Colorectal Cancer and The Couric Effect - Continued: Awareness to Action to Advocacy

00:00:04
Speaker 1: Hi, everyone, Welcome back to UCLA Health'smetically speaking. I'm your host, doctor Eve Glacier. Colorectal cancer is one of the most preventable cancers we face, and yet in twenty twenty six, more than fifty five thousand people in the United States are expected to die from it. And what's especially alarming is what we're seeing in younger adults. Colorectal cancer is now the leading cause of cancer death in people under fifty. These are staggering and heartbreaking numbers for disease where screening can truly change outcomes and in many cases, prevent cancer before it even starts. So if you've been putting your screening off, waiting for a symptom or the right time, consider this your nudge. It's Colorectal cancer Awareness Month and we're turning awareness into action. Today. We're going to break down what screening really means, how to choose the option that best fits you, what symptoms you should never wait for, and how to get past the real life barriers so this actually gets done. And to help us do this, I'm joined by an incredible duo and two of my favorite professional nudgers. Katie Kirk is back with US award winning journalist, advocate, co founder of Stand Up to Cancer, and the person who changed how Americans think about corectal cancer screening. And we're also joined by my USDLA Health colleague, doctor Fulo may gaserentrologist, health equity researcher, and someone who's been working to redesign care so everyone can get screened and get the follow up they need. Katie Fulla, welcome, thank thank you.

00:01:28
Speaker 2: For having us, so happy to be here, happy to be here with Fulla and with you again, Eve, thank you for bringing attention to this important issue. I can't think of anything more important, especially it given that it's Coorectal Cancer Awareness Month.

00:01:43
Speaker 1: Absolutely before we dive in, I'd love to just have a minute so everyone can meet our guests, even though they probably already know a lot about you. But if you don't mind, I'd love for you to share why this work matters so much to each of you and Katie, your advocacy, I think most people know, is deeply personal, and you've talked openly about losing your husband Jay to go on cancer when he was only forty two, and how that changed how you wanted to really use and leverage your platform. My question, just to start is when you think about him, and you think about young people today who are busy, and they're very young, and they say i'll do it later, what do you want them to most understand?

00:02:21
Speaker 2: Well, gosh, when I think about him, I mostly think about everything he's missed. You know, I have a grandson now named Jay, who's going to be two this month. My daughter is pregnant with the second child, Ellie. My other daughter is in Charlottesville, Virginia getting her pH d in history, and I know he'd really get a kick out of that, and they'd have a lot to talk about. But you know, graduations and weddings and milestones that sadly he couldn't be there for. So I always think about that first and foremost. And then I think about the fact that he was forty one when he was diagnosed, and I remember I treated it as a sort of intrepid journalist and did research right away. And one of the things I learned that back then, thirteen percent of calling cancer patients were under the age of fifty, and I was furious, thinking, what are these people expendable? You know, there's no screening recommendation. I don't think many internists or family doctors necessarily imagine that a young person at least back then could be showing signs of coorectal cancer. And you know, now very much on my mind, Eve, as with Fola, is this alarming increase of coorectal cancer among people under the age of fifty. The screening age was lowered by the American Cancer Society a couple of years ago to forty five. Unfortunately, one in five people under the from forty five to fifty are getting screened, So we really need to get that word out that it is now forty five. But what I'm concerned about is all the cases I'm hearing people in their thirties, forties, some even in their twenties who are being diagnosed with this disease. So that's I'm thinking from a public health perspective, how we a get the word out about forty five, but also how we address all these young people who are being diagnosed, and how we come up with potentially different kinds of screenings that can be used that are less expensive, less invasive, and make sure that these young people in the prime of their lives have their colorectal cancer detected early when it's most treatable.

00:04:55
Speaker 1: And also have access to that screening. And before we get into all that, full I'd love to hear a little bit about you. I mean, you're a gaster entrologist, you still see patients all the time, but you're also a health equity researcher. I'd love it if you could tell us what exactly that means. And really, I mean, I don't think I've even ever asked you this. Why have you decided to commit, you know, really your energy to colon cancer prevention and then especially this early onset work.

00:05:19
Speaker 3: Absolutely, First of all, thank you for having me.

00:05:21
Speaker 4: It's here, and I have to say, it's amazing to be here with this fierce advocate.

00:05:25
Speaker 3: On this amazing stage.

00:05:28
Speaker 4: You know, I really consider you one of our first advocates in corectal cancer.

00:05:32
Speaker 3: It's an honor to be here with you.

00:05:33
Speaker 4: Today, and I just want to thank you for continuing to raise awareness about this disease. As you mentioned, my name is Fulla May. I am a physician at UCLA. I spend some of my time taking care of patients, but actually the majority of my time running my lab, and my lab is a clinical research lab that focuses on colarectal cancer. We try to understand why people get and die from colorectal cancer. We try to make sure that as many people as possible get screened for colarectal cancer, and we also try to make sure through our health equity work, that everyone has access to screening regardless of their income, their race, their ethnicity, where they live in the United States. So a lot of our research is really focused about working in community health centers and under resource settings or under resource parts of the country to make sure that people have access to screening tests.

00:06:23
Speaker 3: You asked me the why.

00:06:25
Speaker 4: I've always been really fascinated by diseases that.

00:06:30
Speaker 3: Impact the digestive system. And when I went into training.

00:06:33
Speaker 4: For gaser entrology, really just happened across corectal cancer as a public health problem, and around that time I actually found out that it also impacts my family. So I didn't know it, but I was one of these people who had colorectal cancer in my family and no one was really talking about it, and that really solidified my career path for me.

00:06:53
Speaker 1: Why do you think no one was talking about it.

00:06:55
Speaker 4: I think there's a real stigma about cancer in general. And then I think when they're cancer. Does that affect intimate parts of the body, like the colon, like the rectum. There's some level of embarrassment, maybe even at a level of not understanding are even self blame that can make people uncomfortable talking about it. And I think that in my family it took us a long time to feel comfortable talking about the disease that affected my grandfather. That's very different now and we're very open about it and we're all screened, which is great.

00:07:25
Speaker 1: Well thanks to the work that both of you do. I thought it would be great to just take a moment and really define what screening is because I think just even just not we were talking about speaking in plain language, it's really I think if you're not in the medical world, even the definition of just screening can be a little bit confusing. So quick definition moment. What does screening actually mean? And why do we want to see people when they feel fine?

00:07:49
Speaker 3: So screening? Oh yeah, yeah, I'll start.

00:07:50
Speaker 1: Yeah.

00:07:51
Speaker 4: Screening is a preventive health effort to reduce the potential impact of a disease, and in the setting of cancer, we screen to either find polyps of the colon before they turn into cancer, or to find cancer early enough that we have the best chances.

00:08:08
Speaker 3: Of curing the individual of it.

00:08:10
Speaker 4: We're really fortunate in colorectal cancer that screening allows us to both prevent colorectal cancer by finding polyps, and it also allows us to early detect co directal cancer and other cancers that we screen for. We're mostly just looking for early signs of the cancer, but here we have the extra benefit that we can find polyps in the colon and take them out before they transform exactly.

00:08:31
Speaker 1: And Katie, I'm sure you hear this all the time when people say, wait, I don't have any family history, right, I'm good, Or my bowel movements are normal. I mean, I'm sure you could tell us why that's such a religious assumption.

00:08:41
Speaker 2: Yes, the most colorectal cancer cases are sporadic. I think fully correct me if I'm wrong, But I think it's like seventy five to eighty percent of colorectal cancers have no family history. So I always say no family history is no guarantee. But I think what's really amazing about the colon is it's almost like it's like a package. Right, you know, you can obviously have early detection for other cancers like breast cancer for example, and I had early stage breast cancer a couple of years ago. But with colorectal cancer, if you're able to catch it early as full as said, and you see these polyps that could or couldn't develop into cancerous gross and you're able to remove them during the process of a colonoscopy if they haven't penetrated the colon wall through the lymph nodes, which is kind of like the gateway. Tell me if I'm saying this right full, then if it permeates the colon wall through the lymph notes, then it becomes systemic disease and can be stage three. And then stage four is of course when it metastasizes on other organs. Most you usually deliver the lung things like that. But it's just this genius way because it's encased if you will, and you know, I I don't want to convert it to a sausage, but it kind of is encased in this outer part of the colon. And that's why it's so critically important that people get screened. And you mentioned symptoms. You know, people need to be keenly aware of symptoms, particularly because we're seeing these cases prior to people turning the age of forty five, which is the age of baseline screening, ten years before your first line relative. By the way, for example, Ellie and Carry my daughters, Jay was diagnosed when he was forty one. They both are getting screened at thirty one. Carrie just turned thirty, so she'll get screened at thirty one. Ellie has already been screened. So it's just really important that you get screened when you're feeling well, which is so counterintuitive for people. I think they think, well, I feel fine, nothing's wrong with me. But that's the way this cancer operates. By the time you're symptomatic, oftentimes the cancer has advanced, sadly. So if you have blood in your stools, you need to see your doctor right away, and if the doctor says it's just a hemorrhoid, you need to find another doctor to really check it out. If you have a change in your bowel habits, like your bowel movements look different, I know it's you know, I feel totally comfortable talking about this stuff because you know that kid's book Everybody Poops. Everybody poops. It's sort of like everybody. Most the vast majority of people have colon's and we have to take care of them as much as any other part of our bodies. But you know, unexplained weight loss, bloating, any kind of like just not feeling right, sort of in your digestive trap. You need to talk to your doctor. And that's why screening is so important. But again, I mean, I hope we spend a lot of time because to me, even full of what's the real conundrum is what do we do about these younger patients? As we said, they predicted, I think later this year, corectal cancer was going to be the number one killer of men and women under the age of fifty. And it happened. Soon happened, and they thought, so what do we do from a public health policy to get screening or to get better screening, or make it more accessible to people. And and secondly, the big question I've been asking is why the hell.

00:12:23
Speaker 1: It happens on this that's my new I mean I think that, yes, it happened a couple of years ago, you know, forty five being the new you know, fifty, But I think it's still a surprise for everyone. But they're early onset corectal cancer. I mean, it's very, very alarming, and of course Jay was only forty one forty two fulla what what is driving this? I mean, do you what are your thoughts about what's going on? And how do we, to your point, Katie, talk about it so that young people hear it and we drive them to screening. But we're not panicking them.

00:12:51
Speaker 2: Yeah, but this is the this is the problem. They're they're they're not being told to get screened.

00:12:57
Speaker 3: Right, and they haven't been told because it's a big change. We're telling the mass shift well, but.

00:13:01
Speaker 2: A lot of people. I mean, this is this is why we have so much wood to chop when it comes to this issue. But first I think we should talk about why it's happening, and then we can talk about what needs to change.

00:13:13
Speaker 3: From absolute health absolutely.

00:13:15
Speaker 2: Because why it's happening is super fascinating.

00:13:17
Speaker 4: To me, and I think it's really important to recognize that this is a major shift. So when I was in medical school, which wasn't that long ago, we taught medical students that colorectal cancer was the disease you saw people and when they're seventy.

00:13:30
Speaker 1: Or eighty a retirement.

00:13:31
Speaker 4: Kay, Yes, it was an old man's disease. Let's just be honest. That's what we called it, and it is not how we need to teach about colorectal cancer now. When I'm teaching my medical students now, I tell them that if you see concerning symptoms like the symptoms that Katie just mentioned, you need to be thinking about this disease even in a thirty year old, a forty year old, and a fifty year old. And that epidemiologic shift, that population shift, is why the story is very different than it was in the nineteen eighties and the nineteen nineties.

00:13:59
Speaker 3: Right, the history change so fast it change.

00:14:01
Speaker 4: It's affecting men and women, it's a checking young people. It's being diagnosed at very late stages when we have very little opportunity to cure those individuals.

00:14:11
Speaker 3: So these shifts.

00:14:12
Speaker 4: In how the disease is presenting has really caused us to shift how we think of the disease and also how we manage it. I think Katie just drops some really important pearls and I like to think of them.

00:14:22
Speaker 3: As the three rules.

00:14:24
Speaker 4: There are three rules about how we protect ourselves from colorectal cancer, and we talk about screening and symptoms. Number one, know your family history. If you've got a mother, father, brother, and sister first degree family history of colorectal cancer, you get screened at age forty are ten years below the age of the earliest fan or member's diagnosis. The second rule is, if you don't have a family history, you get screened at forty five, And as mentioned, that was the new guideline that came in twenty twenty one. Okay, as a result of this epidem logic shift. The third thing is the symptoms. And this is where the early onset story comes into play, because when you're talking about people who are under the age of forty five, we're no longer in that screening age, right, So what are we paying attention to in that group? And in that group, we have to pay attention to the symptoms. People who have new and persistent abdominal pain, new and persistent diarrhea, are constipation. People who are experiencing gi discomfort that is not going away, not just kind of like a viral gastintritis over the weekend, but something that's lasting weeks and weeks and weeks. This warrants us to get medical attention and explain weight loss. And that's when it's really bad. When we see iron deficiency, low blood counts, unexplained weight loss, those are usually signs of pretty spread disease. So we want to be paying attention to symptoms even before that. But of course as well, and the workup for that should be a colonoscopy, and as alluded to, you should be talking to your doctor and specifically saying is a colonoscopy something that we should be considering, right?

00:15:56
Speaker 1: And I just want to bring up a point too, because you mentioned hemorrhoids and you're mentioning I think younger and younger people, and I think so much is about not dismissing or normalizing pain or symptoms, right. I mean, if you're a young woman and you're like, oh, I also have heavy periods, I'm iron deficient. I mean, it's just a wake up call for everyone to say, like, no, no, no, don't hang your hat too quickly on what you think is a diagnosis. And you're saying, advocate, get a new doctor if you don't feel like you're being listened to.

00:16:20
Speaker 3: And those are the biggest mimickers.

00:16:21
Speaker 4: The biggest mimickers are women who have heavy mensis who are told that they're iron deficient because of their mensis.

00:16:28
Speaker 3: And then also people who have hemorrhoids. Yes, so people who've had some.

00:16:32
Speaker 4: All amounts of blood in their stool from hemorrhoids are often those are those symptoms are often just attributed to hemorrhoids when they actually warrant fur their investigation. So exactly, those are the things that we need to be paying attention to in young people.

00:16:46
Speaker 2: But what's frustrating for me, you guys, is this isn't enough. You know, it's not enough to say be aware of your symptoms. It's not enough to say find a gastro entrologist. It's it just isn't enough to stop this alarming increase of colorectal cancer. So for me, it's like, and I know, epidemiological studies it's a very hard they're really hard to do, take years and years, and but I am desperate for scientists so much so that I'd love to form a new dream team at Stand Up to Cancer really looking at this issue because they're now early on set cancer coorectal cancer departments and virtually every medical sound now because of the alarming number of people who are being diagnosed with this disease. But you know, just being aware of the symptoms. I just get frustrated because yes, yes, at the very least we have to be aware of the symptoms. We also have to educate doctors to really understand this is happening at a very alarming rate and they cannot completely dismiss that idea that this person could have early stage or tragically late stage colorectal cancer because so many I think, as Fuller will tell you, so many of these people who are young, because they have been dismissed, or because they themselves have dismissed the symptoms, they aren't being diagnosed very late at stage four because it's just not within sort of the realm of possibility for their physicians or for themselves. So yes, yes, yes we have to be aware of symptoms and people have to be aggressive, but we have to do more.

00:18:35
Speaker 1: So what's on that list for you? That more? I mean tell us about you know, stand up to cancer too. I mean, what can research do, what can we as doctors do? What should the public be doing well?

00:18:45
Speaker 2: I mean, first of all, I think we need to support science. I think we need to collaborate. There is a lot of work going on, and we can talk about this eve because this to me is really kind of some of the most interesting things if I want to geek out on science of why this is happening. So I think we need to support the research about that, and then hopefully as things become apparent, we can educate people about these things, change their behavior whatever is happening, you know, figure out how to avoid it. But I think we should talk about all the theories because it's fascinating.

00:19:25
Speaker 1: Fool to tell us. I mean, everyone wants to know this.

00:19:27
Speaker 4: I mean, Katie wants to get to the why, and we all want to know why this is happening, right.

00:19:31
Speaker 3: And I think you're right.

00:19:32
Speaker 4: It isn't enough to screen because we know that's only going to catch people who are of screening age. And it isn't enough to just wait for symptoms because many times this cancer is asymptomatic.

00:19:43
Speaker 3: So what are we doing beyond that?

00:19:44
Speaker 4: You know, we can talk about lifestyle modification, and that lifestyle modification is really dictated by what we think is causing this. And right now we just have a lot of theory. We do not have a case as we had with lung cancer, where there is the smoking.

00:20:02
Speaker 3: Gun it's causing this cancer.

00:20:05
Speaker 4: In fifty percent of cases, We don't, unfortunately, have that for colorectal cancer. What we probably have is a combination of environmental factors that in conglomerate are making us more predisposed predisposed to this condition. And then I think certain families have genetics in there that when thrown into this environmental risk basin, they're more likely to develop this disease. And many of us and science are working furiously to understand the whyse is it what we eat? There's a lot of data right now about highly processed food or ultra processes.

00:20:42
Speaker 2: That was sham I think, and I met the author, Would you author it too? No? No, but I was very excited to meet him. But I do I do have a bone to pick with him because I don't think ultra processed foods alone can be I don't think daring increase. But tell us about that study that was in jam A last November.

00:21:04
Speaker 4: Yeah, So this study was really helpful because we've been getting tips of information from science over time, and we've known to date that UH diets that are high and fat is, particularly animal fat, process meat, red meat, those are things that we've always considered as risk factors for colorectal.

00:21:23
Speaker 2: Camps like Delli meats like hot dogs.

00:21:25
Speaker 1: And your chart cuter.

00:21:27
Speaker 2: I'm sorry, I she was looking love a chartrea play.

00:21:37
Speaker 4: They don't like to hear me say reduce your alcohol in your chart Couterye, exactly so. But so we've had some tips and Andy Chans paper that came out recently at ultra processed food did provide evidence looking at women's specifically in the Women's Nurses study that when you have a greater intake of these highly processed foods, and these are foods you should think about highly as things that are things that are packaged and ready to eat, food that does not look.

00:22:04
Speaker 3: Like it's normal form.

00:22:05
Speaker 4: Okay, so milk and butter are processed, right, we have to do some processing to make them consumable by humans. But things like processed foods are things where they've actually broken down the extra components of the food and also added additives, glues, synthetics, preservatives to make it tasty and ready to eat and also sit on the shelf. So we think that the more of those you consume, it's adding to this kind of meyu where you are more predisposed to developing colorectal cancer. So there's definitely a lot of data about diet. There are also a lot of concerns about other environmental exposures. We have the synthetics that we use in our clothes and our food prefoss as we call forever chemicals, and we started using those products more in the nineteen thirties, forties, fifties, and that's right around the time where we see the birth groups where we therese people who were born and around that time nineteen fifteen ninety sixty went on to live into their forties. And then that's the group where we started to see.

00:23:08
Speaker 2: That would be like on site my husband was born the birth Yeah. So but there are other things. Let's talk about some of the other theories full because I think it's so interesting. I mean, and again I think some of these have not been born out scientifically. But people are looking at the over over prescription of antibio antibiotics. That's another big one that that perhaps it's affecting the bacteria and microbio our microbiome, right, that's one thing they're looking at.

00:23:39
Speaker 4: Because I think about that as microbiome as a risk factor in.

00:23:42
Speaker 1: Itself, just breaking down with the microbactics.

00:23:45
Speaker 2: Yeah, I always think about the microbiome, and I try to picture it. I always have a heart, very catchy sounding, but how do we actually that thing?

00:23:53
Speaker 4: I mean, I think of it as the coral reef of oh I love tracked, right, So like in a coral reef, there's different types and it's your entire g I track. You even have microboom in your mouth?

00:24:08
Speaker 2: Yeah, right, Well that's why heart disease with two decay disease.

00:24:13
Speaker 1: That's another We did a whole session on that mouth is just its open wound.

00:24:19
Speaker 2: Sorry, micro get very excited talking about this.

00:24:23
Speaker 4: In particular, the microbiome are that environment of micro biobes that live in your colon are probably implicated in colorectal cancer. And there's kind of two diverging theories here. There are people who think that it's the environment and the mixture of things you have in that like what is your balance of good and bad microbes? And then there are other people that think that it's more specific microbes that have a causal effect, a cause and effect causing cancers. So we don't know which way or if it's a combination of those things.

00:24:56
Speaker 3: But basically what.

00:24:57
Speaker 4: We understand is anytime we disrupt that beautiful coral reef that homeostasis there, we put our colon in a state where it has a likelihood of developing a colorectal cancer.

00:25:09
Speaker 2: So what about this whole theory which I don't really understand, but I read about it about E. Coli col a particular bacteria that exists in some people really from a very young You help me understand that.

00:25:22
Speaker 4: So, there are a few bacteria that are implicated in cancers. The most common one I think you're thinking you're thinking about is H. Pylori, which usually is implicated in gastric cancers.

00:25:33
Speaker 2: That's in your stomach, different, different, Okay.

00:25:36
Speaker 4: H Pylori is something that you can get infected with. It can grow in your body since a child, right, and when you're later in life, in your sixties, seventies, and eighties, it has a.

00:25:46
Speaker 3: High risk for gastric cancer.

00:25:48
Speaker 4: So we often will test people for this and then we can eradicate it by giving you a set of antibiotics.

00:25:54
Speaker 2: Why, well, some people have it and some people don't.

00:25:56
Speaker 4: So it's a lot about where you live. So there are certain parts of the world where they each By Laura, really, that's the guy who I think also, Yeah, they're parts of the world where this age pilor is just everywhere. It's in the food you eat, it's it's walking around in the communities that you live in. So those people are more likely to be inhabited with that bacteria, and for some people you live with it forever and it does nothing, but unfortunately, for a small percentage of people it can go on to cause gastric cancer.

00:26:22
Speaker 3: So now we're.

00:26:23
Speaker 2: Looking for talking about gastric stomach cancer stomach.

00:26:26
Speaker 4: So the question is, is there like an aged Pylori like bug of the colon that's implicated for coorectal cancer. Recently there is a species of E. Coli that has shown up in some colorectal cancers, but it certainly does not explain what we're seeing because it's not in all coorectal cancers.

00:26:43
Speaker 2: Can you test for H. Pylori? Is that am saying you can? And you can? And if so, should it be tested and and sort of kind of eradicating sort of solely on because if there's chance, isn't it kind of like a polyp like you never know, so you probably should get rid of it.

00:27:04
Speaker 4: So for right now, in many parts of the world, particularly Asian countries, they do test regularly.

00:27:09
Speaker 3: Yes, they scream for H.

00:27:11
Speaker 4: Pylori, and they do eradicate it with these antibiotics because they have a higher likelihood of getting gastric cancer in these parts of the world. We don't test everyone.

00:27:20
Speaker 3: In this country for H.

00:27:21
Speaker 4: Pylori, But in my practice, and I'm sure everybody else, is when we have people who've immigrated from East Asia, our families who've immigrated from parts of South America. Even some people will even say in big urban cities like Los Angeles, when you have patients with a certain set of symptoms, we should be testing for H.

00:27:39
Speaker 3: Pylori. But again, that's more about gastric cancer. And that's so.

00:27:43
Speaker 2: Interesting because I know that when people who live in Asia come to the US and adopt a more American diet, they often they're calling cancer rates go way up. And I remember reading and maybe this is wrongful for gastric cancer or stomach cancer in Asian communities that they think it might have to do with fermentation or is that something there, or is that because they're not getting colon cancer because of fermentation. I don't know that.

00:28:16
Speaker 4: I think for Asian countries, the biggest risk factor is that H. Pylori living in your gut for a long period of time and causing gastric cancer, but it doesn't have a protective.

00:28:26
Speaker 3: Effect for colorectal cancer.

00:28:28
Speaker 4: They screen for gastric cancer, but they also screen for colorectal cancer. And what I would say is really interesting with this early onset epidemic, and we said that's just the study of trends over time, is that we're seeing it in many different countries.

00:28:42
Speaker 3: This is not a US problem.

00:28:44
Speaker 4: And really going back to talking about colorectal cancer and young people, the highest rates are like in Australia, New Zealand, as you mentioned, Puerto Rico we see really high rates, and then in the coastal United States. So again to the why, it's also a question is is there a regional component of this? Are there certain environmental exposures that you have depending on where you live in the world. Those are other theories. Those are coming with the diet, with the microbiome, with the theories about metabolic disease and obesity.

00:29:16
Speaker 1: There's a society now too.

00:29:18
Speaker 2: There's also some other theories that I think are worth mentioning it because I think they're just interesting. One is microplastics, that somehow the prevalence of microplastics in our diet. You know, now we're finding them everywhere ever, finding them in the brain, we're finding them and developing fetuses microplastics, and that that's somehow that's disrupting the almost viscous uh kind of coding of the microbiome and of the intestines, and that they're irritating it, and that that might be something to look at.

00:29:50
Speaker 4: Right absolutely, so that fits into the theory that there are environmental toxins, are carcinogens that are leading to this increase in color rectal cancer in young people. So microplastics is something that has been looked at. It's actually microplastics are actually implicated in many diseases as well as colorectal cancer. The problem with microplastics is that the way that we have produced things in our society, from food, sofa as too and furniture to clothing, they're almost unavoidable.

00:30:19
Speaker 1: And we don't have a test to measure them.

00:30:21
Speaker 3: Right now measure them and we also I.

00:30:23
Speaker 2: Think there are tests, I just don't think they're real, commercial available.

00:30:27
Speaker 4: Are validated, and we can't say that again that that's the smoking gun and that's why I keep coming back to this is probably a combination of factors that you are exposed to, probably not when you're forty, probably in your adolescence or even in your twenties, which is that's really colorectal cancer in your forties.

00:30:46
Speaker 3: I did ask.

00:30:46
Speaker 2: I mean mention of course that I think is super interesting because I'd love to hear what Fola thinks about this. So we just had our stand up to cancer scientific summits in a whole day on early on set cancers, because there are seventy cancers that are on the rise in people under the age of fifty, and colorectal cancer is one, Breast cancer is another. Non smoking lung cancer is another. And I'm so interested in all of these things. But I think one thing that I heard is something about screens. Now, the reason I mentioned this is and it was kind of just sort of mentioned, but I wondered what you knew about this, this idea of our constant use of screens that perhaps in and of itself isn't a factor. Maybe it is, but how it disrupts the circadian rhythms and kind of sleep, and how our interaction with technology and the impact it's having on our sleep cycles may be something that needs to be looked at.

00:32:00
Speaker 4: And I think this is cute and I think that this is fascinating because mechanistically this could be happening so many different ways.

00:32:07
Speaker 1: Right, so there are different conditions, and there are some.

00:32:11
Speaker 3: People who think it's actually the cell phone itself.

00:32:13
Speaker 2: In your right and some sort of brains right exactly discounted.

00:32:19
Speaker 3: So that theory was very popular for a while.

00:32:22
Speaker 4: Again, we have no evidence that a cell phone in your pocket is causing colorectal cancer, but people were.

00:32:27
Speaker 3: Looking into that.

00:32:28
Speaker 4: And then also, as Katie's mentioned, is it the light from the phone are using these devices that's throwing off our cir Katie and rhythm. We know that sleep patterns, the amount of sleep stress levels can be related to cancer risk. Because so that's a theory. And then also let's talk about physical inactivity. One of the strongest associated factors with colorectal cancer is physical inactivity. So the more exposure we have to screens and screen time, the more time that we're sending at home on.

00:32:57
Speaker 3: A screen very much. And who's on screens.

00:33:01
Speaker 4: It's the adolescence, it's the twenty year olds. These are the people who twenty years later are getting colorectal cancer.

00:33:07
Speaker 2: So there's really different mechanisms for your phone all the time.

00:33:11
Speaker 1: Right, Yes, so I'm taking all I know. Well, I mean I have to answer. I mean thinking about my teenage daughters, right, I'm thinking about all of our friends, you know hearing this. If someone's like listening to the three of us talk, I would be panicking right now. Yeah, because because a lot of the things that we're talking about to right, like the microbiome, which we're even struggling to you know, visualize, people are gonna be asking, oh my gosh, like what can I do about this? Or I'm already twenty you know, is my microbiome or my exposures already in place? And what's in my control? Do I have access to food that's not highly processed? So I mean, just to make it a little bit practical too, not only so people don't panic, but what should we be telling our young people and the people that love them?

00:33:51
Speaker 4: And this is I think what Katie was getting back to as well, is what else can we do beyond talking about screening and symptoms? And I think that they're right now. We're searching for those main pillars of advice that we can give to people. I do not want to set up alarms and I don't want people to be panic. And I think when you talk about cancer, unfortunately we have that impact. This is why people sometimes don't like me at their dinner.

00:34:12
Speaker 2: Dabs, but earth at their boards.

00:34:19
Speaker 3: Don't invite that one.

00:34:21
Speaker 4: But I think what I want to say is that we just have to think about things in moderation. Okay, So when you hear me talk about there is a risk between red meat and colorectal cancer, I'm not saying cut out all red meat. I'm saying, instead of having red meat every night of the week, maybe have it once a week.

00:34:39
Speaker 2: Okay.

00:34:40
Speaker 3: When I'm saying alcohol is one of these things.

00:34:43
Speaker 4: That's associated with all cancers, including colorectal cancer, I'm not saying that you need to be alcohol free in your life, but maybe think about reducing down to alcohol just on the weekends or once or twice a week. These are things that you can do to optimize your lifestyle without.

00:35:03
Speaker 1: Removing all the phones and those feel those feel actionable exact.

00:35:07
Speaker 2: I think there are a few other things though, I mean physical inactivity. Obviously exercising everyone needs to be on their phones less our mental health, certainly young people. If you read The Anxious Generation by Jonathan Height and what schools across the country are doing to have no phone school days. That's kind of something they can do. Also, I do think there are certain household products. Maybe we can get you a list, because one of the presenters at our scientific summit who works for runs this organization called Silent Springs.

00:35:44
Speaker 1: And she does, yes, yes, she does.

00:35:47
Speaker 2: She does a lot of early onset breast cancer. And she had a list of household products that you really should avoid.

00:35:54
Speaker 1: And that's education too.

00:35:55
Speaker 2: Yes, And I'm going to get her to write something up in our newsletter about that. I have actually assumed they are coming up. But also I do think there are ways that I don't think you can completely avoid microplastics, even full of, but I do think there are ways that you can try to reduce them. You know, there are certain things that you know, take out containers that you should try to avoid, you know, the heat things don't heats and plastic exactly. And I don't know what the bottom line is. There was so much controversy about like black spatulists, you know, and how they were made out of micro chants and how bad they were, and then the Atlantic said they're bad, and then they said they're not, but I yeah, they attracted it, right. But I do think if you can try to reduce the amount of sort of plastic in your in your world. And then again, you know what Fulla was saying, eat whole foods, eat foods that are.

00:36:53
Speaker 4: From the earth, like you don't minimize your ultra processed food. I mean, I'm guilty of it as well. My little protein a rite in the morning comes in a and I'm often thinking about what I can replace that with.

00:37:04
Speaker 3: Even if I can replace that half the days.

00:37:06
Speaker 2: What's really hard though, you know, like, God, it's hard to be healthy these days, you guys, because now I'm sixty nine, and of course I have osteopenia and I have to keep my bones strong. So all my friends and everybody's saying you got to eat protein. So I'm like, Okay, where do I give a protein from meat? And then I'm like, but I can't eat too much red meat, So where am I going to get? Eating rams? And some people say, like I should be having one hundred and twenty five grams of protein to day because I weigh one hundred and twenty five. I'm like, there's no way I'm going to be able to eat that much overwhelming.

00:37:39
Speaker 1: So what I'm hearing you both say, because you guys both have this gastro intestinal lens, is the advice, the advice that you're giving, that's all doctor Kirk or a doctor Kurk. What this advice that you're giving that does feel controllable and doable are the same things that we're thinking about in terms of your cardiovascular health, right, definitely keeping your heart healthy, right, other cancer vice factors. So the things that against feel doable at least a little bit in our control about our nutrition, our diet, our lifestyle, sleep screens, right, you know, all of those kind of hygiene. Those are things that feel very doable and very very helpful. Wall we're putting money in research, stand up to cancer into figuring this out.

00:38:18
Speaker 3: Absolutely.

00:38:19
Speaker 4: And that's what I try to remind people is that when we're saying, you know, make sure that you watch your diet, and when we reduce your alcohol, eliminate tobacco, try to eat healthy physical activity, it's not just for colorax.

00:38:32
Speaker 3: Good for you.

00:38:33
Speaker 4: This is going to be everything from your brain to your feet, as in your health from your cardiovascular preventing other cancers. So I think that these are things that we all need to be teaching our children and our adolescents and also adopting for ourselves and are going to be good for the full body, mind and soul.

00:38:50
Speaker 1: I mean, I know you've brought so much awareness and we really want to intend this to go into action, and then you're reminding me both it's the education, but even just the screening though. I mean, I think people delay again whether they have you know, they're like, I don't have any symptoms, but tell us like, screening makes a really big difference in how people do. So we're talking about genetic testing, but screening, screening for colon cancer.

00:39:16
Speaker 2: It is the difference between life and death.

00:39:18
Speaker 3: It's absolutely so.

00:39:19
Speaker 1: All those heartbreaking numbers, right, all those heartbroken families, right, this is going to make a dent in that if you get screened, not to mention your own life.

00:39:26
Speaker 4: Well, especially in a disease that's largely very symptomatic. Yes, screening can be everything. Screening can be the difference between life and death. Yes, And we're so fortunate and colorectal cancer that we have many ways to screen. So Katie did her colonoscopy on live TV.

00:39:42
Speaker 5: And two, I'm not that brekful of well, I should say they telecasted Katie's colonoscopy.

00:39:54
Speaker 3: In two thousand exactly where I mean, everyone probably thought you were a little crazy when you did it, but she saved lives. Because we call that the Katie Kirk Effects.

00:40:02
Speaker 4: That she did this on TV, national television, our rates of screening went up by twenty percent, the best intervention we've had.

00:40:11
Speaker 2: It was from such a pure place because you know, I had learned so much during the course of Jay's illness, and I knew that people didn't feel comfortable talking about state cancer. I knew that a lot of people couldn't even pronounce colonoscopy, much less get one. So I felt like it it would be criminal if I didn't share with this huge platform I had at the time, all that I had learned about this disease with an audience that you know, trusted me and knew that it was coming from a very personal place.

00:40:48
Speaker 4: Absolutely, and many people have done that since to try to spread awareness. But I think that was the beginning of that, and I love that because, especially at the time, colonoscopy was the main test we were using to screen.

00:41:01
Speaker 3: Now we have many different options.

00:41:02
Speaker 4: Not everybody can take a day off of work to get a colonoscopy. Not everyone has access to an escort, which is someone to take you to the procedure and home. Some people are fearful of having a procedure where you're put asleep and an instrument is put into your backside. So it's fortunate that we have other tests for people who fall into those categories and who want to be screened but don't think colonoscopy is for them, and that's when we can really recommend these stool based tests. One of them is called the fecal immuno chemical tests or the FIT test. One of my favorite screening tools because it's cheap, it's easy, you can do at home, and at home, you open the kit. You actually it tells you how to safely and cleanly collect a small sample.

00:41:44
Speaker 3: Of your stool from the toilet bowl.

00:41:46
Speaker 4: You package that up in a vial and you can actually mail that in or walk that into your doctor and we can test that for signs of cancer or signs of these polyps, these pre cancers.

00:41:56
Speaker 3: Such very cold guard is a little bit differ.

00:42:00
Speaker 4: What they've done is they've taken that fit test, which is actually looking for blood in the stool, which is a sign of cancer or polyps, and they've combined that with a genetic or DNA component. Okay, so coul guard is another great screening option. You can do it in the comfort of your own home, a little bit of a bigger stool sample that you've got a mail in, but in their factory they actually test that for signs of cancer. It's a little bit better at finding polyps, and it also is very good at finding cancers. So, whether you want to have the more invasive procedure of the colonoscopy or one of these do it yourself at home tests, there's many ways to give people access to screening.

00:42:36
Speaker 2: Now, and it weeds out the people who don't necessarily need to get a colonoscopy. But if there is a positive, yeah, that's true with false positives and false negatives, they have some, but they've really reduced that.

00:42:50
Speaker 4: Actually, I just saw someone influencer posts about this today on Instagram. She had a positive result and she was asking people, what's the likelihood that I have a cancer? What we tell people is that when you have a positive result, one in ten people with a positive result actually have a cancer. I don't say that to scare people, but it's really to emphasize that if you have that positive result, you need.

00:43:12
Speaker 3: To go in for the second step right, which have to follow Flan right.

00:43:16
Speaker 4: And a lot of my research in May Lab at UCLA focuses on that getting people in for that second step.

00:43:22
Speaker 3: In that case, the colonoscopy is actually imperative.

00:43:26
Speaker 4: So those people will need to get a colonoscopy and that's when we check them for polyps or cancers that may have made.

00:43:31
Speaker 3: The test positive.

00:43:33
Speaker 4: So that test, those stool based tests do become a bit of a two step process as compared to the colonoscopy, which is a one step process.

00:43:40
Speaker 2: But we always say the best test is the one that gets out.

00:43:44
Speaker 1: When you hear what Fulla is saying, I'm going to say, you know the current effect two point oh what's your plan?

00:43:50
Speaker 2: Like? I mean, I think we need much more research in understanding why young people are being affected by this disease and how scary it is. When you look at the numbers, they're really skyrocketing. We're not talking about a slight increase right, Pola, yep, and again then to me yeah, and then to me. The plan is doing everything we can that's within our power right now, obviously being aware of symptoms, talking to doctors, making sure patients are keenly aware that if something's off they need to pursue it, and with their doctors. But in the meantime or long term, I want there to be a test that is more accessible, less expensive, and that can be given to people, you know, starting at age eighteen. Maybe I'm crazy about this, but I had coffee with a really wonderful oncology fellow at MONTOFIORI is it a story right? Anyway, she's so nice, she's thirty five, she's really pretty, and she'd like a boyfriend of if anyone knows anybody in New York. I love her. She's so great. But listen, we met for coffee because I'm a little bit of a eni. I'm a good matchmaker personally, that's one of my many unknown skills. But anyway, we met for coffee and she said that that past week she had to tell a twenty one year old boy no family history, yep, no lynch syndrome, no familial polyposis, no, nothing that he had stage four calling cancer and until we say, oh, sorry, poor guy. I mean, my goal and I have nothing to do with it, but I'll support it in any way I can is to come up with a better screening tool that's accessible to younger people. And that's why I'm excited. And I don't know full of how you feel. And I'm opening up another can worms here about liquid biopsies and blood tests that can you know that are really in their nascent period of development, but they're starting. That can be done when you just get your yearly physical and if they're cancer selves in that blood, you can say, hey, we need to look into this. But that's about all I know. That's the extent of my expertise. But what about better new screening techniques that aren't as costly or invasive that can be utilized by the whole population.

00:46:33
Speaker 1: During a physical annual physical.

00:46:34
Speaker 2: Yeah, because I know the risk reward and all that stuff that public health advocates think about, like they can't screen everyone. But I just am so upset when I hear about a thirty two year old man who has stage four coling cancer. Another girl I saw on Instagram who's like in her twenties, This twenty one year old I told you about.

00:46:54
Speaker 1: It's like that is unacceptable to me, that these young people are the face of going cancer is just yeah, I mean we use you know, we are often being contacted now by pediatric offices, you know, trying to seek advice on how to treat colorectal cancer.

00:47:09
Speaker 4: And that was something that they never had to reach out to us about that before. So this is a phenomena that is affecting people very young ages. There's a lot that we have to learn. I do think that the path forward does involve answering this question as to the why. We need research dollars to do that. We need to fund the best teams of scientists, not only in this country but globally because to answer this question, I honestly think you need the science from Australia, from the UK, from Asia, from Africa where we're starting to see these trends as well, to put these pieces together. And then I think the other priority, in addition to understanding the why is what do we do in the meantime? And I think that's what Katie is getting too. Yes, we now have these blood based tests, how can we effectively incorporate things like the blood based tests for coorectal cancer into normal practice safely in a way that we can follow up these patients in a reasonable manner. How do we decide which populations need to be tested in a with age and those are all areas of research that also need to be prioritized.

00:48:15
Speaker 2: And I also know that what prevention, obviously early detection is so critical. But I do worry. I mean, I think we have to put an emphasis on finding these cancers early, and colon cancer certainly when it's when it's treatable and curable. And that's one of our goals for Stand Up to Cancer, because you can really reduce the number of cases.

00:48:37
Speaker 1: But but.

00:48:40
Speaker 2: I think about these people like my husband who are diagnosed with stage four coal directal cancer, and I think about the fact that the treatment has really not changed much since the fifties, where it's five of you and Luca born right is the kind of go to treatment. And they've come up with some others like I guess, uh, campus are I don't even know fort cancer. We've had some rectal cancer doctor Diaz at Memorial for a subset of people with rectal cancer. I mean just phenomenal results. But it pains me and breaks my heart when I think that we can't also, at the same time come up with better treatments for people who have advanced disease. You know, people like James Vanderbeek who had Stage three and you would think that that would have been potentially curable because he had systemic disease, but it hadn't metastasized, right, But he wasn't responsive clearly to the treatment, To people like my husband, to people like that twenty one year old boy, that I the idea that there is very little that can be done for people with advanced col of rectal cancer. That is unacceptable to me too. Me know, therapeutic approaches haven't borne much fruit in colorectal cancer, but we have to keep coming up with better treatments while we also encourage early detection because I don't want to forget about the people who are dealing with stage four Collings.

00:50:17
Speaker 1: That's right, It's not one or the other.

00:50:18
Speaker 3: Absolutely.

00:50:20
Speaker 1: I guess we do have to wrap up, but I would very quick takeaway, if you don't mind. It's really hard for me to end this conversation. I would it's I can see she's.

00:50:28
Speaker 3: The best, I mean, but for years.

00:50:30
Speaker 1: But I honestly with you, the scream.

00:50:37
Speaker 2: You're doing, I have nothing to talk about it.

00:50:39
Speaker 1: And we're talking about this coupling of again, like you two are the dream team, right, I mean, on the larger level, it's stand up to cancer, it's the main lab. But together you're the dream team. I mean, I just I can't thank you enough for coming. I think this conversation truly changes lives, you know, the I hope back two point zero three point zero. I mean, I can't thank you enough. And I do really feel that, you know, if anyone is listening, I think if we moved anyone even you know, even while we're trying to figure out the ideology, the cause, the why, better treatments, I think if we got one person to say, I'm moving from I should do this too. I did schedule. I think that's the impact that we're looking for. And the two of you are so brilliant and compassionate and just your advocacy is just so inspiring. I can't thank you enough for coming on.

00:51:23
Speaker 4: Well, thank you, thank you for championing this topic and for talking about it, because again, stigma has been a problem for our community.

00:51:30
Speaker 3: So we're just so grateful to be here and to share what we can.

00:51:33
Speaker 2: And if you're forty five get screamed, just call your doctor. What are you waiting for? Call your doctor. It's not that big a deal.

00:51:42
Speaker 4: There are many options, many options, and a lot of people complain about the press for colonoscopy.

00:51:49
Speaker 1: The prep.

00:51:50
Speaker 3: Actually the press pretty amazing. It's like a felin.

00:51:53
Speaker 2: It's it's like it's like a colonic But I mean.

00:51:56
Speaker 3: The prep is not a lot of fun free clins.

00:52:00
Speaker 2: But I always say it's so much better than being diagnosed with calling cancer.

00:52:07
Speaker 4: And also that freedom you walk out with after the procedure, knowing that you don't have cancers or polyps growing in your colin that's powerful.

00:52:15
Speaker 2: And also you do it for people you love that's correct.

00:52:18
Speaker 1: And even the reassurance since we both have three polyps because we're twins, that that someone's monitoring me right, And I feel so lucky. And I think that's why this conversation about equating access is so important. I don't think that it can be a we can't have it be a privilege right to be screened.

00:52:35
Speaker 4: You know.

00:52:36
Speaker 2: That FOLA is doing to educate everyone, people in rural communities, you know, people of color, people all over the country. It should be a right, not a privilege. And we've that that is such an important message too, right.

00:52:54
Speaker 1: And clearly and clearly forty five is the new fifty.

00:52:57
Speaker 3: Absolutely is the new sixty.

00:53:03
Speaker 2: I don't know.

00:53:06
Speaker 3: You guys are you guys are the best.

00:53:07
Speaker 1: I can't thank you enough. Thank you so much, and many more, many more conversations.

00:53:11
Speaker 2: Yeah, its is so fun, and thank you for doing this podcast because you're doing a real public service bringing I think medical information, valid science backed medical information, which is so critically important right now in our current environment. And so thank you for doing what you're doing.

00:53:31
Speaker 1: Thank you so much.

00:53:33
Speaker 2: It's a love fest.

00:53:33
Speaker 1: It is I guess science. It's so sexy.