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Welcome to “Should I Call a Doctor?” The podcast where we dive into trending health topics to separate fact from fiction. We bring in experts to talk about all things health, to empower you with knowledge and answer your questions hosted by Inova Health.
Welcome to, should I call a doctor,
the podcast where we dive into the
questions you have about your health and
today's trending health topics
to separate fact from fiction.
I'm one of your hosts, Dr. Sam Owly, an
internal medicine physician at Inova.
I'm Tracy Schroeder. I lead
communications for Inova.
Dr. Sam will give you the clinical
perspective while I ask the questions that
keep patients up at night.
Today
we're tackling an important
topic, colon cancer, um,
but particularly its rise
in younger adults. Um,
and so we have a lot of
questions about that.
Joining us today is Dr. Tim Cannon.
He is our co-director of Innova's
Gastrointestinal Cancer Program and
the Sheridan Director of the
Molecular Tumor Board at Innova.
We are also lucky to have
kan shaman joining us,
one of Dr. Cannon's former patients.
She's gonna share her journey of
being diagnosed with colon cancer at,
I don't know what age, 40. 40. Yeah. Um,
so we're very much looking forward
to this conversation, Tracy.
Yes. We're excited to
have you both here. Um,
and we're gonna talk a lot
about colon cancer screening,
risk factors and treatment,
and we want you guys to help us understand
why we're seeing an increase in the
incidence of colon cancer, uh, in young
adults. So why don't we start with you,
Dr. Cannon.
Why do you feel like we are seeing
such an increase in younger folks?
Oh, this is the, uh, the
million dollar question.
Tracy. Right? It's a lot of media
about this right now. Yeah. I.
Wish there was one clear unifying answer,
and there really isn't so far. I mean,
you hear a lot of theories,
probably the ones that get the most
play are changes in diet, um, uh,
sugar drinks, um, you know,
but I think there are a lot of other
factors that we don't really know, uh,
much about. I think, um, you know,
there have been studies that have, uh,
suggested that for instance, and this
is a little bit, um, uh, you know,
not well established, but
that, uh, breastfed, um,
kids actually ended up having a higher
risk of interesting, of colon cancer.
And, um, you know, red meat may
increase, uh, one's risk, um,
processed foods. Of course, that's
something of interest there.
A lot of attention has been given to, uh,
people who took acne medications
or antibiotics for acne
in their teenage years.
So all of these are contributing factors,
but none of them seem to be a singular
explanation for this rise. But.
Is alcohol consumption, I don't know
if I heard you mention that. Yeah.
I didn't mention that, that,
but that is one Yes, that is,
that is also commonly cited.
I was gonna say, I feel like
I've seen quite a bit about that.
And so how young are we seeing,
you know, in your practice, what,
what would you say some of, um,
the trends are that you're seeing
in terms of patients? Yeah.
I mean, incredibly young. So the,
the statistic I like to
say is since 94 to now,
there's a 50% increase in
young onset colorectal cancer.
So we define that as people who are under
50 consider anything below that to be
a young onset colorectal
cancer, it's gone up by 50%.
I have seen several people in
their twenties Wow. Uh, with,
with stage four colorectal cancer.
And, uh, and I feel this in,
I mean, every,
almost every week I'm seeing a young
onset colorectal cancer patient.
They do seem to be getting younger
and younger. Mm-hmm .
And the cancers they get seem
to behave more aggressively.
Wow. That's really frightening
and, and interesting too.
And such a important reason
that we're talking about it.
I do feel like Katie Couric,
you know, 30 years ago,
made colon cancer screening. Cool.
And so is that, you know, how,
what are the, what are the
symptoms that the, I mean,
anybody but particularly these
young patients that you're seeing,
what are they coming in with initially?
I think,
I think sort of messaging
about the symptoms is the
most important thing we can
do. Because usually when I see a
young onset colorectal cancer patient,
they've seen about three or four
doctors before the diagnosis is made.
And because you just don't
expect it. Right. Right.
There's a million reasons you can
have a lot of these symptoms mm-hmm
.
But the main symptoms too that should
get our attention are bleeding when we go
to the bathroom. Mm-hmm .
A weight loss that's unexpected. Okay.
It doesn't seem to fit
our lifestyle habits, um,
bloating or any changes in bowel
habits. Okay. Okay. And yes,
there are a lot of other
things that can cause but all.
Of those symptoms. Right.
Yes. But, or that can cause
those symptoms. But yeah,
those are the kind of warning signs
that I think should, should sort of, um,
incentivize people to go get checked.
Out.
Is there any aspect of this that is just
the nature of healthcare has changed
that we're more attuned to it? People
are coming in more? I mean, yeah.
The part where you say 20 something
year olds with stage four,
clearly that's not gonna be that
that's someone showing up later. Yeah.
But are these things being
caught on random tests,
or is this everything
you just said? Like No,
it's just things are happening that
weren't happening before versus we're
catching things that we
weren't catching before?
Great question. But I,
I really feel confident that this is
truly a difference in how often it's
happening. Okay. Because we, you know,
there's not much of a difference
really in the way we, uh,
do surveillance for colon cancer as
opposed to every other cancer that also
keeps great data through, oh.
We're scanning 20-year-old all of a sudden
and finding these things, it's Right.
Right. It's outta proportion of the di
the differences in other cancers by,
you know, clearly. Yeah. It's,
it's something real happening.
Yeah.
And so obviously we're
speaking very theoretical here.
This is very personal to you,
Kane mm-hmm .
Could you tell us a little bit about,
I guess, a, what symptoms did you have?
Yeah. And then really as a 40-year-old,
you said when you were diagnosed Yeah.
With this, what was that like? I mean,
and Yeah. Yeah. How did you process that?
Well, so for me, in 2015, so, um,
38 years old, I, it was probably,
it was a two year journey because
I was diagnosed in July, 2017. Um,
but I started experiencing
occasional really bad stomach pain,
um, worse than being in
child labor. And I, you know,
I go to the doctor, and then
in that two year timeframe,
I had at least half a dozen emergency
room visits where I was told, oh,
you got norovirus, it's going around,
or it must have been food poisoning.
What did you eat? And, you know, the
same thing as the rest of my family.
And they're fine. But again, well,
sometimes it doesn't react to everyone.
And over those two years,
I'd done my regular checkups.
I'd seen my primary care. And, you know,
as a 38-year-old woman who's a mom who
works full time, I talk about, you know,
my stomach pain. Well, you know,
you're carrying a few extra pounds.
Keep a food journal, try walking
after you eat. I did all that.
And in my mind I'm like,
well, you know, maybe if I,
if I lost a little more weight, or if I
ate healthy all the time, I'd be fine.
Um, in June, 2017,
I remember at the time I was
working at a global agency.
I went to my boss who was
terrific, and I said, you know,
I think I have kidney stones or
something. I'm in excruciating pain.
I'm gonna go to the doctor, but
I'll be back for this 7:00 PM thing.
We have like this panel we need
to moderate. And he is like,
go do what you need to do. And I
go to the doctor and, you know,
I hadn't had a bowel movement in two days.
And the doctor says, take a laxative.
Go for a walk and see how you feel. Um,
I never made it to the 7:00 PM um,
event that I thought I was gonna
go to because I started to throw up
uncontrollably. My husband
took me to the emergency room.
I remember this was June 26th,
and two and a half weeks later, I
left the hospital. So I was admitted.
Um,
I finally had my first colonoscopy where
they couldn't do the full colonoscopy
because I had a full blockage and
needed emergency surgery. And,
uh, colectomy and biopsy, what, you know,
what they surgically removed to the
part of my colon. And then, you know,
once I was released from the hospital, um,
a couple weeks later had my
pathology doctor's appointment where,
and it happened to be
my 40th birthday, um,
where I received my diagnosis
and it was stage three and
my lymph nodes were impacted. And,
and I didn't know anything about
cancer or treatment or what came next.
But at that point,
what I did know in many ways was an
odd relief because I finally had a
diagnosis. Yeah. After two years.
And we were starting the process
that from so many people, it's like,
once I finally know, then I can
start to make a plan and Right.
And that brings a lot of, you
get some control back. Yeah.
You get a little bit of that
control back. Yep. Yep. Yeah.
So, yeah, that makes sense.
And in that two year journey,
since we're talking about colon cancer
screening, it's a little bit related. Um,
had a colonoscopy come up at any
point in those two years? No.
And this is the one of the biggest
lessons that I learned. I'm, you know,
I'm a communications executive advocacy,
and I didn't advocate for myself
mostly because I was unaware.
I thought so much of this was, well, no
one in my family has cancer. Right. And,
you know, you're on the go at the
time. My son was five, then six,
I'm working full time in the, you know,
peak of my career. And in many ways,
you get the answer you want. Okay,
I can walk into a food journal.
I didn't get a referral. I was under 40.
I didn't have any of the other
indicators. It could be so many things.
As Dr. Cannon said, yeah. Not the.
Typical.
But I knew I didn't feel
right. Yeah. And now,
this is what I always tell
people, you number one,
have to advocate for yourself and find
a provider and a health system that
listens to you and sees you. And
I'd seen in the course of that time,
every kind of doctor, younger, older
man, woman, . Yeah. It, it,
it didn't matter. And it, it's not
a exact, um, you know, science,
if that's the other thing that I learned
is that the answers to a lot of the
questions where we don't know, however,
here's, you know, some of the odds.
Right? Yes. So.
So let's talk a little bit
about screening. I mean,
obviously they thought with UCAN that it
was a number of other things given your
age, given that we didn't have
the data even, you know, five,
six years ago that we have now suggesting
that it's happening to much younger
people. I'd love to hear a little
bit more about the screening.
And then my follow up question to that is,
is this still one of those cancers
that if you catch it early,
it's a lot more receptive to
treatment? Or is that changing too?
Uh, well, definitely if you catch it
early, you have a much better prognosis.
Mm-hmm . So, you know, um,
Kay Ann, obviously mm-hmm .
She's here with us today, seven
years, but are so grateful. Um,
hers was a stage three. Yeah. You know,
it would've been a lot easier if we
had caught it two years earlier. Yep.
It was probably stage one. Uh, the
outcomes, uh, changed dramatically,
obviously from stage one to four. I mean,
if you catch a stage one cancer, um,
the, you know, the, the cure rate is
over 95%. Mm-hmm . Uh,
you know, with, obviously with stage
four it's under 20%. And so you sort of,
uh, you know, it, it improves
step or, uh, gets worse with each,
with each stage of course.
Um, and, uh, and so Right.
Screening is everything.
Mm-hmm . You know,
screening is just so important
currently. You know, the,
the screening age recommended screening
age is 45. That changed recently, uh,
where it was 50 before.
And I'm sure we're gonna get into
the different types of ways that,
that people can get
screened. Um, you know,
I think of colonoscopy as the
gold standard for screening.
That's what I am going to get. I've done
gone through two of them already. Um,
and, uh,
and you know that of course the
advantage of colonoscopy is you can find
pre-cancerous polyps. Mm-hmm
. On average,
it takes 10 years for a
polyp to become a cancer.
And so the advantage of a colonoscopy
is you're seeing pre-cancerous things,
you can remove them before they
become a cancer. That being said,
like everything in medicine, you
know, there has to be a, a, you know,
a match of supply and demand and there
are cost considerations. And of course,
the people that make recommendations of
about when people should get screened
have to consider things
like cost. Obviously,
every single person that sees me
before age 45 is saying, why don't,
why doesn't everyone get a
colonoscopy? Why didn't, you know?
And of course that's true of every
cancer. You know, if when you,
once it's happened,
you wish that everyone was getting
treated at an earlier age. Yes.
But that's not really practical,
nor is it practical to recommend everybody
in America get a colonoscopy at age
45 because there's a
spine and demand mismatch.
And so I always say the best screening
test is the test that you can do gets
done. Yes. Yeah. The one that gets done.
Yep. And so, um, in some communities,
colonoscopy is readily available
in other communities, it may be a,
a stool-based test. Mm-hmm
. You know,
a Cologuard or a stool-based
blood test. There are now, um,
serum based tests like blood,
a blood tests, you know,
you can do that was actually
just recently approved.
They presented their data this year,
uh, the shield tests. So, you know,
there's a lot of different ways that
you can do it. And the, you know,
it's just important that everyone gets
it done one way or the other. Mm-hmm. Um,
these, these other tests
that aren't colonoscopies
are not quite as sensitive at
picking up precancer. I
shouldn't say not quite,
they're not nearly as sensitive
from picking up precancerous polyps.
Mm-hmm . Uh, but they
are pretty good at picking up cancers.
So if you choose a non colonoscopy option,
you just have to make sure
you keep doing it yearly.
Right. And also, you know,
maybe you can't get in to get your
colonoscopy for a number of months,
but you can do that. Now if you're
having some of these symptoms,
you could do the COLORGUARD test or
the blood test and just get yourself an
appointment for down the road
on the colonoscopy. Yeah.
Exactly. Mm-hmm . Yeah. Yeah.
Can you tell us a little bit briefly
about that SHIELD test, the blood test?
'cause that's so like hot off the
press, kind of. Yeah. Yeah. Um,
what are your thoughts on it?
Well, I'm excited about it.
I think one of the most important things
about effective screening is to make it
easy. And this is super easy boost
test, take a box, sign your name on it,
and you know, uh, and, uh, you get
a blood test. And, um, you know,
it's, uh, very sensitive,
well over 80% sensitive for.
It's a great screener.
Colorectal cancer, again, not,
not in the twenties for the
polyps mm-hmm .
So it's not a great screen for polyp,
but if you do it every year, you know,
I think it's, uh, you know, it's very
useful, you know, thing to do. Again,
I would recommend if you're listening out
there and colonoscopies are available,
that's what I would do.
Mm-hmm . Yeah.
But, uh, this is a very,
I think, a very exciting,
uh, alternative option.
And is it just as helpful in
picking up like a stage one
cancer as it is in finding
like a stage three cancer?
Um, not quite. Okay. But it's very, but
very sensitive for Okay. For all stages.
Okay. That's.
Great. Yeah. I think the key, like you
said, differentiator supply, you know,
for, for those who are listening, and
correct me if I'm wrong, Tim, is again,
it's the idea that one of the things
that makes colon cancer screening so
appealing and powerful is
not just catching early,
but that you can catch the
pre, pre early Right. The,
the thing that will turn into
cancer mm-hmm .
And actually do something about it.
Right. You can get polyps removed. Yeah.
Yes. And so I only emphasize
that point to say like, yeah,
if I couldn't get access to colonoscopy
for six months, a year, whatever,
I'd be like, all right, well let
me, lemme try to do this blood test.
Lemme do what I can do.
But that does not preclude still trying
to get the colonoscopy because of that
potential for early intervention, even
before it becomes a cancer. I mean,
that's why it's so powerful.
Um, how much is family
history still playing a role
in as a sort of a precursor?
I like similar. I am in my mid forties.
I've actually had three already in my
life because I have it on both sides of my
family. Um, but it's
grandparents on both sides.
And so I'm pretty proactive about it.
But I don't know how much
I should consider the fact
that they were all smokers
and I don't do that. And so maybe
my risk is lower than theirs was.
Yes. So it's not a biggest, uh, factor
as people perceive it to be. Okay.
Only 20% roughly of young
onset colorectal cancer are
in people that have a known germline
or known, um, hereditary deep,
uh, disposition predisposition.
And when I, it was,
I was striking when you said
yes. You mentioned that you said,
I don't have any family history, and.
You take comfort in that
faulty, you know, I remember.
How could I have cancer? What did I do
to get nobody in my family had cancer.
Right. That's always their
first reaction. 'cause they,
they assume that that's
mm-hmm .
Because doctors are constantly
asking them about family history.
Mm-hmm . They
assume that that's like a,
a really strong risk factor.
That's right. And it can be,
but 80% of the people that come in
don't have any family history mm-hmm
. Or any
genetic predisposition.
And that's important to
understand mm-hmm .
And yes, to build on that,
that was something that I think I took
comfort in and didn't advocate for myself
more because, well, how could it be this,
my grandparents when they passed away
were well into their eighties, you know,
Greek, Mediterranean diet, all
of that, you know, um, you know,
peacefully in their sleep,
don't know anyone in my immediate family
that had cancer or had gone through
treatment. And I over-indexed on
thinking that that meant that,
you know, oh, the likelihood
of me getting cancer is rare.
And the more that I started to learn
about cancer and the screening and,
and the diversity of people impacted, um,
I started to realize that that's such
a small puzzle piece. And, you know,
sometimes you worry where, you know,
if your family isn't forthcoming about
their health situation or for those who
have, you know, maybe been adopted
and don't know, you know, it's okay.
Because again, it's one puzzle piece.
And really listen to your body,
trust your instinct if
you're feeling like yourself,
and then find the providers
in the system that's,
that are the experts . So, you
know, I was talking with my family,
and I still remember
this, my sister saying,
we have to tell people because we don't
know about this and maybe someone can
help us. And that's what I did.
I ended up sharing my diagnosis because
I needed to find where I was gonna get
treated, who was the best oncologist.
And as I was talking and different
friends and people reach out to friends
who I trust and are both
providers, um, you know,
Dr. Cannon's name kept coming up.
And when we met, I remembered, um,
so much of my past month had
been about cancer, my diagnosis,
the same questions over and over again.
And you did much like you did today.
How's your family? How are you
doing? What's going on in your life?
And that a light bulb went
off for me where I was like,
I can be treated my way here.
And not just as a cancer patient,
but also as a mom, as an
executive, as, you know,
a woman navigating this and a
lot of other things. And, um,
beyond the expertise
and the, you know, um,
in Nova being my preferred health
system, I felt like, all right,
we got this , we're gonna,
um, get through it. So yeah.
But we did cover a lot of ground
and it was really great. Can,
to hear your story, I
think, you know, what would,
what sentiment would you both
like to leave our listeners with?
We had mentioned, of course
mm-hmm .
All of these things that
are well studied or,
or in the midst of being studied as
risk factors for young adult mm-hmm
. Colon cancer. Uh, we're
doing a study here on ultra marathoners,
believe it or not. Mm-hmm .
Just, it is a study, but it's in, uh,
going to be presented in
June. Uh, I won't give,
I can't give away the
results actually yet.
But the reason we were interested
in that is because we had, uh,
really three ultra marathoners come
into our clinic with stage four cancer.
Two of them under the age
of 41, just over 40. And it,
it sort of speaks to how diverse
the population is affected by this
shown onset colorectal
cancer. And, you know,
we started to think about
why a runner might, you know,
and they were having a lot of bleeding
after they ran. And, you know,
it brought up some interesting, you know,
sort of, um, molecular, uh, sort of,
uh, theories about why they may get
it. But we're doing a study on that.
It's been a really interesting study
and here in over Trump, we're, we,
we really want to understand
this better. Um, and, uh,
one of the ways that we understand tumors
better is through a molecular tumor
board,
which is a program that is supported by
an incredibly generous donor named when
Sheridan. He has been amazing
at helping us, um, uh,
really pay for sequencing of these
tumors to understand sort of the genetic
underpinnings or even doing
proteomics, which is a sort of a,
a newer type of molecular test to help
us understand these tumors better.
And I think, uh, without
that kind of, you know,
you can't just understand this with
epidemiological studies and surveys asking
people what they ate, you know,
you have to really get in, he said,
the actual science. Yeah. And
that, you know, takes, uh,
philanthropy support and we're so grateful
for the, for the donors we have. And,
and I think we'll be able to help
the future cans mm-hmm .
You know, even more without, with those
kinds of studies and that kind of, uh,
support.
Thank you again guys. Thank
you both. Yeah. This was great.
Thanks for tuning in. We hope
you enjoyed this episode.
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