Colorectal cancer is one of the deadliest cancers in the world. While older Americans are more likely to be diagnosed with colorectal cancer, it has been on the rise in people under the age of 50 in recent decades. In this episode, Dr. Maggie Westfal discusses details on new screening recommendations aimed to catch the disease in younger people. Dr. Maggie Westfal is a MUSC Health colon and rectal surgeon and a member of the MUSC Hollings Cancer Center.

Erin Spain, MS: Welcome to

Advance with MUSC Health.

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I'm your host, Erin Spain.

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This show's mission is to help you find

ways to preserve and optimize your health

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and get the care you need to live well.

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Colorectal cancer is one of the

deadliest cancers in the world.

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And while older Americans are more

likely to be diagnosed with this disease,

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it has been on the rise and people

under the age of 50 in recent decades.

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This trend has led to new screening

guidelines to help catch this disease

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earlier and younger populations and

offer access to leading edge treatments.

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They can help people live longer lives.

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Here with details on new

screening recommendations.

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And the latest treatments is Dr.

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Maggie Westfal and MUSC Health colon,

and rectal surgeon, and a member

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of the MUSC Hollings cancer center.

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Welcome to the show Dr.

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Westfal.

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Maggie Westfal, MD: Thank

you so much for having me.

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Erin Spain, MS: Tell me about

colorectal cancer and why it's a disease

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that everyone should be aware of.

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Maggie Westfal, MD: From a general

population standpoint, colorectal

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cancer is still the third leading

cause of cancer death in the United

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States, and it's preventable.

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It's preventable with screening,

and it's preventable with a

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variety of screening tests.

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So, from a colorectal cancer

surgeon perspective, we always

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recommend a colonoscopy.

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And the reason we say that is because

a colonoscopy can be diagnostic,

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but it can also be therapeutic.

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And so, if you see precancerous polyps

on a colonoscopy, you can remove

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them before they develop into cancer.

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And I think, Many people, in the

general population don't want to get

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a colonoscopy because they hear the

stories from their friends about the

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prep but it really is the best way

to prevent colon and rectal cancer.

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Erin Spain, MS: And something

about colon cancer is that it

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can develop without any symptoms.

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Tell me about that.

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Maggie Westfal, MD: Yeah, and we're

seeing more and more patients with what's

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defined as young onset colon cancer.

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So, colon cancer in patients

less than 50 years old.

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Historically, we thought of colon

cancer and rectal cancer as older

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adults, 60s, 70s, 80 years old.

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However, now we know that it's happening

at higher rates and those rates are

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increasing in patients less than

50, whereas the rates are actually

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decreasing in patients older than 50.

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And I think that some of that comes from,

the hesitation to previously performed

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screening tests in the younger population.

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Like you mentioned, the guidelines have

now, decreased from 50 years old as the

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starting of screening to 45 years old.

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And I think that's because we're seeing

this disease in such younger patients.

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but it's silent for many in that

they don't have abdominal pain.

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They don't have changes

in their bowel habits.

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They don't have cramping.

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They don't have bleeding until it

gets to the point where it's, higher

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stage disease than we would have

want to first initially find it at.

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you know, what we say to patients

is if you find yourself having new

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onset abdominal pain, bloating,

changes in your stool habits, that's

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something to raise your red flag

and be seen by either your primary

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care doctor or a gastroenterologist

or a colorectal surgeon.

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Erin Spain, MS: what do researchers and

scientists know about this prevalence

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of younger people getting colon cancer?

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Is there a reason why this is happening?

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Maggie Westfal, MD: I Think

it's, it's really multifactorial.

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we know that the hormonal

changes of obesity can increase

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one's risk for colon cancer.

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We know that our American diet, which

is often high in processed foods

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and red meats, is pro inflammatory

and, can be, conducive to developing

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polyps and then colon cancer.

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And then our environment, which is

something which is so hard to study,

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because how do you quantify environment

as a thing to then, say, Oh, patients

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in the United States are at higher risk

than patients at a different country

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when you can't really quantify what

that environmental difference is.

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Genetics is a small portion of it.

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It's really only, you know, less

than 10 to 15 percent of all patients

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with early onset colon cancer.

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I think environment, diet,

obesity, and then the other

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factors we just don't know yet.

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you know, the gut microbiome is something

that's up and coming in research and

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that looks at the different types

of bacteria that live in our colon.

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They think that having a lower variety of

bacteria may have you at increased risk

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for inflammation and polyp development,

and then eventually colon cancer.

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But it's still very

much a work in progress.

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Erin Spain, MS: a piece of good news

is that we do have these screening

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tools that are able to detect early

and as you mentioned, the screening

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age has been lowered to 45 from 50.

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Do you feel like this is something a lot

of folks know that they should be getting

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their colonoscopies or doing another

screening method starting at age 45?

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Maggie Westfal, MD: I would say, no, I

don't think a lot of people know this yet.

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And I think we can do a better

job of educating our patients.

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when I tell say 10 people in clinic that

they're due for their colonoscopy at 45,

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maybe half know, that 45 is the new age.

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but I would say at least half don't, it

will be interesting to see in the next

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10 years if that age goes from 45 to

40, as we see these cancers, you know,

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coming in patients earlier and earlier.

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if you're unwilling to undergo a

colonoscopy, like you mentioned,

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there are other screening tests.

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And there are stool tests that you can

send in from your home and there are

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blood tests , and a variety of different

things that you can do, but like I

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said, the best test is a colonoscopy

because it can also be diagnostic and

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therapeutic in, treating those polyps

and decreasing your risk overall.

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Erin Spain, MS: Talk

to me more about that.

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How does colon cancer start and

what can be done to prevent it from

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progressing to that cancerous state?

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Maggie Westfal, MD: Colon cancer starts

with a, pre cancerous polyp, which is

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essentially an overgrowth of the lining

of the colon, and they can be a variety

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of different types, but some will develop

into cancer, and others Don't, but the

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reason why we remove them is because just

looking at them, we don't know which ones

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are precancerous and which ones aren't.

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On average, for patients without

a genetic predisposition to colon

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cancer, it takes about eight years

for those precancerous polyps to

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develop the genetic abnormalities to

then develop into cancer and grow.

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In a patient with a genetic predisposition

to colon cancer, that can speed up to

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over two to three years and be very quick.

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And so the screening that we do

for those two different patient

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populations is different.

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And so the general population will

get screened every 10 years if

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they don't have polyps, depending

on how many and what type of polyps,

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the next screening test might

be 3 years, 5 years, or 7 years.

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But in a patient that has a

genetic predisposition where that

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precancerous polyp can develop

into cancer in maybe 2 years.

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We often screen every one to two

years in that patient population.

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Erin Spain, MS: Tell me more about

what makes someone high risk or how

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they know that they're genetically

dispositioned to have colon cancer.

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Maggie Westfal, MD: It's really

important to try to find out your

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family history when that's possible.

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Ask your loved ones, is there a

history of cancer in our family?

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What kind of cancers are in our family?

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And the important question is, when did

our loved ones get diagnosed with cancer?

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Was it in their 70s, 80s, and 90s?

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Or were they getting diagnosed

with these variety of cancers

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in their 30s or 40s or 50s.

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And so, there's a set of guidelines that

we follow, that talks about how many

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people in your family have colon cancer

or an associated cancer like endometrial

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cancer, ovarian cancer, pancreatic cancer.

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And when were they diagnosed?

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Less than 50 or over 50?

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And then do you have any first degree

relatives that also had those cancers?

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So based on that kind of screening

assessment, we can say, it sounds

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like you and your family are

at high risk for colon cancer.

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We recommend genetic testing.

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And that's if someone has colon

cancer, but it's not you personally.

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If you personally come in and have a

history of just diagnosed colon cancer,

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it's now universally accepted that

those patients get genetic testing.

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And really it's for the patient to

know treatment options, etc., but

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it's also for their family to know

that they need to be screened earlier

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most often and more frequently.

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Erin Spain, MS: You mentioned

that there is a way to look at

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genes and your genetics to find

out if you are at higher risk.

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Can you tell me about that?

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Maggie Westfal, MD: often we screen

patients with colon and rectal cancer.

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They all get genetic testing universally.

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Here at MUSC, If a patient comes

into clinic and doesn't necessarily

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have a family history of colon cancer

or personal history of colon cancer,

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MUSC is actually enrolling patients

in a study called In OUR DNA SC and

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it's a community health project that

was launched by MUSC, which allows for

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the enrollment of 100, 000 patients

to get genetic testing at no cost.

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And so, sometimes insurance will

not necessarily cover genetic

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testing if patients don't

have a strong family history.

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A history or a personal history of cancer.

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So this gives you the opportunity to

be screened and entered into a genetic

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and research database that'll allow us

to look at these genes more closely and

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try to reduce the risk of cancer, in

our population here in South Carolina.

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Erin Spain, MS: How young are

the youngest patients that you're

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screening who are at high risk?

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Maggie Westfal, MD: so if someone has a

hereditary disposition to colon cancer,

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which, typically is referred to Lynch

syndrome, they'll get screened starting at

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20 unless the younger person was 20 when

they were diagnosed with colon cancer.

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then it typically falls

about five years before that.

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Personally, I've seen patients with

colon and rectal cancer as young as 16.

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so it's really important to know

your family history and know

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when you need to start thinking

about getting a colonoscopy.

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Erin Spain, MS: This issue of younger

people being diagnosed is something that

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you're very interested in and that you

are actually conducting research about.

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Can you tell me about that work?

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Maggie Westfal, MD: I'm really

interested in hereditary colon cancer,

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rectal cancer, and looking at not

only the patients that experience

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that from a patient perspective,

but also their family members.

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So, trying to identify at risk families

and assess how well we're doing with

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our guideline concordance screening.

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So, are we, getting these patients to the

doctors every year to get their screening

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tests or because they're not the one

that had cancer, are we not doing well?

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and so I'm trying to assess the families

as a whole instead of just the patients

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to make sure that, we're trying to prevent

cancer from happening in these family

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members, before it becomes a problem.

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Erin Spain, MS: I understand

that certain racial and ethnic

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communities are also more likely to

be affected by this type of cancer.

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Tell me about some of those disparities

that are seen among different groups.

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Maggie Westfal, MD: from a historic

standpoint, African Americans are

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typically diagnosed at a higher

stage, a later stage, and often

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have, worse outcomes overall.

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I don't know that we know

for sure why that is.

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but I think it's a topic

that we have to look into.

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We have to find a way to get

preventative care to every patient

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across all races and ethnicities.

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is it because patients aren't

getting screened as often?

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Is it because the access

to care is different?

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Is it because the perception

of colonoscopies is different

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across different cultures?

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I don't think we know that for sure, but

it's definitely something that would be

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interesting to look at from a research

perspective in order to better the

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care that we provide to all patients.

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Erin Spain, MS: What are the survival

rates for colorectal cancer if it's

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discovered in an early stage and then

if it's discovered at a later stage?

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Maggie Westfal, MD: usually

with survival rates we look at

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Most often five year survival.

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That's what people usually remember when

they're diagnosed with colon cancer.

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You know, what's my risk

of dying within five years?

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And essentially overall, the

five year survival rate is 63%.

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But if you look at stage one and stage

two cancers, that survival rate is as high

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as 91%, which is, you know, very good.

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when you get to stage three

disease, it's about 70%.

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And when you get to Metastatic

disease, it's about 13 to 15%.

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So overall, when you average

those, it comes out to about 60%.

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But like we said, early stage disease,

you're getting your colonoscopies.

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It's discovered early, that's about 90%.

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And then as you get higher, stage

three and stage four, it goes down.

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Erin Spain, MS: what's a piece of

advice that you would like to offer

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to our listeners regarding colon

cancer awareness and prevention?

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Maggie Westfal, MD: getting a colonoscopy

can be scary, and it's often the

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unknown that's most anxiety provoking,

but talk to your providers about it.

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There's a variety of different prep

options now, and I would say patients

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are tolerating it much, much better

than the past when patients used

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to drink four liters of this salty

solution and be miserable and complain

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about it and come in dehydrated, you

know, we don't often use that prep.

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It's usually a much smaller

volume and much more tolerable.

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So I would say if you're 45,

definitely get to your provider,

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get a referral for a colonoscopy.

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But also, if you're worried and

you're having abdominal symptoms or

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you have a change in bowel habits

and you're really not sure what to

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do, definitely talk to your provider.

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Don't wait six months, don't

wait a year for it to get better.

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The earlier that we can get you to get

a colonoscopy and hopefully find nothing

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and at least ease your worry, The better.

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If we do find something, then

we can follow you closely.

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And if we don't, then you can,

you know, be screened at the

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appropriate time going forward.

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Erin Spain, MS: The last question

is something we ask everyone

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who comes on this podcast.

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What do you do to optimize

your health and live well?

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Maggie Westfal, MD:

That's a great question.

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what I will say is I have been

more thoughtful about trying to

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not eat as many processed foods.

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I have two kids and so we've been trying

to limit the amount of processed foods

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that we can with the understanding

that sometimes you're on a road

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trip and you need some McDonald's.

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And so I think, moderation

is the key in our house.

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But if I'm being completely honest, what

I really should do is start taking fiber

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and making my gut health even healthier.

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So, maybe that'll be my

New Year's resolution next

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Erin Spain, MS: Thank you so much, Dr.

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Maggie Westfal for coming on the show, we

appreciate your time and expertise today.

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Maggie Westfal, MD: Thank

you so much for having me.

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Erin Spain, MS: For more

information on this podcast,

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check out Advance.MUSCHealth.org.