Medically Speaking #14

Good evening everyone. I wanted to take this time to get this kicked off. It's my pleasure to welcome each of you to this session of Medically Speaking. It's a valuable collaboration between the Chamber of Commerce, Self Regional Healthcare Foundation, and Lander University. Together we're committed to fostering a healthier more informed community and the testament to the to the mission there heartfelt thank you to our partners making this event possible each of you joining us today appreciate that and a lot of the weather also wanted to say welcome to dr. Wharton Dean of Landers School of Nursing who will be providing a welcome on behalf of Lander University thank you well hello everyone and thank you for coming out into this dreary dreary weather I'm Halisa Wharton and I serve as the Dean for the School of Nursing here at Lander University on behalf of Dr. Richard Costantino his administration and Lander University I welcome everyone and thank you for coming out tonight for what was to be our third medically speaking event of the semester but thanks to Helene it's our first a special thanks to self regional to the chamber for allowing Lander to host the medical medically speaking series I think this is our third year of hosting the series and bringing the latest health care information to our front door. Our students and our faculty appreciate the insight that is shared during the different medically speaking events that gives our students and our faculty the opportunity to learn about the different medical specialties and it helps our students to understand the physicians role and hopefully in the near future it will help them to foster interprofessional collaborations finally I welcome members of our community to our campus and hope you will relax and enjoy the presentations thank you again hey everybody I'm Matt Logan nice to see you all here thanks for coming like Alyssa said it's a kind of a dreary day out there and I think that probably impacted the crowd a little bit but we do appreciate you all making the effort to come out and be with us today to hear from Dr. Brian Green. Halisa and Zach have already given many thanks and I'll just echo those our partners at the chamber as well as at Lander thank you all so much for working with Self Regional to help us put on this series. We did this last year great feedback and we wanted to do it again this year and you know like Halisa also mentioned this is was supposed to be the third of three and said it's going to be the first of three but we are going to follow up with our spine center uh slash neurosurgery talk uh coming up in january i believe it's january and then we also have a very interesting talk from dr kat johnson about weight loss and why is it so hard to lose weight a lot of metabolic uh things can cause difficulty with weight loss and i really think that's going to be a fascinating well really both of those programs will be fascinating uh programs i think you all would enjoy so i encourage you to come back for those if you can, if you can make it. All right, so tonight we have with us Dr. Brian Green, who has a really interesting topic, early onset colon cancer. I know from, I'm a physician myself, I work in the ER some still. What we see sometimes is, gosh, it seems like it's more and more. I'm sure Brian will talk about this, but over the last like five to seven years, more young people coming in and diagnosing colon cancer. I can think of several patients that I've seen over the last five or so years in their, like, early 30s, mid-30s with abdominal pain, and we're working them up, not sure what's going on. You end up getting a CT scan, and my goodness, they've got, like, an advanced colon cancer in their 30s. On my street I live on, there is a good friend of mine who lived three houses down who was in his 40s who was diagnosed with colon cancer and passed away last year or two years ago now. And it seems to be more and more common. So I'm excited to hear from Brian today, learn a little bit more about like why is that? What can we do maybe to help catch colon cancer early or prevent colon cancer in the first place? And so I'm excited to hear from Brian today and learn more. So Brian and I actually, it's interesting just briefly, Brian and I came to Greenwood back at the same time. We both started in 2004. Brian was finishing up his gastroenterology fellowship at Duke University, and I was finishing up my emergency medicine residency at Richland. And we both came back and started at the same time, became friends back then. Our kids are about the same age. So I've known Brian a long time. He's a very smart guy. You're going to hear him talk today, and he's very engaging and kind and just an all-around type of physician that you would want caring for yourself or your family. So with that said, I'll give a little bit more background on Brian. So he originally is from Florida. He has his undergraduate degree in biology from Mercer University, where he was a summa cum laude grad. He went on to medical school at the University of South Alabama, where he graduated AOA. For those who aren't in the medical field may not know what that means, but it means you're in the top 10% of your medical school class. So, again, Brian's a really smart guy. And then he did internal medicine residency also at University of South Alabama. And then, like I mentioned before, gastroenterology at Duke University. He is an owner and partner with Digestive Disease Group here in town and on the medical staff at South Regional and super excited to have him talk today. So let's all welcome Brian Green. Well, thank you everybody for being here and braving the weather out there. It's pretty gloomy. I was actually kind of getting ready to come here. I was driving. My mom calls me and says, Brian, would it upset you too much if your dad and I just stayed home tonight? It's kind of rough weather out there. So if you're here, I appreciate it. Thank you for being here. So this is a very interesting topic. You'll hear a lot about it in the literature and also now in the lay media. So we'll kind of jump right into it. All right. So basically, what is colorectal cancer? Well, it's a malignancy of the large intestine, including the rectum, so we kind of group it together, colorectal cancer. So it's the second leading cause of cancer death in South Carolina and the United States. Approximately 140,000 new cases, or 2,500 in South Carolina, per year. Approximately 50,000 deaths nationally per year, about 800 in South Carolina. There has been an overall decline in new cases over the past 20 years, okay, and that's been a great thing, but we're going to learn a little more about that. But there's been a marked increase in young adults, and we consider that under age 50. So just a little bit of biology here. I know some of you are probably right in the midst of this, so I hope this doesn't give you any PTSD or anything for biology classes. But this is how this colorectal cancer develops. So here's a slide. It basically is going to start as a normal epithelium, and these are pathologic slides. So then you get proliferation, it gets larger, larger, and eventually makes its way to cancer. But the one thing, I mean, if there's anything good about a cancer is it is typically slow growing and there is a precancerous stage, okay? And that would be the polyp stage here. So that allows us to detect that and then intervene. And this does make colon cancer unique among cancers. The other leading cancers are going to be prostate cancer, breast cancer, lung cancer, okay? Well, when we were getting screening modalities for all of those things, and those are important, most of those modalities look to detect cancer at an earlier, more treatable stage with a better outcome. Colon cancer is unique in the sense that we really have a pre-cancerous stage, and that is the polyp stage. And so if we can remove it, people never get cancer. It's not that you're going to get cancer and have a better outcome because, you know, earlier treatment, which is important, but the thing with colon cancer is we can actually prevent it. And so it makes it kind of unique among cancers. So just a few pictures here. So basically this is a polyp. Typically they grow on stalks, okay, but sometimes they can be flat. So and then you go here and this is a cancer. This is what we do not want to see, okay. We've seen it way too often, but this is what we don't want to see. You know, it's grown larger, grown around the lumen of the colon. So all right, so what are some of the symptoms of colorectal cancer? Well, early on, there's really none, Okay, and that's a scary thing. People say, well, hey, I feel good. You know why I need to come get checked? Well, you know, the problem is I know lots of people with colon cancer don't really have any symptoms, okay? So what are the findings? Okay, basically I've got occult blood in the stool. And so occult blood is going to be blood that's not visibly seen but can be detected with the various modalities, so with a chemical type of analysis. And those would be the little stool cards that people do when they go home and then mail back in. So, you know, mild disease, okay, it's going to be rectal bleeding, change in bowel habits. As it gets, you know, some of the findings are going to be a rectal mass or on rectal examination or blood in the stool, overt blood, meaning blood the patient's seeing. Okay, late stage, you know, we hate seeing, is going to be the fatigue, and the fatigue comes from the anemia. It's going to be the abdominal pain. The abdominal pain's coming because the, you know, the colon cancer's now growing into the wall of the colon and starting to get into the mesentery. that's where you're going to start getting pain from it and then obviously the weight loss abdominal mass and the bowel obstruction so well as we in many cancers the same as breast cancer same as lung cancer same as prostate the earlier stage you find it in the more treatable it is okay and this graph is basically just showing so this is the survival by stage these are the Duke classifications, Duke A, B1, B2, C1, C2, and then D, okay? So, you can see, and this is based on how deep it invades into the wall of the colon, okay? D is going to be basically its spread, and that's, you know, that would be stage four, and these roughly correlate to stage one, two, three, and four, so. All right, but the thing is, it is preventable, and this gets to that, And what I mentioned, the fact that it's slow growing and we have a precancerous stage. So what are some of the things we do? Well, we have screening tests, okay, because, again, we can't wait to depend on symptoms. So we need to screen asymptomatic people if we want to prevent colon cancer. Well, now that age has changed to 45, and what used to be 50, we'll go into that a little bit more. What are some of the options, okay? Well, it's a colt blood, which is a fit test. It's very similar to the old hemocolt-type things. It would be something that, you know, somebody does at home, mails back in. Now that's done yearly, okay, and, you know, that's still an acceptable option. The problem with it is it is yearly, you know, and it's, you know, people don't like messing with their poop that much, you know. I mean, you know, once a year messing with your poop gets a little old. So ColoGuard is a little better, so then you don't have to mess with your poop every three years, okay. So that's better, and ColoGuard is certainly more sensitive, okay. It's not, you know, it's, the current sensitivity is probably about 75%. You know, the study is kind of varied, but roughly 75%. So, I mean, it's good. I mean, it's better than hemocolt, and that's what allows it to be every three years, okay? It's most sensitive for bigger lesions, okay, for cancer or advanced polyps, okay? That's the reason they do the every three years thing is because they want to catch, they're really, they're not, the sensitivity is probably only 35% for small polyps, okay? That would be less than a centimeter or five to six millimeters. which still can be significant, can still grow. Now, it's going to take a while for those polyps to grow. That's why they do it every three years, because the idea is as soon as that polyp grows big enough or it gets advanced enough, the idea is it would be caught, and then it would be intervened. So the thing is, with both of these tests, if it's positive, it comes to colonoscopy. Okay, so, but again, they're both, I mean, I always say whatever test the patient's willing to do is the test, okay? So, and then there's colonoscopy, which is, I guess, sort of considered the gold standard now. And it's every 10 years. And the reason it's every 10 years is because of the accuracy is higher and the sensitivity. So, you know, you ought to be under good hands, a good, you know, cardiologist, good prep, all the right things. You know, it ought to be 98, 99% sensitive, okay? So, and that sensitivity even for small polyps should be 95% or higher, you know, certainly not, at least 90%. And so that's even for small polyps. So the idea is that you're going to catch that small polyp, that 4- to 5-millimeter polyp, 6-millimeter polyp, remove it so it doesn't grow later. And that allows it to go to the 10-year interval. And the attractive part about that is that you only have to think about it once every 10 years. And you don't have to worry about it every year or every three years. So it also allows polyp removal at the same session. So if you have the polyp, I always tell patients, when you walk in here, if you've got a polyp in the colon, when you walk out, it won't be in there anymore. So it'll be gone. All right, so windy colorectal cancer screening really take off, okay? And some of you students, you all probably weren't even born now, but for the rest of us, we can remember this, but basically, Katie Couric, okay? And really, it's now defined in the medical literature. It's literally called the Katie Couric effect, okay? And again, some of you may not know Katie Couric, but she was an extremely popular anchor on one of the major networks, a morning anchor. And her husband died of colon cancer, okay? And, I mean, this is a, he died probably like in the, I guess it would have been right about then. It would have been a little before that, I guess, in the late 90s. And he was actually pretty young, too, okay? And it was just, I remember when it first came out, it was just, you know, we really didn't hear much about colon cancer. And suddenly, you know, it's this, you know, it used to be this thing that people were kind of scared or embarrassed of. It was, you know, real private, you know. But she really brought it to people's attention. She was willing to get out there, talk about her husband's battle with it, and he died of it. And she really, really did a lot. She basically had a colonoscopy on TV, on the morning show. She had a colonoscopy. So here's a picture of Katie Couric getting her colonoscopy. We're getting ready for it on air, live. All right. So with, you know, again, you look, 2000, Katie Couric had her colonoscopy. 2001, Medicare approved screening colonoscopy in average risk individuals. I mean, really, what a tremendous thing. Now, you know, we really need to give her a lot of credit for that. Obviously, there was a lot of data, a lot of scientists coming out, a lot of publications, but she really brought the awareness to the public and then the politicians, and then the politicians get the pressure to get Medicare to cover it. So Medicare started covering it. 2018, the American Cancer Society achieved the 80% by 2018 goal. So what this is, they approved screening colonoscopy in 2001. We start trying to screen people. We're doing lots of screening colonoscopies. Everybody's doing them. And the American Cancer Society, their goal was to get 80% of eligible individuals. Now, at this time, it was just age 50. So it was, you know, anyone age 50 was to get 80% of Americans to have had a screening. It didn't have to be colonoscopy. It could be colo, well, we didn't have a colo guard, but it could be fit testing, but colonoscopy, some type of screening. And I was really involved with the American Cancer Society when we were doing this. I was doing a lot of talks with them in different locations. I was on some different boards, and we were going up and down the East Coast. And I remember when we had this, we had a big, I mean, boy, we were feeling great. I remember being at the American Society meeting in Baltimore when they had it, and then we had another meeting down in Atlanta, and I was giving a talk. And, I mean, it was huge. We were excited. I mean, 80%, which, you know, I mean, it's pretty darn good because it's going to be hard to get 100%. Okay, so, and we were thrilled. It was great. We're all happy about it. So what you can see was happening here, and so these are all the graphs that we were looking at. So you can see from 1970, okay, you can see the rate of colon cancer mortality heading down, down, down, down, down, down, down in 2010. Again, we're feeling great about ourselves. We're, you know, it's a great thing. You can see the overall incidence. Let's see. All right, so there's an overall decrease in the incidence, okay? And this is where I want to get at. The incidence is basically the number of new cases, okay? So this is the people that are getting colon cancer. And, again, this is the thing that we're actually preventing colon cancer. It was pretty amazing. I believe it's one of the first cancers that we've really, you know, decreased the incidence of, okay? Usually we detect cancers earlier, but to have a cancer that we're actually reducing the incidence of, meaning less people are getting it. And we largely do the uptake of screening colonoscopies with removing polyps before they become cancerous. However, around about the same time, you know, all these publications are coming out and the data is coming out, we're starting to see some things are popping up that don't look so good. We're happy we've got 80%, but there's some things popping up. And what we're seeing is there's a rise in the incidence in some groups, and that was young adults, okay? Basically less than 50 or age 50 to 54. So this is kind of a busy graph, but I'm going to just basically show. So these are going to be people. This is age 50 to 65, 65 and older, and this is people less than 50. So as you can see, we're seeing over time, this is very similar. The graphs we saw, and this is just basically one's colon cancer, one's rectal cancer, and colorectal cancer put together. So anyway, you can see down, down, down. But look what's happening here. It's going up. So around that same time, you know, so we start to know some other things. That was 2018, 2019, I think, when that study was published. Well, here, now you start seeing things in the media, in the lay press. Just some notable people, both South Carolinians, Chadwick Boseman, the Black Panther, diagnosed stage 3 colon cancer, diagnosed at age 39, died at age 43. Okay, a South Carolina native. Lawrence Meadows, the brother of Craig Melvin, also Craig Melvin was a South Carolina native also, stage four, diagnosed at age 39, died at age 43. He did have some symptoms of blood, weight loss for several years prior, and he didn't tell anybody about it. And we still have a problem that there's a lot of men out there, I'm going to beat up on the men, they don't want to talk about it, they don't want to ignore it. know and so um the women are much better at screening um i guess they're more used to pap smears bret breast exams those kind of mammograms but there's a lot of men that just are really um trying to ignore it and but we're trying to trying to educate and and and and teach more so but anyway um craig melvin was very helpful he was again i don't know if you're sure who he is but he's an anchor also on one of the major networks and so he has done a lot of stuff um i've worked with him myself he's really been very helpful with us for the south carolina um south carolina colon cancer prevention network that i'm part of and the south carolina gastroenterology association he's been um very helpful he's come up and talked to the governor with us sometimes the legislature um he's just been a real i mean he lives in dc now but he's um he's come down and has been very very helpful for us so he's and he's really tried to get the message particularly to the african-american community uh there's again there's a lot of embarrassment a lot of um people that don't want to talk about it and he's really been very very helpful with that so then because of the data that was coming out because of the increased awareness again in the media in 2018 the american cancer society that i'm very proud of that was getting what i was part of they went ahead and began they made a recommendation to start screening at age 45. and i was at the meeting when we part of the i guess round table or whatever and we were talking about this and and we got some flack i mean there was some flack in the literature you know other you know people well you know why why are you doing this it was going to be you're not going to be able to afford it as a society you know you can't uh you all these extra people you're going to screen you know do this and um there was a lot of flack out there okay um about it but again i felt strongly about it i'm really proud that the organization i was part of we went ahead and made that recommendation and but then you can see there was a bit of a delay there so it went until 2021 that the u.s preventative task force and this is a big one that works um and this is when most of stuff starts when the u.s preventative task force comes out with it that's kind of almost kind of become standard to care for the most part um then 2021 also you know everybody kind of jumped on the bandwagon then america college of gastroenterology one of our major uh organizations did it and then the multi-society task force and so um everybody kind of jumped on it in 2021 so all right so what what is early onset colon cancer so the difference in this is it's typically identified do the signs and symptoms rather than screening because we're not screening these people okay we certainly haven't been now we're screening 45 to 50 but we have people that are getting younger than 45 so we're not even screening those people even now with our current um our current new recommendations so it's typically going to be recognized by rectal bleeding abdominal pain or change in bowel habits Now, if you remember that, the graph I showed you, I think, or maybe some of the things, if you already have symptoms when you get diagnosed with colon cancer, that likelihood is going to be more advanced. It's going to be more likely to be a stage three or stage four. And so that's the terrible thing here. So early onset colorectal cancer, when compared to later onset patients, are experienced symptoms for longer prior to diagnosis. They typically experience it in 243 versus 150 days. So, again, they're young. They think, hey, I'm invincible. well, this can't be colon cancer because I'm too young, right? They also had a longer delay to diagnosis, okay? And, again, that's part of the thing. I mean, and I'll even tell you, I mean, I've been in Greenwood for 20 years now. Twenty years ago, if a, I don't know, a 30-year-old came in and was having, you know, blood in the stool, a little change in bowel movements, you know, we might say, okay, well, you know, let's, you know, try this. You know, let's do a rectal exam if you've got hemorrhoids. Okay, maybe, you know, we might, you know, I'm not saying we'd ignore it, But we might try it now if a 30-year-old comes in, it's a colonoscopy. I mean, they're just getting it. I mean, you know, I mean, it's because I diagnose people in their 30s with colon cancer at least once a month right here in Greenwood. So now it's the new messaging we're doing with American Cancer Society. It's a new kind of messaging. You know, everybody for four or five years, American Cancer Society, we had to kind of come up with new messaging. And basically our new messaging is never too young, okay? Now, you know, 12 years old, okay, probably not that. 15 years old, 18, maybe not. Okay, but the new messaging is never too young, and the idea is that we, you know, you just can't, you know, no longer can you say, oh, well, I'm, you know, I'm 27, you know, I'm 25, you know, I can't get that. You really can't say that anymore, so. So why is this happening? Okay, when you analyze the data a little bit more, and you get in some of those smart statisticians, and they get in there and look at all this stuff, so what they're basically seeing is that the younger birth cohorts are carrying the elevated risk with them as they age. And for the statisticians and the audience, that'll tell you more. But basically, they have these things called the inflection point, and this is the birth cohort effect. And again, it basically looks for patients where the inflection point comes is people born after 1960. It becomes stronger in those ones at the end of the 60s, right about 70, it really gets strong there. Okay, so that suggests that exposure is prevalent in early life, okay, or they are accumulated across the life course may contribute to the increasing incidence of early onset colon cancer. And that's the whole birth cohort effect. So what's happening to these people? What's happening to the folks that are born after, you know, after 1960, late 60s, early 70s? You know, genetics aren't changing. You know, genes aren't changing that quick. Okay, so maybe hundreds or thousands of years, but they're not changing that quick. So what's happening? Okay, so what started happening in the 60s and the 70s? All right, so some fun pictures. So there was some fun stuff that happened, the good things in the 60s and 70s. All right, we had Saturday Night Fever and the Berlin Wall, and lots of good things happened in the 60s and 70s, okay? But we had some other things that weren't so good. We thought they were good. McDonald's, fast food, you know, takes off. And now that was, you know, a fast food restaurant on every corner. So there didn't used to be. I remember the little town I was from, boy, we had to drive to get to a McDonald's. You had to drive like 50 miles, you know what I mean? But now that town has three McDonald's, okay, on every corner. So, all right, what are some of the other things? Okay, so this is the old food pyramid. The government has revised this some. But, you know, basically what they're saying here, they're putting the cereals, you know, These are things you're not supposed to eat much of. These are things you're supposed to eat a lot of, okay? You've got the cereals. A lot of these are processed foods here, okay? You know, they have some vegetables and things, but this is supposed to be your bulk, you know, muffins, you know, cereals, you know, breads, okay? And that was the, I mean, that was what we thought was the thing because we were so worried about any kind of fats, basically. Any kind of fat was terrible. Fat was terrible. Fat was terrible. Cholesterol was terrible. So we didn't want to have any of that. So instead of having any kind of fat, we ended up having a lot of carbs. So there's also some thought that it may be contributing to the rise in diabetes also. So heavy carbs and heavy in sugars and these processed foods. So that's kind of a whole other topic, but it may also be linked with that. So, all right, what are some of the other things that happened after 1960? Okay, well, obesity rate went up 15%, 1976 to 1980, 23%, 88 to 94, 30 99 to 2000 and the predictions are even higher i mean it's going to be even higher now so all right so what are highly processed foods okay that was what the bottom of that food pyramid that was the um some of the bread the muffins the things the cereals okay and these are just some examples okay you know i mean again we all see it you know pizza pizza place everywhere you know it's the cereals it's the you know i mean i'm just giving you some examples here so um they're everywhere they're ubiquitous okay all right so what a little more what is a highly processed food okay they're um also known as ultra processed foods but they're basically contain primarily extracted or synthesized ingredients okay some of the hallmarks are going to be they don't have fiber they have high lots of sugar okay the companies the manufacturers are making add the sugar because they want you to like it they want it to taste good they want the kid to buy you know to tell their mama to go get me some more of that you know whatever cheerio or that whatever that cereal is you know they want to sell that you know and um that's how you're going to sell it put more sugar in there make it taste better so a lot of salt excess salt again you like that tastes good you may not even know it's in there um and just one other clue is going to be long list of ingredients okay um often hard to pronounce substances unless you're a scientist or working in an organic chemistry lab you probably can't pronounce a lot of the stuff in a lot of these highly processed foods and so that's just kind of a clue when you're reading the label and you can't recognize it another little thing i'd heard is that if it's if most of the ingredients are things that you could not find in a normal kitchen okay if you were more likely to find them in a science lab and less likely to find them in a kitchen that's a highly processed food so um so they gained popularity in the the mid-20th century okay as manufacturers began to leverage technological advances okay i mean again the big factories i mean they can put this stuff out you know you can only put out you can only grow so many vegetables you can only grow so many chickens you can only grow so much of that um you can you can't they can't store forever but you can store you know cereals you can store some of these frozen pizzas you can store some of this stuff forever and so well forever but i mean you can store it a long time and again that's going to yield the companies the uh grocers can can can store it longer and they can continue to sell it so um that's the long high you know shelf lives so and they basically become a fixture of our diet you know i mean look at you know go to the average grocery store so another hint um is when you go to the grocery store try to shop around the outside you've probably heard this but the outside is going to be the vegetables going to be the meat it's going to be the dairy products going to be those things going around the outside when you get in the middle part okay those are going to be the more processed foods so just another little hint so just some other examples going to be white pasta white bread potato chips pretzels sweetened juice products soft drinks sweetened breakfast cereals margarine where he constipated meat products hot dogs candy cookies cakes you know this is a nova system it's a um you know they've got to come up with some way to classify these things this is actually a group i think actually south america that came up with this but it's it's a pretty good i mean it's a little cumbersome just for the average person but uh but you i put it up there but basically you know group one are going to be just minimally processed foods fresh fruits vegetables you know single ingredients some canned fruits vegetables beans you know whole grains dairy milk those kind of things you know you're going to get you know group two is going to be the things you know a little more processing you know olive oil different oils sugar salts you know um but then as you get up to get to group three and group four you're gonna see you know a lot more uh processing by the time you get to group four your things that you can't you know you couldn't recognize the ingredients if you if you you certainly couldn't find them in your standard kitchen so now how to prevent colon cancer so basically get screened age for now it's age 45 and older definitely symptoms or not symptoms get screened okay but the big caveat is here you know don't ignore symptoms regardless of age okay that new point is never too young okay rectal bleeding abdominal pain change in bowel habits it's never too young don't ignore it talk to your doctor about it get active and avoid obesity okay the big things i mean that's it's in everybody's ability just start moving more okay just move more i mean they they're changing they're constantly up you know they used to say i know what i think it was 30 minutes of aerobic exercise five times a week i mean now the government's saying i don't know i mean i think it's up to like an hour you know five days a week or something it's a lot but whatever you can do the more you can move the better okay so don't get stuck that i've got to do this or that just move more um get you know and try to avoid obesity don't smoke okay we've done better at that as a society getting the awareness out to not smoke so hopefully people aren't doing that um avoid highly processed foods okay you know i mean um you know for a lot of us you know at age 51 you know i ate those things when i was younger too so i mean there's not you know probably much i can do about it now i can i can you know i can try to encourage my kids not to okay i can try to you know raise awareness by talking to you talking to you know let you tell your children you know try to you know you know try not to have to eat it so much, and then, you know, try yourself, you know, to change, to make some changes. Then a few other things, you know, people always ask me, what else can I do, Doc? What else can I do? So there are some studies on calcium supplementation, okay, particularly for women, because women are always going to be at prone, at risk for osteoporosis, so you kind of get a dual benefit there. Vitamin D, again, vitamin D has had a lot of popularity, you know, and because it does a lot of good things, you know, we've realized a lot of us are vitamin D deficient, you know, we're all using suntan lotion which is good prevent colon you know prevent um skin cancer but we're not getting as much vitamin d we're not outside as much um and so i mean it's easy take a supplement if you need to so um vitamin there are some studies that would say vitamin d certainly vitamin d deficiency can be linked to a slightly higher risk of colon cancer colon polyps diets higher in fiber um you know the american diet in general european diets are not very high in fiber third world countries have a lot higher fiber in their diet now there's going to be some genetic differences too, but, you know, it's certainly as a population-based thing. It's something we can see, you know, populations with lower cancer risk have higher fiber intake. So eat more fiber and possibly a low dose of aspirin. Some studies with this, now aspirin obviously increases the risk of bleeding. So we're kind of careful to recommend that. If you already have another reason, you know, as a primary prevention of, you know, cardiac disease or you have a strong history of cardiac disease, you know, take the aspirin. It may help that. It may also help colon cancer I mean if I've got somebody that or prevent I've got some that's growing that I'm removing polyps every two or three years and they're saying what can I do you know well that probably is worth taking an aspirin then so but you have to again balance the risk and the benefits with the aspirin so so that is it and um I'll be glad to take any questions anyone has yeah yeah pretty much they're they're essentially all are covering at 45 now yeah once the us prevented a task force came in with it um most insurance had companies had to cover it um medicare i mean if you are on my care it'd be allowed to be 45 but but that they cover it so most the uh i know the state blue cross blue shield plans do there's not many left that don't right what happens is you no longer get it it's no longer considered to be a um What is it called? It's no longer like a, it's screenings. It's no longer preventable. So it's now, it's now a diagnostic versus being screening. So that is a, that's an issue. You're right. You know, and, and I'm, I'm also part of some national advocacy boards or we try to, I go to DC a couple of times a year and talk to the legislators and the Congress, and we're working on that. We have a Medicare has, has reduced that. We, our big talking point, this is of course doing everything pre-COVID. So this was pre-COVID when I was going around the legislators. We called it the pilot penalty. Okay. And so they are working to reduce that. They've already started to reduce that in some of the Medicare populations. It's like a five-year plan. It costs them a lot of money. It's costing the Medicare a lot of money, but it's in the works. Okay. And it's already starting to kind of phase out. So that won't be an issue too much longer. So, yes. cases that you shared today with males, and I know you mentioned that they may ignore their symptoms, but is there any evidence that would explain if there's a increase? Yeah, definitely. Yeah, no, males, they have a definite increased risk of, yeah, that's when you're talking about risk factors, yeah, risk factors. Males, yeah, I guess the way we might put it, you know, an average for polyp for just walking in and having a polyp at age 65 what is your likelihood or age 50 having a polyp okay and you might say i think the numbers are similar like depending on it's going to be like roughly 35 percent of males are going to have a polyp and only about 25 percent of females so males are definitely higher so not only do they ignore symptoms more like but they also just grow polyps more. Yes? As the incidence and number of people is like getting higher, do you think the screening age will become like lower and lower? Yeah, it almost certainly will. It's already, I mean, it's probably going to be 40. How long that's going to be? I would probably in the next five years, five to 10 years, we're probably moving with 40. Because it always lags. You know, you get to see the you know, the data always going to lag behind what's happening out there. I I had been noticing it, and just like Dr. Logan mentioned, you know, we had been as health care providers, you know, so the term is in the trenches that are out there doing this stuff. We had started to notice it probably 10 to 12 years ago. When I was at Duke doing fellowships, that had been 20 years ago, so I've been in Greenwood 20 years. I was at Duke, okay? You know, a huge volume center. I mean, golly, I don't want to be colonoscopies. Duke University does, okay? I bet in the three years I was there, I probably knew of maybe three people in their 40s with colon cancer, okay? I mean, that's not much, okay? here you know i diagnosed someone in their 40s with colon cancer once a month twice a month you know easily maybe you know so and we started seeing that about 10 or 15 years ago so you know it's um we were seeing it but it takes that long there's kind of a delay because you've got to see it then somebody's got to report it somebody's got to be doing a study um you know we're doing you know right now colon cancer prevention network in south carolina so we're constantly analyzing that data, publishing that data, but it's going to be a little bit of a delay. So I would anticipate it'll be down to 40 probably in the next five to ten years. Yes? So kind of follow up on that one. Do you think it has more to do with the population at Springwood being a more rural community versus then having less access to healthier output versus something like a bigger city or that area like you right yeah that is a good point yeah that is yeah so i'm not comparing apples to orange you know and apples apples here so but you're right but they're seeing it more there too i mean obviously we're seeing it nationally or whatever so but there's yes there's there's a good data that rural populations okay with less access to health care uh higher rates of poverty um lower higher rates of obesity uh worse diets no doubt there's a higher rate of colon cancer when i'm on a lot of these um i can say because i work with something that's called the colon colon cancer prevention network it's a it's a thing i participate in the university of south carolina colon cancer research and we started this thing maybe 15 years ago where basically we provide free screening colonoscopies to uninsured patients okay throughout the state and so that's been a a wonderful source of data okay because what we're realizing is that group okay so you're if you don't have i don't think i don't think i'm giving anything away i think we're about to publish this it's it's at least an abstract form so i'm not giving it away but it's going to get published here pretty soon but basically we're we realize it's just the fact that you're poor makes you more likely to have colon cancer okay now there's going to be things about that you know it's probably your diet probably but even when you control for you know you try to control over as much as you can so um that's one of those that's going to be published here soon so but so in answer to your question yes well actually like you just mentioned that access to good healthy eating resources is hard for certain people it's easier to grow like a box of macarons you don't have too much cost now but my kids are a little 29 cents Absolutely. Yeah. And that's maybe with the, um, like I said, with our group, with the, you know, you know, the more disadvantaged folks, you know, is there having to just get whatever they can get. Yeah, I mean, I don't want to be a conspiracy theorist. or anything like that but it is just right i mean the the i mean it's going to we hear about big pharma big tobacco but now it's big food you know i mean because you know you again you can't the the farmer growing the vegetables i mean there's only the profit margin is only so much growing broccoli but the profit margin can be very high packaging cereal you know and then you can get the cartoon characters advertise it and get the kids to get it so i think there's i mean this you know although you know he'd be careful you know government intervention and government involvement But I think this is an area that would be ripe for that because it's going to have to take something like that, you know. So, yes? Do all polyps turn cancerous? And how long did it take to get that way from formation? Right, okay. So there's two general types of polyps. One is called hyperplastic, okay? And we do not think that those have a risk to grow. Now, they're not going to grow big like some of the ones you're seeing. Most hyperplastics are going to be small little polyps, you know, four to five millimeters small. And they typically don't get any bigger than that. And we think that they probably just sit there and don't do anything. And although me looking at it, I think I can usually tell, yeah, it probably is, but you can't tell for sure. You know, there's been some, I thought that was probably hyperplastic, but you take it off and it turns out to be the other type, which is called adenomatous. Okay. Adenomatous polyps have already taken that first step molecularly to have that loss of control of growth. And what basically cancer is is where the cells have lost the normal, again, you students would know this, but, you know, a normal cell should have a certain period of time to live, and then after that it needs to die, and then the new cells grow, okay? And so basically cancer is where the cells have lost that control, and so they're just going to continue to grow and continue to grow and continue to grow. The adenomatous cell, adenomatous polyps, have already had that first mutation, okay? So they've already lost that control, so they're going to grow. And how long does it take? Well, we think, you know, it's certainly somewhere in the five to 10 year range, you know, under, and that's why we come up with those intervals. You know, if you remove a polyp, just a standard polyp, we're going to say, come back in five years. Okay. You know, if you have more polyps, we'll say three years or a bigger polyp or more advanced polyp. And so we feel like it's about that long. So if I took a polyp off and you started growing the next day, you know, we, we feel like it's typically not going to be any sooner than five years. We're probably going to be longer than that. But, you know, again, you know, we don't know for sure. So, but you've got they come up with something, but in generally, yeah, in that five to 10 year range. And that gives us the opportunity to intervene again, you know, and that's the thing, because it is slow growing. I mean, you know, unfortunately, lung cancer, pancreatic cancer, I mean, geez, you know, that's, you know, first we don't diagnose them usually until they're later. Of course, you know, we are fortunately screening now some for lung cancer, but, you know, it does have the polyp stage and it is slow growing. So it gives us a chance to try to catch it and intervene. How much does genetics play into the colon cancer versus your diet? Yeah, well, you know, it's, you know, there's certainly, there's definitely genetic syndrome. There's something called familial adenomas polyposis, hereditary non-polyposis colorectal cancer. No doubt, those are definitely possibilities, okay? But, you know, those are very specific syndromes, very specific DNA, you know, gene mutations. So the vast majority, I mean, if you look at the numbers, there's like 85% of people that develop colon cancer will have no family member with colon cancer. So that's going to be a new development, okay? I mean, a newly developed issue. So you can't, it's 85% to 90%, no family history. They're just getting it. All right, thank you. Dr. Green, thank you very much. That was very informative. of this guy's done two colonoscopies on me and I would say to you that a couple of things about those they've really done a good job of improving the swill that you have to thank the night before so that's not as bad as it used to be secondly the little sleep that you get during the procedure with propofol you can understand how Michael Jackson may have gotten addicted to that stuff because I if I had that at home I'd take it every night but that's number two and then the last colonoscopy I got I remember waking up and he stuck his head in and said everything looked good and he looked at me and he said you got a beautiful colon and I said I'd love to hear that kind of thing but but thank you very much for being here with us tonight this is gonna be on our podcast deal through the hospital dr. Wharton if you'd mind coming down we're gonna do a photo op with with you Zack I want to introduce truck rim ski who's one of our foundation board member trustees and co-chair of the business and industry committee which kind of spearheaded this medically speaking series there are some refreshments up there so y'all go on up there and grab a little drink and a bite to eat and then president Matt will do this little photo op and we'll go on up to so thank you all for coming out tonight