steele: Fantastic. And tell us about maybe an interesting place or when you think about, "God, this is a place that I've been to that was awesome," what would that be?

Dr. Patricia Ajayi-Fox: So I went to Costa Rica after residency, and I thought it was pretty great because you could zip line and then you could have the beach all in the same country.

Dr. Scott Steele: Yeah, that's fantastic. And so you've been all around the world and tell us a little bit about what do you like about being here in Northeast Ohio?

Dr. Patricia Ajayi-Fox: Northeast Ohio. I mean, I think I like the people a lot. I feel like the Midwest in general has a lot of nice people, so I like that. I like the variety of food and restaurants that you get in Cleveland. And of course, I love working here at the Cleveland Clinic.

Dr. Scott Steele: That's great. And we're lucky to have you here. So what's a final take-home message for our listeners and what can we do to help close these disparities, close the gap here, and improve the outcomes for all patients with colorectal cancer?

Dr. Patricia Ajayi-Fox: Yeah. So I think a take-home message that I want everyone to be able to hear is colon cancer is a very preventable disease. And your physicians here at Cleveland Clinic, we care about you and we're all trying to do our part to ensure everyone has access to these services, whether it's colonoscopies or stool tests. Because we don't want to keep having these outcomes of late stage identification and any kind of loss of life. So we're here to partner with you and to serve our community to ensure they have access to this.

Dr. Scott Steele: Great, great words. So to learn more about colorectal cancer or to schedule a colonoscopy, please visit clevelandclinic.org/colonoscopy. That's clevelandclinic.org/colonoscopy. And to speak with a specialist in Cleveland Clinic's Digestive Disease & Surgery Institute, please call 216.444.7000. That's 216.444.7000. Finally, please remember it's important for you and all of your family to continue to receive medical care and stay up to date on healthcare screenings. Don't ignore those symptoms. Rest assured, here at the Cleveland Clinic, we're taking all the necessary precautions to sterilize our facilities and protect our patients and caregivers alike. Dr. Ajayi-Fox, thank you so much for joining us here at the Cleveland Clinic's Butts & Guts.

Dr. Patricia Ajayi-Fox: Thank you.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts & Guts.

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Butts & Guts

A Cleveland Clinic podcast exploring your digestive and surgical health from end to end. You’ll learn how to have the best digestive health possible from your gall bladder to your liver and more from our host, Colorectal Surgery Chairman Scott Steele, MD.
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