Shaina Farfel, a Nurse Practioner in the Vanderbilt Occupational Health Clinic, talks about why a colonoscopy is important for our health and highlights ways to approach our loved ones to encourage them to get screened.

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Rosemary Cope:  Welcome to this edition of the Vanderbilt Health and Wellness Wellcast.  I am Rosemary Cope with Work/Life Connections.  I am here today with Shaina Farfel.  Shaina is a Board-Certified Family Nurse Practitioner, who is a member of the Occupational Health practice here at Vanderbilt University Medical Center.  She received a Bachelor and Master of Science in Nursing from Johns Hopkins University and a Bachelor of Science in Biology from the College of William and Mary.  March is National Colon Cancer Awareness Month, and for this Wellcast, we are making it personal.  Keeping the loved ones near us is something we should never take for granted.  We all share such important parts in another's lives, so we all need to take the time to have meaningful conversations about each other's health.  Shaina, who needs to have a colonoscopy, and why is that important?

Shaina Farfel:  I just want to give a quick little primer on what colorectal cancer is.  This is a cancer that starts growing, either in the large intestine, also known as the colon, or the rectum.  It is a highly-prevalent cancer with high rates of morbidity and mortality, and according to the American Cancer Society, colorectal cancer is the third most common cancer diagnosed in both men and women in the U.S.  That is excluding skin cancer.  It is also the third leading cause of cancer-related deaths in the U.S.  Unlike other forms of cancer, we do have the ability to screen individuals for early detection of precancerous lesions, which can prevent the development and/or spread of colorectal cancer, greatly reducing rates of serious illness and death.  So, basically, everyone who has a colon is at risk and should be screened.  For most folks, the recommendation to start screening for colon cancer starts at age 50 and generally continues until age 75 if prior screening is up-to-date, or when life expectancy is 10 years or less.  We will stop screening at that point.  Some people may be at increased risk for developing colon cancer if they have a certain genetic syndrome or high-risk family history, such as a first-degree relative who has been diagnosed with colorectal cancer before the age of 50, and so recommendations for those folks may begin earlier and more frequent screening may be necessary.  The thing to remember, though, is it is very important to talk to your primary care provider to see what screening recommendations are best for you.

Rosemary Cope:  You know, many of us are reluctant to talk about this procedure, and it also is a signal that we are getting older, and that alone can be a difficult topic.  What are some things I can say to my own loved ones to encourage them to have a colonoscopy?

Shaina Farfel:  You are definitely right.  This can be a really tough topic to talk about and talking about colon cancer can be a taboo subject for a lot of people, but since screening is universal and affects all of us, we should try and make an effort to have more open and transparent discussions so we can break down some of those commonly-held misconceptions and barriers to screening.  So, there are a couple of ideas that I have for tips for talking to family members or friends about getting a colonoscopy that may encourage them to get one sooner.  The first thing is that with the Affordable Care Act, it now requires health insurance plans that started on or after September 2010 to cover colorectal cancer screening.  So, hopefully this protects individuals from incurring large out-of-pocket costs, and again, you would want to just check with your health insurance plan for specific details.  Secondly, as a primary care provider, you know, a lot of people would say to me, "Well, I am not having any symptoms - why do I have to get this testing done?"  So, my response would be, often, early stages of colon cancer in individuals over the age of 50, it can be asymptomatic, and so you may not know or may not be having any issues.  So, screening can pick up on things a lot sooner and decrease that risk.

Rosemary Cope:  Something simple like I hear high blood pressure is a silent killer also, so I get it checked just to be sure ... same thing.

Shaina Farfel:  Same thing.  Same thing.  You may not be having any signs or symptoms, but it is still recommended to get checked out.  A lot of people, it is interesting, actually fear the colon prep even more so than the procedure itself, and I actually have some good news for those folks.  There are newer preps out on the market that taste a lot better.  They are lower volume.  You can even split the prep up into taking some the day before and then some the morning of your procedure.  So, again, I just encourage folks to talk to their gastroenterologist about those options.  That can be a lot easier.  The last couple of things - it is important to remember colonoscopies are actually fairly quick procedures.  They are about 30 minutes with some recovery time afterward.  You are under light sedation, so you don't really remember much, if anything at all, and you don't have to do it for another 10 years after you get it done if everything is normal, and that is a really long time.  And you know, if they were to find something, although screening may be a little bit more frequent than every 10 years, they can remove it on site and not have to schedule you for another appointment.  I think the last thing that is really important, too, and that a lot of people may not know, is that colonoscopy isn't the only way to screen.  So, if you would prefer to do another method, there are fecal occult blood tests they are doing, taking a stool sample and looking for blood.  There is something called a sigmoidoscopy.  There are CT scans that can be used, and really, not any one screening modality is recommended over another.  The idea is that you talk to your primary care provider and use shared decision-making to find out what is best for your individual preferences and values.

Rosemary Cope:  So, if I am going to talk to, say, my mom or my dad or whoever my loved one is over 50, I might say, "These are some of the things that I have researched and found out," just what you have been telling us, and, "I might be willing to go with you or help you through this the best way I can support you," and sometimes the hype is a lot worse than the actual event, so to be a reassuring person is really helpful.

Shaina Farfel:  Exactly.  Exactly.

Rosemary Cope:  Can you tell our listeners about ways they can protect their own colon health?

Shaina Farfel:   There lots of good studies out there that have shown that there are a number of factors associated with decreasing risk of colorectal cancer, and so things like eating a diet high in fresh fruits and vegetables and other dietary fibers has been shown to be protective, so fiber-rich foods like split peas, lentils, broccoli, bran cereals, whole wheat pasta ... all of that is great stuff.  Regular physical activity, we hear it all the time, 150 minutes or more of moderate-intensity exercise a week is shown to also decrease your risk of colorectal cancer, and there are some other studies out there that have actually shown some evidence to suggest that aspirin and other anti-inflammatory medication, such as ibuprofen, can actually be protective against the development of colorectal cancer, except that you definitely want to consult with a provider before taking any of those to make sure that they are okay and safe for you.  So, just a couple of things.

Rosemary Cope:  Okay.  That sounds good and doable.

Shaina Farfel:  It's totally doable, yeah, very easy.

Rosemary Cope:  Shaina, thank you for giving us some great information and some suggestions about this.

Thank you all for listening.  If you have a story suggestion, please email it to us at health.wellness@vanderbilt.edu, or you can use the "Contact Us" page on our website at www.vumc.org/health-wellness.