#391 ‒ Colorectal cancer screening： importance of early screening, colonoscopy as a screening and preventive tool, and how to build a personalized strategy
Episode Stats
Summary
Colorectal cancer is the second leading cause of cancer death in the United States, and it s projected to be responsible for roughly 55,000 deaths this year. And yet, unlike many other cancers, it is arguably the most preventable cancer we know of.
Transcript
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Hey everyone, welcome to a sneak peek episode of the drive podcast. I'm your host, Peter
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Atiyah. At the end of this short episode, I'll explain how you can access the episodes
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in full along with a ton of other membership benefits we've created, or you can learn more
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now by going to peteratiamd.com forward slash subscribe. So without further delay,
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here's today's sneak peek of the episode. Welcome to a new episode of The Drive. In
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today's episode, I'm diving into colorectal cancer screening, why colorectal cancer is one of the
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most preventable cancers we know of, and why getting screening right matters so much. In this
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episode, I'm going to discuss many things, but among them, how colorectal cancer develops,
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why colonoscopy is uniquely valuable as both a screening and preventive tool, the troubling rise
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in early onset colorectal cancer, and how to think clearly about the growing menu of non-invasive
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screening options and their limitations. If you're not a subscriber, you'll only be able to
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listen to a sneak peek here. So without further delay, I hope you'll enjoy today's episode of
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Colorectal cancer, or CRC as we'll abbreviate it, is the second leading cause of cancer death
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in the United States. And it's projected to be responsible for roughly 55,000 deaths this year,
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according to the American Cancer Society. That puts it behind only lung cancer as far as cancer
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mortality. And yet, unlike many other cancers, CRC is arguably the most preventable cancer we
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know of. And the reason for this is that CRC follows a well-characterized slow progression
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from completely normal tissue to a benign polyp to a precancerous polyp to frank malignancy.
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and that progression almost always takes years, often a decade or more. And because the colon is
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a hollow organ and sits outside the body, as crazy as that sounds, we can directly access
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and visualize it. We have the ability to not only detect those precancerous lesions,
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but also remove them before they ever become cancer. So no other common cancer screening test
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can make that claim. A mammogram can detect breast cancer, a low-dose CT scan can detect
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lung cancer, but neither of those are able to look directly at the cancer. And so a colonoscopy can
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not only do that, but it can also remove the precancerous lesion in the first place. And yet
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a 2020 CDC estimate claims that 68% of colorectal cancer deaths may be prevented with screening,
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even at the traditional recommended intervals. Again, that statistic should stop you cold.
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We're talking about a cancer that in most cases gives us a decades-long window to intervene,
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and we're still losing nearly 70% of people out of that 55,000 deaths a year because they never
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walked through the front door to get a colonoscopy. Even more, I would argue that this number could be
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closer to 100%, i.e. 100% reduction in colorectal cancer death with more aggressive screening
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protocols, including starting earlier and screening more often. So today I want to cover
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this topic comprehensively. We'll start with the basic biology of colorectal cancer and why it's
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uniquely suited to screening. Then we'll talk about the rise of early onset colorectal cancer
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in younger adults. From there, we'll go into the colonoscopy itself, how to prepare for one,
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how to ensure you're getting a high-quality exam, and how to think about screening intervals.
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We'll discuss real risks and trade-offs, and finally, we'll walk through the growing landscape
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of non-invasive screening alternatives, both stool-based tests and blood-based tests,
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and talk about what they can and can't do. The goal here is to leave you with a very clear,
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practical picture of colorectal cancer screening, whether you're 35 and wondering when to start,
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or 55 and wondering when your KolaGuard test is good enough.
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