Colorectal Cancer Screening Options with Dr. Arielle Kanters

Podcast Transcript

Annie Zaleski:

Hello, and thank you for joining us for this episode of the Health Essentials podcast. I'm your host, Annie Zaleski, and today we're talking with colorectal surgeon Arielle Kanters about colorectal cancer screening options. According to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. However, the number of colorectal cancer-related deaths has actually been dropping for several decades. One reason for this decrease: More people are getting regular screenings and, because of this, colorectal polyps are being discovered and removed before they become cancerous. Dr. Kanters is here to talk about the different screening options for colorectal cancer as well as when and why you should get screened. Dr. Kanters, thank you so much for being here today.

Dr. Arielle Kanters:

Thanks for having me.

Annie Zaleski:

First off, can we define colorectal cancer? Is this the same thing as colon cancer? Are those terms interchangeable?

Dr. Arielle Kanters:

Certainly. Colorectal cancer is any cancer that happens essentially in the large intestines. That includes your colon and your rectum. Colon cancer specifically is just what happens in the colon portion whereas colorectal includes also the rectum and this doesn't really make a difference in terms of screening or in terms of staging. What it does make a difference for is how we actually end up treating it. We generally just use the word colorectal cancer to mean everything, but then if someone ends up having rectal cancer, we'll talk about why it would change a little bit in terms of how we ultimately treat you.

Annie Zaleski:

That's very helpful. A lot of people might hear the terms that might wonder what the differences are. That's fabulous. What are some of the symptoms then, of colorectal cancer? What are some ones maybe you'd notice first or ones that are maybe more obvious than others?

Dr. Arielle Kanters:

Certainly. There are some kind of nonspecific symptoms. People having changes in their bowel patterns. That means that they could be suddenly becoming more constipated or start to have like skinnier stools. Sometimes people will talk about having these ribbon stools because they're getting narrower, but the most common thing that we see people coming to us with is with blood in their stool. A lot of people are very quick to brush that off as being hemorrhoids, but it's important to pay attention to it and if it's persisting, then you see a doctor about it. Other symptoms can be weight loss or increased fatigue and those are again, kind of nonspecific and can be true of any cancer, but if you're having those experiences along with changes in bowel patterns and/or blood in your stool, absolutely talk to your doctor about that.

Annie Zaleski:

What makes you more prone to developing colorectal cancer? What are some of the risk factors?

Dr. Arielle Kanters:

There are certain exposures we have in our every day. People who smoke. Certain medical conditions, such as diabetes or obesity, those can all increase your chance of colorectal cancer. There are also diagnoses, for example, inflammatory bowel disease. If you have a history of Crohn's disease or ulcerative colitis that will increase your risk. There's also family history. There are hereditary, gene-controlled colon cancers that can run in families, but also having a family history of polyps or colon cancer increases your risk of having it. That's one of those things that we think about, one thing that we always ask our patients about when we're trying to better understand what their individual risk factor is for colon cancer. The other thing is more recently, some data has shown that certain foods such as red meats can actually increase your risk of colon cancer, but these are ones we're still trying to better understand at this point.

Annie Zaleski:

Obviously because there are so many symptoms and they could mean different things and also there are so many different risk factors and a regular screening is important. Why else are regular screenings important?

Dr. Arielle Kanters:

Regular screenings just help us identify pre-cancer polyps. It's colonoscopies, which are a really important part of the screening process for colorectal cancer. They're really helpful when you have a problem and it helps us identify whether there's an issue going on like a cancer, but it can also help us identify polyps that could eventually turn into a cancer. One of the main benefits or major benefits of colonoscopies is that not only are we able to see these problems, but we can also act on them. When we do colonoscopies, if we see something that looks atypical like a polyp, we actually remove them and so we're eliminating this polyp as a potential source for cancer in the future.

Annie Zaleski:

How tiny can these polyps be that you can identify and is there a way that if you see a cell that maybe is a little bit abnormal, but not yet a polyp, is that also something potentially when you're screening?

Dr. Arielle Kanters:

The polyps are actually very small. When we do the colonoscopies, the colonoscope actually makes everything look really big, so we can easily pick up a polyp that's 1 or 2 millimeters in size. One tenth of a centimeter. Very, very small. Those who perform colonoscopies, colorectal surgeons and GI docs, we are all trained specifically how to identify these changes. If we see anything that looks atypical, like there's this area that the tissue doesn't look the way it normally would, we can also take a sample of that, but generally our concern is less about a cancer or a pre-cancer in those situations.

Annie Zaleski:

I know that recently screenings for colorectal cancer have changed, now they're recommending age 45 you should start them. If you do have a family history, should you get screenings earlier?

Dr. Arielle Kanters:

Yeah, absolutely. It depends on which family member has a history of colon cancer and this is one of those things that's really important to talk to your primary care doc about, making sure that they understand because we can risk stratify you based on who in your family has a history of colon cancer. It's very different if it was your Dad than if it was your mother's aunt. That can change things in terms of how early we start screening you for. You bring up a really important point that I think a lot of people aren't aware of yet. We've all been told, and when I say “we,” I'm putting myself in that category. We've been told that you start screening at 50, but in the last few years, the last 10 years really, we've seen this really significant increase in young colon and rectal cancer patients and so recently, they've decreased that age from 50 to 45. I know myself and others are still having people coming to us for their first colonoscopy at the age of 50, when really in today's standards, they would've started getting scoped five years prior.

Annie Zaleski:

Are there any other risk factors then besides maybe showing some symptoms and family history that would make it that you should start getting screening at an earlier age?

Dr. Arielle Kanters:

Yeah. I mentioned earlier, there are certain diagnoses, especially those related to your intestines or colon and your small intestines. Inflammatory bowel disease, for example. If you have a history of inflammatory bowel disease, you should be getting regular colonoscopies both to evaluate your disease, but also because that inflammation that is always going on in the intestines, increases your risk of a cancer. These scopes are really important to also make sure that something isn't turning into a cancer cell. Other things would again just be, a family history of polyps as well. If your family history has a lot of certain types of polyps, there's something called a polyposis syndrome. That could be a reason that you need to be scoped earlier because these polyps, because you have so many, can turn into a cancer as well. Then there are other family histories like genetic abnormalities that increase your risk of colon cancer, even if you don't have a family history of colon cancer itself, if you have one of these genetic defects, then that would increase whether or not you need to be scoped.

Annie Zaleski:

Wow. That's all great information to know. I think a lot of people might not realize a lot of that stuff, so that's really interesting. Let's move on to talk about some of the types of cancer screenings then. As I understand it, there are two types. There's the stool tests and then there's what's called visual or structural tests. What are the differences then?

Dr. Arielle Kanters:

Absolutely. I'll start with the visual tests. That's the one I think people are most familiar with. Colonoscopies, like I said before, they allow us to actually look at the entire inside lining of the colon and we can actually even look at that last part of the small intestine as well. It is a visual test. We are trained to look for abnormal cells, abnormal polyps, or I should say, not cells specifically, but abnormal tissue. We can not only identify it, but then we can sample or remove it, decreasing a risk of a cancer or diagnosing a cancer in the future. There is another type of visual test called a CT colonography. It's a type of CAT scan that creates a virtual colonoscopy essentially, where you again, can look on the inside of the colon. The downside to something like this, is that you can't actually remove it. If they do find any abnormalities, then you still need to have a colonoscopy.

              That's a really important thing to remember overall with all of these screening tests. For example, the at-home stool tests, if there's an abnormal one, you do still need a colonoscopy to follow up and better understand why the test was abnormal. The home or the fecal tests are tests that actually look for certain types of cells or chemicals in your stool. A patient will collect a stool sample and the amount of stool depends on the type of test you're doing and it'll look for either breakdown of blood products, look for blood products themselves, or they can actually also look for abnormal DNA. They can look for cancer DNA in your stool because if there is a cancer in your colon, the cells from that cancer or that tumor will basically break off and be passed in the stool. These at-home tests can look for those abnormalities.

Annie Zaleski:

Wow. It's amazing just how evolved the technology has been for detecting things. I think 10, 15 years ago, this wouldn't have been on people's radar. That's amazing.

Dr. Arielle Kanters:

Yeah. It's incredible. I'm biased. I'm a colorectal surgeon, so my personal opinion is that a colonoscopy is always the way to go because that way we can know what we're dealing with. Ultimately, if someone is really not able to undergo a colonoscopy for any number of reasons, the fact that they can undergo a less invasive screening test to at least figure out if they need a colonoscopy, I think is fantastic. Whatever we can do to improve our screening practices is fantastic.

Annie Zaleski:

I think that's helpful too, because people get nervous and people might not want to do... A colonoscopy is so scary, they might not want to do anything. It's nice that there are these other options to kind of show them, "Hey, you can totally do this. It isn't as bad as you might think it is."

Dr. Arielle Kanters:

Absolutely.

Annie Zaleski:

Let's go in-depth to some of these screenings you've mentioned already, how you prep, the safety and accuracy and what they are like. Let's start off with the colonoscopy, the major one.

Dr. Arielle Kanters:

Yeah. We would consider this to be the gold standard, meaning that it's the one that we compare everything else to. Your first colonoscopy would happen at the age of 45, if you're of average risk. If you have a family history or any of the other risk factors I was talking about before, that would potentially make that age a little bit younger. The prep is usually done the night before, or it starts the day before and continues overnight. It is a laxative essentially. MiraLAX™ is the name brand, but a polyethylene glycol. It's a laxative that will help clean out your whole colon so that when we do the colonoscopy, we can actually look at the entire inner lining of the colon and look for these polyps. It also does require that you fast right before the procedure because you receive sedation or full anesthesia. Sedation you'll still be awake, but you're relaxed and you're sleepy and honestly, most people don't remember much of it, but then full anesthesia would be you're completely asleep and have no memory of any part of the colonoscopy. These are the two different approaches we use and depending on patient request and surgeon preference or practitioner preference, you might get one of those types of sedations.

Annie Zaleski:

How soon then do you get results after doing that, and how accurate are results from a colonoscopy?

Dr. Arielle Kanters:

You can have the immediate feedback from the person who does your colonoscopy. For example, if I found nothing wrong, I can tell you right away, "Your colon's clean. I saw no polyps. You're good for 10 years." If we do find something abnormal and we take a sample, I usually quote about three to five business days before the results come back. The pathologist will take that tissue, they'll cut it into really small pieces and then they'll look at all of these pieces under the microscope, looking for abnormal cells or for cancer cells. They also will be looking for signs of a pre-cancer as well because different types of polyps can mean that you need to have a colonoscopy sooner or later, depending on how high risk these polyps are. Once those results come back, then your practitioner should contact you, let you know what they are, let you know if there's any additional follow up that needs to be done and when your next colonoscopy is due.

              Sorry, you also asked about how accurate these are. The accuracy depends a fair amount on the patient, too. Doing a really good bowel prep and really cleaning out the whole colon is really important because if there's stool left over in the colon, it might actually cover a smaller polyp that we wouldn't see. The good news is we can almost always see the larger lesions, the larger polyps or anything that may be concerning for a cancer, but we could potentially miss something that is smaller. Also some people have a slightly harder colon to actually get a colonoscopy, because our colons fold. They go all the way around the body, but then they also have these folds in them and so when you're doing the colonoscopy, you need to look all around as you're going through. There can be an opportunity to miss a smaller polyp, which is why it's important to be up-to-date on your colonoscopies so that if a very small polyp is missed, it is caught on the next one before it could turn into anything scary and to be really diligent about your bowel preps.

Annie Zaleski:

Is there anything that people need to worry about just in terms of safety? I think obviously anyone having anesthesia, doctors always explain if there are any risk factors. Is there anything else that people need to worry about or potentially be aware of?

Dr. Arielle Kanters:

Absolutely. The main things I talk to my patients about before a colonoscopy are discomfort during the procedure, especially because I usually use sedation. I ask them to always let me know if they're uncomfortable or if they're having any pain. The main limiting factor in terms of me being able to give them more pain medication is just making sure that their heart rate is nice. Their heart should be beating and they're taking deep breaths. As long as you can accomplish those two things, we can give you more medicine to keep you comfortable. The next thing I warn people about is bleeding. The scope itself puts you at very low risk of bleeding, but any biopsy we take can increase your chance of bleeding. The bigger the biopsy, the higher the risk and so if someone's on a blood thinner normally, it's really important they talk to their doctor ahead of time and they know when to stop it before their colonoscopy procedure and that they also talk to the person doing their colonoscopy and asking when they can restart it.

              If it's restarted too soon or it's stopped too late, then that would increase your chance of bleeding. The other, it's the scariest thing that people will hear about, but the least likely to happen is something called a perforation or a hole in the colon. This happens in extreme circumstances, less than .1% of the time does a perforation happen. Just like with biopsies and risk of bleeding, with really big biopsies then that increases your risk of a hole being made in the colon. If after surgery, you're having significant belly pain, you start to have fevers or chills or just something doesn't feel right, it's really important that you contact your practitioner and let them know and most likely be evaluated in an emergency department.

Annie Zaleski:

That's really good to know. That's really in depth and I think knowing what the risks are will put people at ease, too. That's great. Let's talk a little bit about the virtual colonoscopy, the CT colonography. How does that differ? What can people expect?

Dr. Arielle Kanters:

With a CT colonography, you still need to do a bowel prep which, in my personal experience, is oftentimes the worst part of the whole procedure. Just something to be aware of that for the colonoscopy, you're asleep, you're actually not going to remember much of it and sometimes it's really the bowel prep that people dread. Fortunately, we've had some advances in our bowel preps as of late, so another important thing to talk to your primary care doc or the person who is going to be performing your colonoscopy about different options. Some of the newer bowel preps that we are doing are better tolerated. People, I'm not going to say they enjoy them, but they don't hate them as much. With a CT colonography, you do still need to do the bowel prep, but the benefit to the patient, is that you don't have the actual scope going into the colon. That decreases those risks of discomfort, bleeding and a perforation.

              The other important thing is that you don't need sedation. If you have a heart condition or a lung condition that puts you at increased risk with sedation, you can avoid these things. Just like I said before, the major downside is that you can't actually act on anything that you see on a CT colonography. What you'll ultimately still have to do is have a colonoscopy to better understand what they're seeing, so if it's just a simple polyp or a tumor and to sample it so that we can know what it is.

Annie Zaleski:

Awesome. I should have asked actually, both of these things, are those outpatient or are you expecting a day maybe for these? What can people expect?

Dr. Arielle Kanters:

They're both outpatient procedures. You're receiving sedation with the colonoscopy, you kind of consider yourself tapped out for the day. We don't recommend going to work or making any important life decisions after you've received any sort of sedation or anesthesia. You also need someone to take you home afterwards because the anesthesia won't be out of your system yet. The CT colonography, since you don't require sedation, it's easier from that standpoint. You can drive yourself, you can pick yourself up and it is an outpatient procedure.

Annie Zaleski:

I think there's another kind, I believe called a sigmoidoscopy. Tell me a little bit about what that is for screening.

Dr. Arielle Kanters:

A sigmoidoscopy or a flexible sigmoidoscopy is basically a mini scope. It lets us look at the anus, the rectum, the sigmoid colon, and then the descending colon. Basically it lets us look at the left side of the colon. Just to talk a little bit about colon anatomy, your small intestine sits in the middle of your belly. It hooks into the colon on the right side, it goes up the right side, across the middle, down the left side, and then comes out in the middle, out your bottom through the sigmoid colon. A flexible sigmoidoscopy lets us look at that left side of the colon. It is an opportunity to evaluate a portion of the colon, but it doesn't look at everything. Currently the recommendations are, if you are going to pursue this as your screening option, to do it every five years, but the opportunity to find polyps or cancers isn't as good as with the colonoscopy. One thing they have found is that if you combine a flexible sigmoidoscopy with something called a FIT test, which is actually what looks for those markers of blood in your stool, you have to do FIT test every year and then you can couple it with a flexible sigmoidoscopy. It gets closer to a colonoscopy. But again, if the FIT test is positive and the flexible sigmoidoscopy is negative, you still need a colonoscopy to look at everything.

              Other benefits of this one are that you can potentially just do an enema as opposed to a complete bowel prep. It depends a little bit on the patient, whether they can get away with it and a flexible sigmoidoscopy doesn't necessarily require sedation. For example, here at the clinic we'll do them in our clinic offices. We can actually do them for looking at rectal cancer, looking for basic sources of bleeding, et cetera. If that's the route you were going, that could be performed, but I will also say most practitioners do not offer flexible sigmoidoscopies as the standard screening methodology. It's generally more offered in places where colonoscopy is not an option.

Annie Zaleski:

Makes sense. Are there any other screenings that we haven't talked about that are the structural ones that people might need to know about or want to know about?

Dr. Arielle Kanters:

Those are mostly the main ones. Again, I'll put my bias out there. I believe colonoscopy is the right way to go. I understand it can be a very scary and intimidating process. Everyone's heard the horror stories about the prep and about the discomfort and I really recommend that you talk to your doctor about it, about the things that are making you nervous and hopefully they can put your mind at ease. You could also reach out to the GI doctor or the colorectal surgeon who will be performing your colonoscopy and see if they can help explain things. If the bowel prep's your biggest fear, you can investigate other options. If you're concerned about sedation, then they can investigate using full anesthesia. It's important that fear not be the one main thing that keeps you from getting these scopes done.

Annie Zaleski:

I think you touched on this a little bit, but how often should you be getting these screenings?

Dr. Arielle Kanters:

With a colonoscopy, it's every 10 years and that assumes that it's a negative colonoscopy. When you have your first one, it's kind of like you're starting from ground zero. If we find anything on that scope, if we find polyps or high risk lesions, that will actually shorten the amount of time before your next scope. For example, let's say we find a number of high risk polyps, or you just have a lot of polyps and we need to double check and make sure that none were missed, that could shorten your next scope to maybe two years or five years. It depends on the situation. As for a flexible sigmoidoscopy, if you're doing just flexible sigmoidoscopies, that's every five years, but if you combine them with the FIT test, with a stool test where they look for blood products, then you'd get that stool test every year and your flexible sigmoidoscopy every 10 years. Again, that one's not as much a standard, but it is something you can discuss with your physician if you feel like that's what's best for you.

Annie Zaleski:

That's a great segue, because I want to talk now about at-home colorectal cancer tests. I think more and more people have been seeing these tests being advertised and hearing about them. What are they and how does that differ from what we had just been talking about?

Dr. Arielle Kanters:

Sure. We were just talking about the visualization test. That's where you can actually physically see what's going on inside the colon. The at-home tests are at home. There's not a practitioner there with you. These tests rely on looking at samples of stool and looking for atypical cells or atypical chemicals that would indicate something is wrong. There are three main ones that we talk about. There's one called the FOBT, the fecal occult blood test. That's where a sample of stool is analyzed for a certain type of byproduct called guaiac. This is probably the least sensitive of all of the tests. It also requires that you change your diet. You have to avoid things like red meat. A few days before you can't have any nonsteroidal anti-inflammatories like ibuprofen beforehand because it's looking specifically for a blood breakdown product.

              There's something also called a FIT test, which I've referenced before. It's a immunohistochemistry test where they have certain antibodies that actually can identify blood in the stool. This is more sensitive. You don't have to change your diet in the same way, but all it tells you is that there is blood in your stool, which could be that you had a bad episode of diarrhea that can cause bleeding, or it could be that there's a tumor that is bleeding. It's like it's getting scraped every time you have a bowel movement, some blood will shed in your stool. More recently, we actually also have DNA tests, fecal DNA tests. When there is a cancer in your colon or anywhere in your intestines, it will actually shed some of it cells and those will end up passing in your stool.

              These tests look for that DNA in your stool. These are the most sensitive of these three tests, but there are some down sides to it, most notably that it doesn't find pre-cancer. One of the main benefits of a colonoscopy is that we can not only treat cancers or identify cancers, but we can treat pre-cancers so that these pre-cancerous polyps never reach the point of turning into a cancer in the first place. Relying on these fecal tests mean that you're potentially missing out on an early pre-cancer that could be eliminated and never turn into something scarier.

Annie Zaleski:

Wow. In light of that, who would be the ideal candidate to use these at-home tests?

Dr. Arielle Kanters:

We're talking about low risk patients with no symptoms. If you're having blood in your stool, I can guarantee they're going to be positive and you're going to end up with a colonoscopy. These are not for the people who are already having problems. If you're having new weight loss, if you're having low blood counts that can't be explained, if you're losing blood in your stool, these are all reasons that a full evaluation needs to be performed. If you have a family history of colon cancer or a medical condition that increases your risk, this is also a reason that a full colonoscopy needs to be performed. These are for the perfectly healthy 45 year old with no family history. Those are the people that are the right candidates for at home tests. I'm still going to recommend though, full colonoscopy.

Annie Zaleski:

Excellent. You touched on this a little bit, but beside changing diet and things like that, what is some of the other prep like for these tests?

Dr. Arielle Kanters:

That's the biggest one. There's not much else you have to do other than just being comfortable, collecting a sample of stool and sending it back to the lab, whether it's sent back to your doctor or it's sent to the lab directly.

Annie Zaleski:

It's a lot simpler. You can see what the advantage is because it's less than a couple days and things like that.

Dr. Arielle Kanters:

Absolutely. Other than having to wait on the results, it is definitely a much simpler process. This can also be good for someone who, for example, is very high risk in terms of having sedation or having anesthesia and maybe a CT colonography isn't an option for them. This is some way that we could at least screen and better understand if the person's at risk, that the risk of the colonoscopy is lower than the risk of missing something because one of these screening tests is positive.

Annie Zaleski:

What are some of the other advantages of these tests?

Dr. Arielle Kanters:

Absolutely compliant and I completely understand. No one wakes up one morning and says, "I want to have a colonoscopy today." If ultimately, this is going to be the thing that gets you in to get screened for cancer, absolutely do this. If you feel that you strongly will not undergo a colonoscopy, for whatever reason, please ask your doctor about at home fecal tests, because that is a great way to at least figure out if something else needs to be done and better understand your risk for possibly having a cancer at the time.

Annie Zaleski:

You mentioned that there are different things, if there's blood in your stool, it could be from different sources and things like that. How accurate are these tests generally considered?

Dr. Arielle Kanters:

They can be accurate as long as they're used consistently. By committing to doing at-home tests, you're committing to a yearly... Depending on the one that you're doing, essentially a yearly at-home test, and they really only seem to be accurate if they're used consistently. The FOBT test, the fecal occult blood test or the FIT tests, they are both done annually. The DNA tests, the recommendation for them ranges between every one to every three years, depending on whose guidelines you're looking at. You are committing yourself to a much more regular examination. Depending on insurance, the cost may also be higher for however much you have to pay and that compared to a single colonoscopy every 10 years, which is also something you have to think about. That's something that your insurance company can better explain for you.

Annie Zaleski:

That's what I was going to ask, is that do you need a doctor's note? Do you need a recommendation? How do end up taking an at-home test?

Dr. Arielle Kanters:

Absolutely. These are things that will be prescribed by your physician. They will write an order for it and the collection kit will be either delivered to you or given to you in the office. Yes, it has to come from a physician and an important part of that is making sure that this is the right test for you, because if you're having symptoms, this isn't the right way to go. If you have a family history, this isn't the right way to go. It's important that you have that conversation and figure out if this is the right test for you.

Annie Zaleski:

Is the same age applied for this? Do you start generally at age 45?

Dr. Arielle Kanters:

Yeah. Just like with the colonoscopy, the recommended initial age for a low risk or a standard risk individual is 45.

Annie Zaleski:

I think a lot of times people might just think, "OK, age 45 is when I can start, but I can start it earlier just to be on the safe side." Is that something that doctors recommend?

Dr. Arielle Kanters:

No, we don't generally recommend that. If you are concerned, if there's a reason you feel like you need a screening test sooner, that's when you have the conversation with your physician, because ultimately, your insurance will not cover it unless it's indicated, because part of the goal is that they're paying for the things that are indicated for your health. If you're just pursuing a test that is not necessarily indicated, there will not be compensation for that.

Annie Zaleski:

What else should people know about at home tests? Is there anything we haven't covered that you think might be important or that might be useful for people to know about?

Dr. Arielle Kanters:

If that's the route that you're going to go, you have to be ready and committed to doing it regularly. If you're not doing it annually or whatever the current recommendation is, then you're losing the accuracy, the efficacy of doing this kind of a test and putting yourself at risk of something being missed. Other than that, just remember that if it is positive, that's not the end. You need to speak with your physician about what the next steps are in terms of figuring out what's going on.

Annie Zaleski:

I think that dovetails really well into the end. All of this makes people nervous, from taking the test to prepping for it, to getting results in general about colorectal cancer screenings. What do you tell people who might be frightened or anxious about facing this, either for the first time or after many times?

Dr. Arielle Kanters:

Absolutely. Everyone has a family member who talks about the worst experience of their life being their colonoscopy. I can completely appreciate that and understand that. I think it's really important to talk to people. Talk about their experiences because the vast majority have not had negative experiences. What's really important about these screening tests is that colorectal cancer is very treatable when it's caught early. It is actually one of the more treatable forms of cancer out there that we experience as humans and so, catching it early, or even catching a pre-cancer and never letting it turn into a cancer is so important to us continuing to live. Thinking about the benefits of catching something early, or looking into why you might be having some bleeding, completely understand telling yourself that it's hemorrhoids is a lot easier than having a colonoscopy, but it's really important that we make sure it is something as simple as hemorrhoids, because we can also treat that and we can help you take care of that problem, but we always want to make sure that there isn't something scarier going on.

              I recommend that you talk to your doctor, talk to your family members, talk to your friends and talk to someone whose life was saved by getting a colonoscopy or their colorectal cancer screening test. Those are the people that can really tell you why it was important to them and ways that they were able to cope with things. There's actually also ways you could prep for it, relaxing breathing, meditation videos. There are a lot of ways of prepping yourself mentally for this experience that can actually help you on the day of the colonoscopy as well.

Annie Zaleski:

That's great because that has the side effect as well of helping your overall health, so you're getting all sorts of benefits.

Dr. Arielle Kanters:

Absolutely. You get your colonoscopy, you take care of your wellbeing, your physical wellbeing and your mental wellbeing, nothing wrong with that.

Annie Zaleski:

Is there anything else you want to add that we haven't talked about that you feel is important to mention?

Dr. Arielle Kanters:

I just want to encourage everyone to really be open about their experiences when it comes to colorectal cancer. One of the challenges about colorectal cancer is that it's a very private thing that people don't want to talk about. People are not that open about their poops and their bowel patterns and I understand that, but if something seems wrong, talk to your doctor about it because catching cancer early means we can treat it and you can be that survivor as opposed to a scary story about someone who let something go too long. I want to encourage you to get your screening. I want you to encourage you to talk to your doctor about any symptoms that you may be having and any family history of colorectal cancer so we can make sure that we're doing our job for you getting you into that right pool and taking care of you when we can.

Annie Zaleski:

Wonderful. Dr. Kanters, thank you so much for being here. I think you've really demystified the process for a lot of people and offered some good advice that's going to really reassure people as they're facing colorectal cancer screenings.

Dr. Arielle Kanters:

Thank you for having me. It's something I'm really passionate about and I encourage anyone to reach out to us here at the Cleveland Clinic to talk more about things.

Annie Zaleski:

Wonderful. Thank you so much.

Dr. Arielle Kanters:

Thanks.

Annie Zaleski:

Regular screenings for colorectal cancer are important because early detection removal of colorectal polyps before they become cancerous is key. For more information about colorectal cancer screenings and to find a location near you, visit clevelandclinic.org/colonoscopyre.