Well Wisconsin Radio

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Host: Hello, and welcome to Well Wisconsin Radio, a podcast discussing health and wellbeing topics with experts from all around the state of Wisconsin. I’m your host, Renee Fox, and today my guest is Kim Angelo, Marketing Development Leader for Exact Sciences Corporation. Kim, thank you for joining us today to talk about raising awareness for colorectal cancer. 

Guest: Thank you for having me.   

Host: Can you start our conversation off today by telling us about the work that you do to raise awareness for colorectal cancer at Exact Sciences Corporation?  

Guest: Yes, I’d be happy to, Renee. I’ll start with kind of that overall mission of exact sciences is to eradicate cancer and the suffering that it causes. And, our goal is to do this through tests that help prevent it, detection to find cancers earlier, and guidance for successful treatment. In my specific role as a market development leader, I focus on reducing the number of individuals who remain unscreened for colorectal cancer. So, this includes a lot of different types of efforts, but one would be working with employer groups to provide screening option, um, education and resources, and then all the way to giving more specific details on when noninvasive screening tests for colorectal cancer, such as Cologuard, are an appropriate option. 

And, my role also encompasses more of a broader advocacy approach to colorectal cancer screening as well. And for me, this takes on a very personal tone as I have a family history of colorectal cancer. And in fact, this year, 2024, it marks 30 years since I lost my mom to colorectal cancer back in 1994.  Uh, she was age 50 at diagnosis. Um, and she was diagnosed at stage four. So, from a very young point in my life, I was exposed to the importance of a stage of detection for cancer. And when I learned that colorectal cancer is in part preventable through screening, it really fueled my passion to educate people around me to get screened and not put it off. 

And, another fact about colon cancer is that it is considered the most preventable, but the least prevented cancer, simply because people just don’t like getting screened. So, it’s my mission personally and professionally to make a positive impact on this.  

Host: Can you tell us a little bit more about, you know, what contributes to that development of colon cancer and what steps our listeners can take um to, you know, do that prevention?  

Guest: Great question. So, I’ll talk about it in terms of modifiable risk factors and non-modifiable risk factors. That’s how the American Cancer Society kind of differentiates the actions that you can take as an individual to reduce risk. So, what is modifiable? Things that we can change, right?  

So, first, maintaining a healthy body weight. We know that obesity is associated with multiple types of cancers. Another factor would be engaging in exercise. So moderate to vigorous exercise can reduce your risk.  Avoiding red meats and processed meats may also help to reduce risk.  When we think of smoking, we automatically think of lung cancer, but smoking is also associated with multiple types of cancers, including colorectal cancer, so avoiding smoking. And, then lastly, alcohol use. We know that moderate to heavy alcohol use is also linked to an increased risk of colorectal cancer.   

Then if we take a step back and consider the non-modifiable risk factors, uh, the first one would be age. Age of the individual, um, can increase the risk of colorectal cancer. And, if that person has had a personal history of what’s called adenomatous or precancerous polyps, or if they’ve had previous colorectal cancer diagnosis themselves, you’re at an increased risk. Uh, if the individual has a personal history of inflammatory bowel disease. So, this would be things such as Crohn’s disease or ulcerative colitis. 

Um, or if the individual has a couple of the, um, inherited syndromes that are associated with colon cancer. These are things like the Lynch syndrome or familial adenomatous polyposis. But this is a very small percentage of patients who get that colon cancer diagnosis. It’s about five percent of patients. And then lastly, your racial and ethnic background also, um, can increase your risk. So specifically, American Indian and Alaskan Native people have the highest rates of colorectal cancer in the United States followed by African American men and women.   

Host: Who is most at risk for developing colon cancer?  

Guest: Really important question, Renee. So, colorectal cancer has increased significantly in patients under age 50. So specifically, there’s been a 51 percent increase among individuals under age 50 since 1994. But it’s important to keep in perspective that the majority of patients are diagnosed over age 50. So, it goes back to your risk increasing with age. Um, you are definitely at elevated risk if you have that first-degree family member who was diagnosed under age 50, or if you’ve had multiple family members diagnosed with colorectal cancer. 

But I think a key fact about Colorectal cancer is about 75 percent of people who are diagnosed do not have a family history of the disease. So, it aligns with, you know, having a colon and needing to be screened for colorectal cancer. This is why people who are at average risk with no known risk factors need to get screened.  

Host: Excellent. Thank you. What are some of those common signs and symptoms of colon cancer?   

Guest: So common signs and symptoms is, can be a little tricky because you don’t always have signs and symptoms as an individual who is developing colon cancer. And that overarching goal is really to screen before you have signs or symptoms. Okay? Um, so if you do have symptoms, you would definitely reach out to your physician. So, those symptoms could look like a change in bowel habits.  They could look like diarrhea or constipation or a feeling like you can’t empty your bowels completely. Um, if you see blood in your stool or you have abdominal pain or cramping or aches that do not go away. Um, if you have unexplained weight loss, these are all reasons to seek out your physician right away.  Uh, but I, I align with my initial point. You might not have any symptoms. And this is why screening for colorectal cancer at the earliest opportunity, which in the United States, if you’re at average risk, is when you turn 45, is so important.  

Host: So, March is National Colorectal Cancer Awareness Month. So, as you know, it’s a time when the Colorectal Cancer Alliance really puts a spotlight on this disease and encourages more people, you know, to start doing the screenings at age 45. Um, can you talk a little bit more, uh, about the importance of screenings?  

Guest: Absolutely. So, when it comes to colorectal cancer, screening really is everything.  It is possible to prevent colorectal cancer by screening and not every cancer can claim that fact. And the way that works is by screening. If you find a precancerous polyp, they can be removed, and now you’ve prevented colon cancer. So, if you don’t screen, it’s really tough to prevent it.  So, if an individual is turning 45, it’s recommended that they begin screening that very same year. You don’t start talking about it at 45 and then kind of getting around to it when you’re 48 or 49. When you’re 45, congratulations! It’s time to start screening for colorectal cancer. 

Host: So, I know the U. S. Prevention Services Task Force made the change in that screening recommendation from 50 to 45 in 2021. Um, can you talk a little bit more about why that recommendation changed?   

Guest: It’s a great question. I’m glad you brought this up. So, this change was prompted by a rise in cases of colorectal cancer in people younger than age 50. So as a result, the U. S. Preventative Services Task Force, that you mentioned, which is one of the governing bodies of screening recommendations in the United States, they recommended that individuals at average risk for the disease begin screening at age 45 instead of that traditional age of 50 in the past.  And, this guideline change also aligns with the American Cancer Society, which lowered their age for initiation of screening to age 45 back in 2018. 

So, the bottom line is really that screening works. So, starting earlier has the potential to make a positive impact on early detection and prevention of colorectal cancer.  

Host: Great, thank you.  Um, can you provide an overview of the different screening options that are available? Um, and what helpful information should our listeners consider when thinking about which option might be the best for them?  

Guest: Yes, that’s, that’s a really important question because if an individual is at average risk, there are choices when it comes to colorectal cancer screening, okay? So, what I’d like to do is kind of walk through the top three methods for colorectal cancer screening today.  

So, the first is the colonoscopy. So, this is a visual exam of the colon and rectum. It uses a scope to look for and remove abnormal growths in the colon and rectum. And, it’s indicated for adults who are at high risk or at average risk. And, this is a test that occurs every 10 years if it’s clean, meaning if you do a colonoscopy today, Renee, and they don’t find anything, you’re good for 10 years of screening credit. 

Okay. Um, this is an invasive test though, right? It’s an invasive test that requires, you know, a day of bowel prep, um, and fasting. So, you’re fasting for a day, you’re doing the bowel prep in the evening to prepare that colon for a good, thorough visual exam.  It, uh, is covered by most insurers, and if you receive a positive result, meaning, uh, the gastroenterologist sees something inside the colon that needs to be removed, such as a simple polyp, they just remove it there, on the spot.  

So that is, um, you know, the review of a colonoscopy and then next I’ll move over to one of the noninvasive tests and this is Cologuard®.  It is also referred to as a multi-target stool DNA test. So, this is a test that’s looking for altered DNA and blood in a stool sample. Essentially what happens is a patient captures a bowel movement in a small bucket that is part of the Cologuard® kit, and they send in their sample to the exact sciences lab and tests are completed to that sample looking for altered DNA that could indicate there are changes occurring in the lining of the colon or the presence of hemoglobin or blood in that stool sample.  This is important, so this test is only indicated for adults who are age 45 and up at average risk.  

Okay, right, so high-risk colonoscopy. Average risk, you have an option.  So, average risk adult. So, a high-risk adult would be someone who has had colon cancer before, or they’ve had a positive result from another screening method in the past six months, or they have a diagnosis that increases their risk of colon cancer, like I mentioned previously, inflammatory bowel disease like Crohn’s or ulcerative colitis. Or, if they have, a family history or certain hereditary syndromes associated with colorectal cancer, those are patients that are colonoscopy.  

If you’re average risk, without those, uh, history points in history, uh, or features I should say, um, you are eligible for a noninvasive test.  The Cologuard® test is taken every three years, meaning if you take that test today, Renee, and it’s negative, meaning no sign of altered DNA or hemoglobin, which is blood in the stool, then you don’t need to repeat your screening again unless you have symptoms, uh, for three years. 

Okay, um, there is no prep required. There’s no fasting. There’s no bowel prep. The time that it takes to have a bowel movement is the time that it takes to do the test. And this is also a test that is covered by most insurers. And, if you do receive a positive result, which means that altered DNA and or blood was found in your sample, the next step is a colonoscopy.  

Okay, and then the third option is called the FIT or the FOBIT test. So, I’ll explain what those are. The FIT is all, is technically called the fecal immunochemical test. The FOBIT test is a fecal occult blood test. So, these are kind of saying exactly what they’re looking for. They’re simply looking for blood in the stool and it’s a card that a patient would, um, kind of smear a sample of stool on the card and then the card is sent in and blood is looked for, um, in the lab.  

So, this is also for adults who are at average risk, right? This is a test that is taken every year. This is a yearly test. It’s just looking for blood. So, we need to look every year. And, um, it’s also, of course, noninvasive, right? It’s done at home. There’s no prep required for a FIT test, but FOBIT tests sometimes require food or medication alterations prior to.  

Um, it doesn’t take much time, right? It’s just the time it takes to have a bowel movement. It is also covered by insurance and similar to a Cologuard® test, if a positive is seen, a colonoscopy is warranted.  So, as I take a step back from those three options, I would note the best test is the one that gets done. It’s the one that the patient’s willing to do. Right? That’s the best test.  

Host: Yeah. Great. Really helpful. I appreciate you going through the examples, um, of all the options that are available. And, I’m curious to, um, learn more about, um, the stool-based tests that people can perform at home that you mentioned, um, you know, have the introduction of those additional options helped increase the number of people who are screened?  

Guest: That’s another great question, because that’s the goal, is to increase the number of patients who are screened for this disease state. So, there have been a few studies, um, showing increased CRC screening rates when noninvasive testing is offered. So, one example is a study that was published in 2018. It was published in the journal Gastroenterology by Dr. Levin and colleagues, and this study examined a multi-modal colorectal cancer screening protocol, meaning including both invasive and noninvasive options to the patients. And this approach resulted in a 44-percentage point increase in colorectal cancer screening.   

Also, important to note is the American Gastroenterological Association supports colorectal cancer screening that includes both noninvasive screening options and colonoscopy to address patient barriers and to improve participation.  I would kind of summarize it by saying no one looks forward to colorectal cancer screening, but there are barriers to colonoscopy prep and procedure that sometimes lead a patient to doing nothing.  

And, if we’re not screening, we’re not preventing cancer. And this is why it’s so important for patients to know their options. There’s power in knowing your options and making the best choice individually with your physician. This is shared decision-making, and it makes a positive impact on getting screening accomplished.  

So, to summarize, what can noninvasive colorectal cancer screening help to do? It can help rule out colorectal cancer in patients, and really reserve or prioritize colonoscopy for patients who are at higher risk, and those with a positive result from a noninvasive test.  

Host: That’s great. Thank you so much for sharing. Really, um, great results that are happening.  Um, so, if any of our listeners are interested in getting a colon cancer screening and haven’t done so before, can you talk about the steps that they should take to get started and how do they find out which screenings are covered by their health insurance?  

Guest: Wonderful questions. Uh, how to make it happen, right? So, first, talk with your doctor. That’s the first step. So, talk with your doctor. Understand the options that you’re eligible for based on your personal risk factors, if you have any. If you’re a high-risk patient based on symptoms, a diagnosis, or a family history, your option is a colonoscopy. But again, if you’re average risk, you might be eligible for a noninvasive at-home test such as Cologuard®.  

The second step that I would recommend taking is to call your insurer or visit their website to verify coverage. That’s really important. Um, I will note that the Affordable Care Act requires both private insurers and Medicare to cover the cost of colorectal cancer screenings because these tests are recommended by the U. S. P. S. T. F. which we referenced before. And this law requires that there should be no out-of-pocket costs for patients such as co-pays or deductibles. But sometimes plants are grandfathered. Nothing is perfect, right? So, you can find out if your insurance plan is grandfathered by contacting your health insurance company or your human resources department. And, this tends to be the exception to the rule, but it’s worth noting.   

And, as a last note, in Wisconsin, 97 percent of patients who take a Cologuard® test have zero out-of-pocket costs.   

Host: Wow. That’s great news. Wow. Thanks so much for sharing those tips.  So, if someone completes an at-home test, um, that does detect the possibility of cancer, I know you referenced earlier that the next step is for a colonoscopy, but can you talk a little bit more, um, about that process and the steps that are usually taken?  

Guest: Yeah. So, if a patient does a noninvasive test first, and they have a positive result, it does mean that a colonoscopy is the next step. And, so sometimes that’s kind of the motivator that a patient might need to get that done, right? Um, because if you have a positive, we want to see what, if anything, is going on inside that colon.  

Uh, I think also important to note is a positive noninvasive test result doesn’t necessarily mean that a patient has colorectal cancer. A positive result from a Cologuard® test could mean that either that altered DNA or blood was found in the stool sample, and we just need to go take a closer look. If a patient receives a negative test, that means that neither of those features was seen and the individual is good for three years of screening credit. I should also note, um, as it pertains to Cologuard®, false positives and false negatives can occur. Uh, in a clinical study, 13 percent of patients without cancer or advanced adenomas received a positive result and 8 percent of patients with cancer received a negative result. 

So, when we get a positive noninvasive test. It is always the next step to complete that colonoscopy next.   

Host: Awesome. Thank you. So, do you have any final words of advice for our listeners?  

Guest: Absolutely. My words of advice are if you are age 45 or up, and you have a colon, you need colorectal cancer screening. Know your risk factors, if you have any, and talk with your doctor about your options. And then lastly, choose the screening option that you are most comfortable with and get it done.   

Host: Wonderful. Excellent advice and recommendations. Really appreciate your time today, Kim, and all the helpful information that you’ve shared.  

Guest: It’s my pleasure. Thank you, Renee.  

Host: Thank you.   

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• Colorectal Cancer Alliance
• Exact Sciences 
• Cologuard

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