Dr. Ben Evans is a colon cancer expert | colonoscopy | stool-based tests | rectal bleeding | polyps

DESCRIPTION

The average age in which people are diagnosed with colon cancer continues to drop.  Louisville-based gastroenterologist Ben Evans, MD says for decades the conventional wisdom was that one should begin getting screened for colon cancer at age 50.  Now, he says you should learn your family history with colon cancer and colon polyps, and with that as your guide, you should start screening as early as your twenties.  Dr. Evans says that while the colonoscopy remains the gold standard for colon screening, there are stool-based testing alternatives that can be done in the privacy of your home.  However, he notes that if one of the home-based tests reveal a positive result, you will need to undergo a colonoscopy.

Intense research has yet to come up with an answer as to why those being diagnosed with colon cancer are getting increasingly younger.  Dr. Evans says the mortality rate for those diagnosed with cancer continues to climb while to varying degrees, the mortality rate is dropping for all other types of cancer.

In addition to checking your family history with colon cancer, you can help yourself by living a healthy lifestyle.  Dr. Evans suggests quitting smoking, reducing alcohol intake and consumption of processed foods, while being sure to load up on fruits and vegetables.

Dr. Evans says you should be aware of colon cancer symptoms.  They include bloody stool, rectal bleeding and abdominal pain.  If any of these symptoms materialize, he says you should not leave anything to chance and seek medical attention.

Additional Resources:

Support Group:

The Colon Cancer Prevention Project: https://www.coloncancerpreventionproject.org

TRANSCRIPT

Bruce Morton: Greetings.  This is the Cancer Interviews podcast, and I’m your host, prostate cancer survivor Bruce Morton.  For a long time, where colon cancer screening was concerned, the conventional wisdom was that one should start right around age 50.  Well, that has changed.  Sadly, the average age in which people are being diagnosed with the disease has lowered, necessitating one get an earlier start when it comes to getting in front of colon cancer.  Our guest on this episode is here to articulate that urgency.  He is a gastroenterologist, Ben Evans, MD of Louisville, Kentucky, and Ben, welcome to Cancer Interviews.

Ben Evans: Thank you, Bruce.  Thanks for having me today.

BM: Ben, before we start, we want to learn a little bit about you, so, if you would, tell us a bit about your professional background.

BE: Yes.  I am a gastroenterologist in Louisville, Kentucky.  I have been practicing here since 2006, specializing in a sub-specialized area of gastroenterology called therapeutic endoscopy, where we do a little bit more advanced procedures than most gastroenterologists.  Over the last three to five years, instead of taking care of patients with complications of colon cancer, I decided I wanted to put more of my efforts into prevention, education and getting the word out about how important it is to get screened for this disease.

BM: Ben, for every type of cancer, early detection is very important.  To be specific, regarding colon cancer, how does one benefit when they have taken steps to get in front of the disease?

BE: Colon cancer starts from small growths to the colon wall called polyps.  Once a gastroenterologist can see a polyp on a colonoscopy, on average, it will take that polyp about ten years to potentially grow and turn into a colon cancer.  The prevention part is to identify those who are at high risk of having colon polyps earlier in life than age 45 and educating the public that this disease is affecting people in their thirties and forties more often than it did before the year 2000.  If we can get people in and get them screened, find the polyps, remove the polyps, then they won’t get colon cancer. 

BM: Data shows the colon cancer mortality rate is trending up.  Why is that?

BE: That’s a great question.  Unfortunately, since the 1990s for patients under the age of 50, cancer mortality rates have decreased across the board, except for colon cancer.  Now, colon cancer is the number one death rate for people under 50.  It is higher than breast cancer in women.  Nobody knows exactly why this is happening.  A lot of data showing lifestyle and diet are two things that are going to be important in helping to prevent early colon cancer.  Obesity is at risk for a lot of different cancers, cigarette smoking for any kind of cancer, diet in the United States and Western society or a low-fiber diet.  It is recommended that 25 grams of fiber a day in the average is good, but the average American gets about 10 to 15 grams a day.  There are more processed foods that we have available here in the United States.  That plays a role, as well as less exercise, a sedentary lifestyle and drinking too much alcohol.  Those are some of the lifestyle things that researchers have come up with that could be contributing to this incidence of colon cancer at a younger age.

BM: By the way, we hope you will find time to like and subscribe to our channel.  And if you click on the bell icon, you will be notified whenever we post an interview.  We also want to remind you we are not distributors of medical advice.  If you seek medical advice, please contact a licensed healthcare professional.

We had mentioned at the top that the whole notion of people beginning colon cancer screening has become dated information.  These days, Ben, at what age do you think screening should begin?

BE: Honestly, I think we should begin discussing risk factors and preventative factors for colon cancer with patients in their twenties.  For a patient who does not have a family history of colon cancer or polyps, it is recommended to start screening at age 45.  However, if a patient has what we called a first-degree relative, immediate family, or aunt or uncle, a second-degree relative, if the patient has a first- or second-degree relative with a history of polyps or colon cancer, they need to contact their doctor because we would decrease their age of screening and start sooner, possibly ten years.  So, if mom had a history of colon cancer and she was diagnosed at 48, then I would recommend screening at age 38, maybe even 35. 

BM: How difficult is it to get younger people screened?

BE: In 2026, this disease is happening with patients in their thirties and forties.  So, the first thing is, this is not an old man’s or old woman’s disease.  This is something that is affecting young people.  The other part, the barrier if you will, is that many people think colonoscopy is the only way to get screened for colon cancer.  Colonoscopy is an invasive procedure, however, there are other methods we can use for screening.  A lot of people shy away from colonoscopy because of the prep that you have to drink the night before that keeps you in the bathroom, you have to take off of work to have the procedure, you have to have a driver drive you home from the procedure because you are going to receive anesthesia, so, it can disrupt somebody who has a limited ability to take time off from work to have these things done.  So, I think that’s the other barrier.  If you cannot have a colonoscopy, there are other methods out there.

BM: And what are some of those methods?

BE: Stool-based testing is the second most important method of colon cancer screening.  We have two types of tests.  One test that you do every year, where you do it in the privacy of your own home and it detects if there is any microscopic blood in your bowel movement, which could indicate a colon polyp or something else, and there is a DNA test that you would do every three years.  That picks up on small molecules or proteins that are shed by polyps, and it can pick up blood as well.  The thing about those tests is that if one uses them, they should not think that screening has been done in full.  That is the other big barrier.  If you have a positive, then you need to have a colonoscopy.  A lot of people like to say that they one of the home tests, I don’t know the result, I did it, but I am okay.  The answer to that is, you’re okay if it is negative, but remember if it is the one for blood, you have to do it every year, and if it is the one for DNA, you have to do it in three years. 

BM: Ben, if I am hearing you correctly, despite the alternatives you have mentioned, when all is said and done, where colon cancer screening is concerned, the colonoscopy remains the gold standard, yes?

BE: Yes.  That’s because it can identify pre-cancerous lesions and those lesions, or polyps and they can be removed; but it has the disadvantages it is an invasive procedure and logistically disruptive.  A lot of people don’t want to have an instrument put in that part of their body necessarily, but I think if you have talked to anybody who has had a colonoscopy, yes, the prep is the worst part about the complete process.  You are completely sedated, you are in a fast sleep and you wake up and feel like nothing happened.  And if you have no family history, and the procedure reveals no polyps, it is recommended that you wait ten years before your next colonoscopy.  So, those are the advantages and disadvantages of that.  The stool-based testing disadvantage is, if it is positive, then you need a colonoscopy.

BM: Earlier you have enumerated some of the bad lifestyle choices one can make that can lead to a colon cancer diagnosis; but is there some way that someone can improve their awareness by knowing the symptoms of colon cancer, and while we’re at it, what are those symptoms?

BE: Great question, Bruce.  So, one study showed from the time of the symptoms in patience the age of 50 diagnosed with colon cancer, there was a seven-month lag time between the onset of symptoms and the diagnosis of colon cancer.  I would love for patients to hear that the important things are to really try to know your family history the best you can.  If there is a history of colon cancer, that is extremely important, but just as important is a history of colon polyps, especially in a first-degree relative, like mom, dad, brother or sister.  The more details you can have, how many polyps there were, how big they were, the type of polyp, the more details, the better.  So, really knowing your family history.  It is extremely important because the more folks you have in your family with colon cancer or colon polyps, the earlier you want to talk about one of these methods of getting screened.  The other thing you can do for yourself is trying to live a healthy lifestyle, not excessive alcohol use, try to eat more fruits and vegetables, more fiber in your diet, less processed foods, try to quit smoking if you smoke, exercise more, try to be more active, but specific symptoms, any kind of blood in your bowel movements or rectal bleeding or abdominal pain.  I try to explain to patients if you eat something maybe you shouldn’t have and you have some belly pain for a day or two, that’s probably not colon cancer, but if the pain is non-relenting you should seek attention.  The last thing to notice is a change in bowel habits, those are other symptoms of colon cancer.  And I think it is just having patients be more aware.  I would say we all need to be a bit more aware, we should listen to that voice in the back of our heads that maybe something is not right. 

BM: Regardless of whether you feel you might be diagnosed or if you are diagnosed or if you are in the post-treatment phase, support is so important.  There is an outstanding organization right where you are, in Louisville, the Colon Cancer Prevention Project.  If you would, tell us what the Project can do for others.

BE: It is a nonprofit organization here in Louisville.  Its main focus is educating the public and raising colon cancer awareness, working on health systems’ improvement.  We provide a lot of survivor support for people in underserved areas here in Louisville.  We are trying to be as active as possible.

BM: And what the Project can do extends far beyond the Commonwealth of Kentucky, through its website, whose address is https://www.coloncancerpreventionproject.org.  Ben, we are about to wrap up and we will conclude the way we usually do with the following question: If you ran into an individual who had just been diagnosed with colon cancer, they might have a lot of questions, you a lot of answers, but if there is one point you would want to make sure that person remembers, what would it be?

BE: I would tell that person to keep an open mind, to think of all the treatment options you may have for their particular cancer.  I would also encourage that person to reach out to others in the community and organizations like the Colon Cancer Prevention Project so that they can get linked up with survivors of colon cancer who walked in their shoes they are about ready to walk in.  I would encourage them to share this news, do not be shy about it, do not be embarrassed about it.  The more people they can share this news with, they can make others think that perhaps they, too, should get checked out, maybe they can prevent others from being diagnosed.

BM: That sounds like great information with a multiplier effect.  Ben, thanks so much for being with us on Cancer Interviews.

BE: Thank you again, Bruce.

BM: And we want to remind you as we always do when we conclude, that if you or a loved one are on a cancer journey, you are not alone. There are individuals out there like Dr. Evans, organizations like the Colon Cancer Prevention Project that can make the cancer journey a little bit easier.  So, until next time, we’ll see you on down the road.

Additional Resources:

Support Group: The Colon Cancer Prevention Project 

https://www.coloncancerpreventionproject.org

SHOW NOTES

TITLE: Ben Evans, MD, Colon Cancer Expert – Louisville, Kentucky, USA

The average age in which people are diagnosed with colon cancer continues to drop.  Louisville-based gastroenterologist Ben Evans, MD says for decades the conventional wisdom was that one should begin getting screened for colon cancer at age 50.  Now, he says you should learn your family history with colon cancer and colon polyps, and with that as your guide, you should start screening as early as your twenties.  Dr. Evans says that while the colonoscopy remains the gold standard for colon screening, there are stool-based testing alternatives that can be done in the privacy of your home.  However, he notes that if one of the home-based tests reveal a positive result, you will need to undergo a colonoscopy.

Additional Resources:

Support Group:

The Colon Cancer Prevention Project   https://www.coloncancerpreventionproject.org

Time Stamps:

01:59 How one benefits from early detection of colon cancer.

02:59 Ben is asked why colon cancer mortality is trending up.

05:19 When colon cancer screening should begin.

07:44 Says colon cancer doesn’t just victimize old people.

08:46 Describes colon cancer screening options other than colonoscopy.

10:13 In terms of colon cancer screening, Ben says the colonoscopy remains the gold standard.

12:13 Names the symptoms of colon cancer.

17:51 His advice for anyone freshly diagnosed with colon cancer.

KEYWORDS (tags):

colon cancer

polyps

colonoscopy

therapeutic endoscopy

stool-based testing

rectal bleeding