This episode of What the Health tackles the critical issue of colorectal cancer, discussing its impact, symptoms, and the importance of early detection. The show features Michael Sapienza, the CEO of the Colorectal Cancer Alliance, who shares his personal journey and the Alliance's mission. 

They explore the types of screenings available and how early detection improves survival rates. The episode emphasizes the need for regular screenings and provides valuable information on navigating the process, especially for high-risk groups and underserved communities.

00:00 Introduction to Colorectal Cancer

01:38 Meet Michael Sapienza, CEO of Colorectal Cancer Alliance

01:54 Mission and Vision of the Colorectal Cancer Alliance

03:34 Personal Story: Michael's Journey

05:21 Colorectal Cancer Statistics and Trends

06:22 Challenges in Screening and Prevention

09:27 Understanding At-Home Tests and Colonoscopies

14:45 Demographics and Risk Factors

18:03 Genetic Causes and Family History

20:12 Symptoms and Importance of Early Screening

22:53 Treatment Advances and Challenges

29:46 Call to Action: Get Screened

34:25 Conclusion and Final Thoughts

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Connect with WellWell USA:

• Website: https://wellwellusa.com/ 
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Connect with the Colorectal Cancer Alliance

• Website: https://colorectalcancer.org/
• Facebook: https://www.facebook.com/ColorectalCancerAlliance
• Instagram: https://www.instagram.com/colorectalcanceralliance

Connect with Michael Sapienza:

• LinkedIn: https://www.linkedin.com/in/michael-sapienza-913a375/ 

Screening Information

• More information about screening:
•  https://colorectalcancer.org/screening-quiz 

https://colorectalcancer.org/screening-prevention/get-screened-45

WW - Colon Cancer Episode

Unfortunately, these diseases don't always provide symptoms or warning signs, making them easy to overlook. That's a recipe for deadly disasters. The good news is that there are more ways than ever to test for these problems, and early detection is the best way to short circuit the worst scenarios.

Questions naturally abound when it comes to these cancers, their symptoms, consequences and treatments. Thankfully, we've lined up a guest who can answer all of this and more, both from a personal and professional perspective, so it's definitely worth staying with us and listening up.

Okay, so welcome to what is always the most important part of our podcast, where we delve into, a subject with, an expert to help us gain insights on what's confronting people and how they can deal with it. And today we're delighted to have, Michael Sapienza, with us, who is the CEO of Colorectal Cancer Alliance, to help us dive into this subject.

So Michael, thanks so much for joining us on, What the Health.

[00:01:52] John Salak: Okay. Can you tell us a little bit about the Alliance, because sometimes we reference these groups and people don't understand the scope or the depth of what they're trying to do, and we obviously will provide links so people can reach out and contact you guys in whatever fashion is appropriate, but give us a handle on what the Alliance is designed to do, its mission, and what it's trying to accomplish.

We want to make sure that people know about colorectal cancer and that it is the preventable cancer. So we actually do these large, videos slash, what we call, I guess, PSAs, et cetera. So we did one with Ryan Reynolds. We've done one with Dak Prescott. We've done one with Terry Cruz, really just to get the word out that colorectal cancer is the preventable cancer.

We also do screening navigation, all across the country. So meaning how do we make sure that if people know about screening that they get screened. And then we have the largest patient support program. So if unfortunately, one of the 150, 000 people in the United States that are diagnosed with colorectal cancer every year needs support. Whether that's psychosocial support, financial support, information about their actual disease or their tumor or surgery. We have live navigators that support those individuals. And then we have a huge research program called Project Cure CRC. We'll invest about a hundred million dollars in cutting edge research over the next two years.

[00:03:34] Michael Sapienza: This is our 25th anniversary, but actually my story is such that my mom unfortunately died of colon cancer on Mother's Day in 2009.

And I was, by training, I was actually a professional musician. I was a classical trumpet player performing all over the world.

And, my parents called me and they said, we've hit a bump in the road. And I know if both my parents are on the phone at the same time that there's something going on there. And I of course looked up the statistics for, colorectal cancer and they were not very good, but fast forward, she passed away in 2009.

So really, really proud of what we've been able to do. We have a lot of work to do to end this disease, but yeah, sure.

In the U. S. Let's just start in the U. S. because that's where our audience is from to give them a perspective.

[00:05:53] John Salak: Wow. Is this number rising? Is it stable? Is it lowering? Where are we in the battle?

She had never done. So You know, if you think about it, right, the, problem is, is just that, that people aren't getting screen. So, if you look at actually people over 50, we are seeing a decrease in mortality and in incidents, meaning the number of people get it, but that is mainly because people 60 and older are getting their, either their colonoscopy, their Cologuard or their fit test, right? But unfortunately, right now, the number one cancer killer under 50 for men is colon cancer and the number two cancer killer for women under 50 is colon cancer. So there's been a huge rise in the number of people that are young and not just under 50, but I always have to say because of my mom's age, 50 to 59 as well.

So the screening rate for breast cancer overall is like 80 percent of people get screened for breast cancer, only about 63 to 65 percent of people get screened for colorectal cancer. And when you look at this younger group, and when I say younger, I'm talking even 45 to 56. It's about 45 percent of those people and that's nowhere near enough.

And that's why we're still seeing this unfortunate rise in young onset colorectal cancer.

I don't want to think about my rectum. You know what I mean? I don't want to think about those parts of my body too. What do you think the reason is for the resistance?

And so, you know, if you're a single mom, a single dad, or even a two income family, that's not making a lot of money. That is a hard thing to do. And so, unless you're super proactive about your health, that is a big barrier. And then as well, if you live in a rural area where it's about 100 miles to the closest endoscopy center.

That's also a barrier.

Then if you think about the at home test, Cologuard and FIT, both of them great tests. Cologuard, they'll ship it to your house. You can do it there, but there is maybe a little bit of a ick factor for some people because of the stool. But I would just say it's like either way, or the thing I would just tell your audience is I was, I could talk all day about the things that are not great about all of these tests, but my mom died. And the only reason why

my mom died is because she did not do it. Period.

[00:09:24] Michael Sapienza: mean? Yeah.

[00:09:34] Michael Sapienza: Yeah. So the fit has been around for a long time, maybe 20 years.

Cologuard, it just celebrated its 10 years. So you're probably thinking of Cologuard, the one that has the dancing box commercials, and honestly,

they've done an amazing job. The Cologuard test is actually way more sensitive and specific for. Finding cancers, finding precancerous adenomas, et cetera. And they ship it to you and they have a navigation program that really helps. For fit if you're part of like Kaiser or a bigger system, they have the ability to make sure you do those tests every year. But see, the thing that I think is really important for people to know is if you're somebody like me that has a family history of colon cancer, I have to get a colonoscopy. You are not recommended for any of those at home tests.

If you don't have a family history, you certainly can do a ColoGuard. ColoGuard is recommended every three years. If the ColoGuard test comes back positive, you then have to get a colonoscopy. In the FET test, you have to do every year. And again, if it's positive, you have to get a colonoscopy. So I think it's really, really important that people know it's not just as simple for breast cancers. Go get your mammogram. Okay. If you get your

mammogram, you're good. And if you have dense breasts, you have to get a dense breast mammogram. is a little bit more complicated.

And that's where I say, John, we have a website it's get screen. org where people can really learn about, okay. Do I have a family history? Can I get a color guard or a fit at my house? Will I be okay? When do I have to go back and do it? and all of those things. Yeah.

But again, there is an ick factor to it. So people are probably hesitant and you know it's a combination of things, too.

You don't have to do the prep. You don't have to take off time from work, et cetera. So it's just really important though, that if you have a high risk, meaning you have a family history that you absolutely get a colonoscopy, or if your Cologuard test comes back positive, you got to get that colonoscopy.

I don't know how else to put it, you know?

Imagine if it's like a mole on your skin is what I tell people. Get a mole on your skin, the doctor does that skin check. They take it out right then and there to prevent it from turning into full on skin cancer. Well, when you get a colonoscopy, they go in there and they can clip that polyp out right then and there, take it out, which is what prevents the cancer from forming.

So, , yeah, there are downsides to the test, but at the same time it saves your life period. it is the preventable cancers, I say.

Because your alliance is a colorectal, alliance. So that's, you know, I want people to have a handle on that.

You're going to do a resection of your colon. They're going to take that, little tumor out, and they're going to reattach it. If it's in your rectum, they may do radiation first. They may do chemo first. They may do surgery first. And oftentimes there are other complications based on the, place of where the, tumor is. So we call it colorectal cancer because under the microscope, it is very, very, very similar, but it is two different types of organs.

Your colon and your rectum are actually different organs themselves and serve different purposes.

Who should be on guard?

Well, one, all the normal ones, exercise, okay. A diet high in fiber.

a diet low in red meat and processed meats. It doesn't mean no red meat or no processed meats. It just means, it's a model file factor that can help,

[00:15:37] Michael Sapienza: Smoking Smoking can obviously increases your risk significantly of any sort of mutation and cancer. So those are modifiable factors. So exercise, diet high in fiber, vegetables, fruits, low in red processed meats, and smoking piece. So those are things for anybody at any age. That is going to help lower your risk. , the other things that I would say in terms of demographics. African Americans have a 20 percent higher incidence rate and 35 percent higher mortality rate. But that is not inherently biological. That is nothing to do with Them being African Americans. It has to do with other factors, whether that is socioeconomic factors, whether that's racism and healthcare, whether that is, the fact that they may not get their tests on the right time, or do they get the right quality of care?

So african American men have the lowest screening rate of all individuals in this country. We did this Leave from Behind. We is what we call the campaign with Dak Prescott and we did it for a reason. , he speaks as a male African American, and we saw 16 million people watch this video and, hopefully that will really help people realize that everybody needs to be screened.

It doesn't matter who you are, even if it's somewhere where the sun don't shine, or if you're at average risk again, take those tests. So African American men, African Americans in general, I would also say there's two other high risk groups, and it's not because they're inherently at risk. It's because of what I said earlier.

Do they live in the middle of Kansas?

[00:17:17] Michael Sapienza: Do they maybe live in the middle of New York state where they're a hundred miles from a place where they can get a colonoscopy? And that's again where I say, get that Cologuard, get that fit test,

right? As long as you are average risk. And then the third group is that group that I said earlier, people between 45 in their mid 50s.

So if you think about those people, they're like, they may have like kids in high school or in college or they're still running their businesses. They're like in the prime of their life from a professional perspective. And they're like, who's got time for that? I'm fine. I'm in invincible and whatnot.

But that's actually when you need to be doing the colonoscopy, the Cologuard or the fit test. So those are really the biggest things. Yeah. Those are the biggest things, that I would say.

[00:18:08] Michael Sapienza: Yeah, absolutely. So there are three types of cancer that normally people get. So one is just sporadic, no matter what you do or what happened, you just get it. You have a mutation of a cell, and you get cancer. There's not much you can do. There's the second is familial. So if I were to get colon cancer, it would be called familial because I don't have a cell or a genetic mutation that was passed on from my mom to me, but if I got it, we would call it familial. And then the third one is to your point, John, the hereditary or genetic one, which is my mom had. or was born with a genetic mutation that predisposed her to colon cancer or could be others. So in, in colorectal cancer, there's a couple ones, right? Everybody's probably heard of BRCA because Angelina Jolie made it super famous. Unfortunately More people have what we call Lynch syndrome, which is the colorectal cancer, hereditary cancer than that have BRCA. And so it's about 1 in 270 people in this country have Lynch syndrome, which, predisposes you or put you at higher risk for colorectal cancer, endometrial cancer, ovarian cancer, breast cancer, skin cancer, pancreatic cancer, a bunch of them.

And so about 10 percent of people that get colorectal cancer have either Lynch syndrome or a variation of other types of hereditary cancer. So I would say if you're worried about that, you should go to ccalliance. org. We have a family history like quiz on our site that will ask you a bunch of questions. But basically if you look at your parents or you look at your parents siblings, or your grandparents and there are multiple cancers that people have died from, you definitely should talk to a genetic counselor or talk to your health care provider about do you potentially have a hereditary risk?

[00:20:30] Michael Sapienza: Yeah, it depends. Sometimes yes, sometimes no. And that's the hard part about it, right? If you do have these symptoms, it could mean that you have it. So, unexpected weight loss. Change in your bowel habits, blood in your stool, especially dark blood, what else? Night sweats, those sorts of things could be indicators. But I'll tell you, John, like, I have met thousands of patients that, oncologists says, are cardboard eating, marathon running, and have no symptoms, but they're too busy to get screened. And they come into his office with stage four colon cancer.

So the number one thing, and I'm going to just say it again, is to get screened.

Period. Because you just don't know. Like, there are a lot of people that don't have those symptoms. It's very similar to pancreatic cancer.

Is it more than half? And again, it's obvious as to how early you catch any of these diseases?

something like stage two. I'm guessing here without looking exactly, but it's still very, very, very high cure rate. Stage three , that's where, depending, are you early stage three? Are you later stage three? But if you're early stage three, you still have a very, very high probability of being cured from the disease. It's once you get into late stage three and obviously metastatic or stage four, where Some people survive, but not very many

people.

So if you look at the comparison, so the five year metastatic survival rate for breast cancer is about 35 percent of patients. And that means 35 percent of patients live five years or longer when they're diagnosed with stage four metastatic, only 13 percent of colorectal cancer patients that are stage four live five years or longer. But again, I'll reiterate what you just asked.

If you get screened, The sooner you get it and the sooner they find the polyps, et cetera, the better chance you have of survival by a significant margin.

Mm hmm.

We're actually the second lowest funded cancer per mortality in the United States, which makes no sense. So we are trying as an organization to really put this on the map. We're putting our money where our mouth is.

And basically since then, that's equal to about 3 billion to 4 billion of research. And there's been 300 new FDA approvals for breast cancer. Well, for us, we still have a lot of the same standard of care. from the first line, meaning the first, chemo that you get that was around 20 25 years ago. So there are advancements.

Don't get me wrong. About seven years ago, there was an advancement for about 5 percent of patients. We call those patients, microsatellite instable, which means like that. their DNA mutations have gone a little bit crazy.

[00:24:24] Michael Sapienza: They actually had a drug that people may or may not have heard of.

It's on television a lot called key Truda,

and it allows the immune system unlock the tumor. And actually, most of the people, not all, but most of the people that have MSI high are completely cured of their disease, completely cured, which is like amazing. So if you think about, president Jimmy Carter had, he had melanoma he got on key Trudeau, the same drug completely cured him.

And as he's good. I don't know how old he is. He's 99 or a hundred years old. So what we're trying to do in colon cancer is to take the other 95 percent of patients, which we call MSS microsatellite stable and see if we can get the immune system to open up so that same immunotherapy drug will work on those patients unsuccessful so far, but we're trying to do that. We also are looking at what we call targeted agents. So if you have a mutation that is, in any sort of cell, let's say it's a KRAS mutation. How do we find drugs that target the KRAS pathway? Right. And so there to say there are no advances would be, an understatement. For example, We just had a BRAF drug come out.

We had a HER2 drug come out. You probably heard of HER2 because of breast cancer, but there are some colon cancer patients that have them, but we're really trying, the alliance is really trying to infuse money. Both, in researchers at institutions, but also in small biotech companies. So we get to a cure much, much faster.

do you feel you're making progress in the battle against these cancers?

It's yes, of course, we want them to have a quality of life. Of course, we don't want them to have to quick work. There's financial toxicity and all of those things, but mainly they don't want to die, and so the progress I would say is it's moving. And, , I'm learning more and more and the colorectal cancer alliance and project is learning more and more. On how we can speed up that progress. But to say that I'm not frustrated would be a total understatement, John. I mean, there are so many intricacies into this. And, we live in a capitalist society. And yes, whether you're. And I won't name any pharma names, but big pharma, their existence is they have to talk to their shareholders. They need to be profitable. And so does that mean they're not creating awesome drugs? No. But does it mean that they may be able to create better drugs if there is a different system or a better way of getting clinical trials into the hands of patients quicker? Absolutely. And so I think one of our jobs is an advocacy organization is to push that whether that's to push those companies to look at it differently, whether that's to help change the minds of some individuals on Capitol Hill about everybody's saying, Oh, evil, big pharma. And they have all, they charge too much and this and that.

And the other thing, well, there's two sides to that coin. Sure. They're charging too much maybe, but at the same time, innovation does cost money. So one, how do we get them to charge less? Look at how much does it cost to develop a drug? And can we reduce that cost? But also realize that innovation isn't cheap.

It isn't. And then how can we be smarter together all decrease the cost of that innovation so that we really can have more developments? Because again, the bottom line is patients want to live and they want to live longer. Period.

[00:28:43] Michael Sapienza: Yeah, the number one would probably be that affects men and women almost the same. Well, whether we talk

about the higher risk and all that stuff is different, but it affects them almost exactly the same men and women.

The second person I met was a 29 year old woman who died. After about a year and her husband, unfortunately, her caregiver died three years later

[00:29:29] Michael Sapienza: because not from colon cancer, but just because of, as you probably know, being caregiver, if you are one like that is not an easy job, and it takes a huge toll you.

So again, I think the biggest misconception is that it is an old white man's disease.

[00:30:00] Michael Sapienza: colorectal cancer screening is. gonna save your life. So I would just say that first and foremost, if you are an average risk, which means you do not have a family history of the disease or don't have a history of tons of polyps in your family or Crohn's or colitis, you should start getting screened at 45. And I'm going to say that again. 45 is when you should start getting screened for colorectal cancer. If you have a family history of the disease, let's say your mom or your dad was diagnosed at 40, then you should be start getting screened 10 years before that age or the age of your first degree relative.

So if they were 45, you should start getting screened at 35. If they're above 45 years old, or about 50. years old than the age is 50. If you have a family history, you should start getting screened at age 40. If you have a first degree relative and then in terms of the intervals of being screened.

So let's say you get your first colonoscopy at 45, they find no polyps, you're good to go for 10 years. Unless you have any like, Crohn's or colitis, but most everybody, if you have a clean colon at 45, you can wait 10 years. Let's say they find polyps when you're 45. Well, it depends.

Are those precancerous polyps or are they not? So you need to talk to your GI doctor about, do you go back every three years or every five years? If you have precancerous polyps and they're aggressive or larger, definitely three years. But you want to listen to your GI doc about that. For a ColoGuard test, it's every three years, but again, the starting age is still the same, 45.

And for a FIT test, again, every year, but starting at 45. And for ColoGuard and FIT, if those tests come back positive, you have to get a colonoscopy.

[00:32:11] Michael Sapienza: That's a, really great point. So two things I would just say, so if you live in a state that does not have Medicaid expansion, so you have to look that up, which means that the Affordable Care Act does not cover preventative services for people that have Medicaid. Your colonoscopy, your FIT or your Cologuard will be subject to your coinsurance or your copay. So I would encourage people that anybody listening that is in one of those states. I think Texas is one of them. But if you are one of those, we do have financial assistance. We

have programs help individuals that are in those states. If they have large copays or coinsurance, visit ccalliance. org for that. Otherwise, if you live in any of the other, I think it's probably 40 states, I can't remember exactly, that do have Medicaid expansion, almost everybody should get their preventative screenings for free. It's free. It is part of the Affordable Care Act.

That is really, really good. If you have any questions, visit get screen dot org. We have all the information there. Because it's confusing if you have different type of insurance, etcetera. And then John, just the last thing I would just say about primary care physicians, yeah.

You know how many diseases there are out there in this world, and sometimes they don't have the time to go through the 150 of them.

Especially with colorectal cancer being at the second leading cause of cancer related death, they would tell everybody, Okay, you got to do it.

You got to do it. But they don't. And so we, just, stress for, everybody. You got to be your own advocate. And you got to get in there when the guidelines tell you to.

Give us a website again, not that we won't give it at the end of the podcast.

[00:34:26] John Salak: Okay, I know we could go on and on about this. It's an incredibly important topic It touched you both personally and now professionally, so we thank you for your time. You've given us great information and we can't encourage people enough to get screening because it's easy to do and as you point out it is such an easy way avoid the worst case scenario in terms of these diseases.

So Michael, thank you very very much for your time and your effort and all the work your

Alliance is doing.

[00:34:56] John Salak: Before we move on, we wanted to again encourage listeners to take advantage of the hundreds of exclusive discounts WellWell offers on a range of health and wellness products and services. These cover everything from fitness and athletic equipment to dietary supplements, personal care products, organic foods and beverages, and more.

Signing up is easy and free. Just visit us at WellWellUSA. com, go to Milton's Discounts in the top menu bar, and the sign up form will appear. Signing up will take just seconds, but the benefits can last for years. So, obviously, we need to stop ignoring colorectal cancers. That's about the worst thing anyone can do.

Remember, about a hundred and fifty thousand Americans are diagnosed annually with these cancers, making them the fourth most common form of cancer in the U. S. among men and women. They are also some of the most deadly cancers we deal with. Fortunately, there are easy ways to lessen their risks. First off, diagnostics are easier than ever thanks to at home tests.

It's also crazy to avoid colonoscopies. They are quick, painless, and they are an essential way to keep these cancers at bay. In addition, It's also crazy to avoid colonoscopies. Early diagnosis saves lives by a substantial amount, like promoting a 90 percent survival rate. Ultimately, there is no good reason to avoid testing regularly at home via a scope or both.

Not sure what to do? Just follow your doctor's individualized testing recommendations. Chances are You will learn to love your decision. That's it for this episode of What the Health. We'd like to thank Michael Sapienza, CEO of the Colorectal Cancer Alliance, for sharing his personal and professional insights on this issue.

The Alliance is a great source of information for anyone with questions about colorectal cancers. Just visit colorectalcancer. org to learn more. That's colorectalcancer. org. So, thanks again for listening to this episode of What the Health. We hope you'll join us again.