CredentialsPositions
Board Certifications
Education and Training
- Robert M. and Mary H. Glickman Professor of Medicine, Department of Medicine at NYU Grossman School of Medicine
- Professor, Department of Population Health at NYU Grossman School of Medicine
- Co-Director, Translational Research Education and Careers (TREC)
- Director, Outcomes Research, Division of Gastroenterology and Hepatology
Board Certifications
- American Board of Internal Medicine (Gastroenterology), 2006
Education and Training
- Fellowship, Emory University School of Medicine, Gastroenterology, 2006
- Fellowship, Emory University, Gastroenterology, 2006
- Residency, University at Buffalo School of Medicine, 2003
- Residency, University at Buffalo State University of New York, 2003
- MPH from Johns Hopkins University, 2000
- MD from Aga Khan University, 1998
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Kats's Corner with doctor Aaron Katz,
your trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven to ten WOOR. It'sthe Chairman of Urology at NYU Land Gone
Hospital, Long Island. Here isdoctor Aaron Katz. Well, good morning
everyone, and welcome again to CATS'sCorner here on wr iHeartRadio. So glad
(00:43):
you could join us this morning.We have a very interesting show for you
and March is Colorectal Cancer Awareness Monthand does put the spotlight on this very
common form of cancer that affects bothmen and women. And we're going to
have a very nice discussion this morning. With the first time are here on
(01:04):
Katsus Corner, I've invited a realexpert at NYU doctor Asthma. Shakatt Asthma
is a professor in the Department ofMedicine UH and also a professor in the
Department of Population Health at the NYUGrossman's School of Medicine. And she has
(01:26):
an expertise in the area of coalerectal cancer and its implications on population health.
And I thought that since March wasthe awareness month, that we should
have a wonderful expert here on Kats'scorner. Thank you so much, Ozma
for joining us this morning. Reallyappreciate that for you coming on, thank
you, thank you so much forhaving me. I'm very excited. Yeah,
(01:48):
it's our pleasure. And you knowbefore the show, you were telling
me about some of the statistics theepidemiology of how much how common colon cancer
is in the United States. Maybeyou can tell our audience about that.
So March's colon Cancer Awareness month,and colon cancer is a big deal.
It's a common cancer and it's alethal cancer. It's the third most common
(02:12):
cancer in both men and women inthe US, and it's the second leading
cause of cancer related death in theUS. Ten percent of all cancer debts
are from colorectal cancer. And thereason, you know those figures are alarming
is because colon cancer is we feellargely preventable and treatable. So our goal
(02:34):
is to reduce the burden of thisdisease by early detection and even prevention.
And maybe you can tell us aboutthe people that obviously age is a major
risk factor for both men and women, but beyond just you know, age
of maybe over fifty and maybe maybewe are seeing younger people, which we'll
talk about, But beyond age,are there what are some of the other
(02:58):
risk factors for call cancer? Yes, as you pointed out, age is
the largest risk factor, and therisk of colon cancer goes up with age.
In general, every US adult whoseaverage risk has about a four and
a half to five percent lifetime riskof developing colon cancer. But you know,
we are seeing colon cancer in youngerand younger individuals, and that's another
(03:21):
alarming trend that we are trying tounderstand and hopefully to curb. So scholon
cancer is increasingly diagnosed in people youngerthan age fifty, and traditionally we didn't
use to screen people younger than fifty, and hence, in the last few
years we've all changed our guidelines tostart screening at age forty five for average
(03:42):
risk men and women. So youknow, in younger individuals, any symptoms
such as rectorld leading an emia needto be taken very seriously and evaluated,
perhaps with a colonoscop In general,other risk factors besides it are being male,
having a high BMI or individuals thathave obesity have an increased risk,
(04:02):
and then a diet that's high inred meat also have been linked with colon
cancer, and cigarette smoking is oneof the biggest risk factors. So some
of those, as we know,are not modifiable, but a lot of
them are so. In particular cigarettesmoking. Reducing weight and keeping a healthy
(04:24):
BMI and also getting screened at theappropriate age is extremely important. Yeah,
I didn't know about smoking, actually, I mean, certainly it makes sense
diet and weight or it would berisk factors for colon cancer. The things
that we incorporate into our diet everyday, they're going through our intestinal track
(04:46):
and winding up in the colon andif there's carcinogens there. But I wasn't
aware of the smoking. I guesssmoking gets into your lungs and into your
bloodstream and all those toxins I guesscan wind up in the colon as well.
Are there any what are your thoughts? Absolutely so the colon is one
of the largest organs in our body. After skin, our GI tract has
(05:08):
the largest surface area. And inthe colon, the cells are also very
rapidly dividing, so you know,we estimate that the entire colon sheds it's
lining almost every five to seven days, so there is really high rapid cell
turnover, so carcinogens that are inthe bloodstream over triggered due to inflammation.
(05:30):
We think also the gut microbiome hasa role in this cascade, so they
can very easily produce some of thesemutations or early changes that can get perpetuated
very quickly because these cells are sorapidly dividing, so there's a lot of
chance for error, and some ofthem, those you know, neoplastic or
dysplastic cells can grow over time,fortunately slow growing, but still you know
(05:58):
the fact that there's such an archlining and so much potential for sales to
go somewhat abnormal is what's alarming,and that's thought to be implicated with both
diet, smoking, and other environmentalrisk factors. And you mentioned that the
earlier age of onset that you're seeing, and I know that you deal with
(06:18):
lots of different populations of patients andor you go to the VA, you
work in Brooklyn, you work inManhattan, and seeing a lot of patients,
what do you think is going onthere? Was it always there that
in younger patients and we just weren'tscreening, or is there something new going
on in the environment or other toxinsthat may be causing colon cancer to develop
(06:40):
in younger people. Yeah, that'sa very important and somewhat unanswered question.
So it really is a new trend. These aren't just cancers that just happen
to be there, and because nowwe're doing more colonoscopy or looking more acutely,
we're picking them up now. Sothat does not seem to be the
case. There actually seems to bean increased number of these cancers. Not
(07:03):
only that these cancers seem to beappearing in younger people at advanced stages,
which also means that you know,they're not just indolent cancer that if we
had screened at fifty or sixty wewould have still found. So, you
know, that's an important area thatwe need to understand better the risk factors.
So far, again, we don'tknow exactly what's causing this change,
(07:26):
but it seems it's almost a birthcohert effect, So individuals born after nineteen
seventy and later seemed to carry thisincreased lifetime risk of developing colon cancer compared
to coherts that were before that betweenthe nineteen forties and nineteen sixties. And
some of the prevalent theories at themoment are again the obesity epidemic, because
(07:49):
right around when obesity started becoming increasinglyhigh in adolescence is kind of this age
group that's now grown are now thirties, in their thirties and forties, so
obesity, metabolic syndrome, early onsetdiabetes are all implicated as well as gut
dis biosies due to a lot ofantibiotics. Use I mean, this is
(08:11):
a generation that also got a lotof antibiotics. As you remember, we
used to be very liberal with antibioticsor just about anything. So the idea
is perhaps that early exposure to antibioticskind of triggered a dys biosis that changed
the microbiome and over time proliferated thisinflammatory senotype in the colon that led to
(08:35):
some dysplastic changes. And then theother factors are kind of being worked on
at the moment. Clearly there's environmentalfactors, there's more environmental pollution, and
also diets have gotten poorer, sothose kind of go hand in hand with
this epidemic. Some of those thingsare obviously difficult and out of our hands,
(08:58):
and you know, viruses and certainthose things can all play a role.
So now that you're seeing younger peoplewith it, you mentioned earlier that
you've changed your recommendation for screening,and I want to get into screening,
and of course many people dread thecolonoscopy. So let's just first talk what
are the current guidelines for screening?When should When should people get screened for
(09:20):
colon cancer? So the guidelines usedto be starting at age fifteen average risk
men and women, and by averagerisk we mean individuals that have no current
symptoms and have no significant family historyof colon cancer or related cancers. However,
you know, seeing this worrisome trendpretty much since about twenty fifteen.
(09:43):
Over the last ten years or so, we have now changed our guidelines and
every society, including the US PreventedServices Task Force, which is the guideline
that Medicare follows, have all changedtheir guidelines and dropped the screening age to
start at forty five. So whatthat means is now mediicare as well as
(10:07):
all commercial payers cover screening starting atage forty five. So that's one of
the things that has changed in orderto try to pick up these cancers early
and prevent them from either becoming moreadvanced age or growing larger. So that's
one of the changes in the guidelinethat's occurred. However, if an individual
(10:31):
has a family history, which meansa first degree relative such as a mom
or a dad that was diagnosed withcolon cancer or uterine ovarian cancers in women,
then screening should start at age fortyso even younger because those individuals are
considered at somewhat increased risk and whichseems higher than the average risk. So
(10:56):
knowing your family history is really important. And then you know, asking your
clinician or provider what is my screeningage and when should I think about arranging
a screening test is extremely important.Yeah, and those are thank you very
(11:18):
much for that. So it's nowforty five years old for the average risk,
but if you're a higher risk,you're going to go down to forty.
So you know at NYU are westill I assume that the kolonoscopy is
still the gold standard in your practiceat NYU. Is that true? Is
(11:39):
there anything new with the kolonoscopy andare there maybe any other other tests that
people can do instead of the colonoscopyor is it still the kolonoscopy that people
should do. Yeah, so klunoscopyis in the guideline recommendations and it's the
most common test in the US that'sdone for screening. Allows for not only
(12:03):
ability to detect early stage cancers,but also look at all these precursor legions,
these polyps and we call them adenomasthat can grow larger over time before
they can turn into anything worrisome,so we can detect it and remove it.
So it's a one stop for detectionand prevention. And then if a
(12:24):
colonoscopy is normal, we can actuallyconfidently give people a ten year pass.
That's how durable we think the colonoscopybenefit is. Our technology has rapidly improved.
We at NYU have been doing someof these studies using some new computer
(12:45):
assisted detection tools as well as betterpreps to improve our yield at colonoscopy,
so we can be even more confidentthat we've gotten a good look at everything
and have missed any worrisome visions.But there are other options. Not everybody
wants to opt for a colonoscopy,even if you know we recommend it.
(13:07):
So we offer a colonoscopy first.But there's tool tests now available, and
there's either a fit test or acolo guard test. They are both tool
tests that patients can do in thecomfort of their own home and mail the
specimen in. Again, they're bothcovered, and if the test is negative,
(13:28):
then they're good for one year orup to three years in case of
cologuard. And if that test isabnormal, suggesting there's some microscopic blood or
other markers in the stools that needinvestigations, then we schedule them for a
colonoscopy. So I like to tellpatients to think about it as a one
step test such as a colonoscopy,or you know these two step tests,
(13:50):
which is doing a tool test firstand if that's positive, then doing the
colonoscopy. But all the roads leadto a colonoscopy down the line. And
as a matter of you know whatpeople are comfortable with now if you do,
and by the way, if you'rejust waking up in the morning.
We're talking with doctor Asthma Shakatt,who is professor in the Department of Medicine
in the NYU Land Going System.She also is a professor in public health
(14:13):
and an expert in colorectal cancer screeningand detection diagnosis. If you'd like to
make an appointment with her, I'mgoing to give you the number and I'll
announce it again at the end ofthe show. It's two one two two
six three three zero nine five.It's two one two two six three three
zero nine five. So let's saythat you decide, you know what,
(14:35):
I don't want to do the colonoscopy. I don't want to do the PRAP
and I want to miss a dayof work for whatever reason. And you
do the stool test to call aguard let's say, or another stool test,
and it comes back negative. Well, if it comes back positive,
obviously you're going to need a colonoscopy. But if it comes back negative,
how reliable is that negative? Howhow can you know? Can people just
rest assured, Okay, I'm good, I don't have to do this for
(14:58):
another I guess you said year orso. Is there a false negative rate?
With those stool tests, yes,absolutely. So with these tool tests,
you know their sensitivity is getting prettygood, but it's not one hundred
percent. And sensitivity for a onetime FIT is seventy four percent. For
cologuard it's about ninety percent. Butagain, none of these tests are one
(15:22):
hundred percent, and that's sensitivity forcolon cancer. For advanced tereinomas, these
kind of precursor lesions, the sensitivityis much lower, and that's why these
tests need to be done more frequentlyevery year in case of FIT, and
every three years in case of cologuard. So really the most sensitive and specific
(15:46):
test is a colonoscopy, and thecholonoscopy also is highly effective, but it's
operator dependent. So some of theother work that we do is understanding how
to make cholonoscopy as effective as possible, and it requires high magnification klonoscope,
an endoscopist that has a good trackrecord of finding these prepersillusions called aeronomas,
(16:07):
And we make sure that we holdourselves accountable to certain metrics that make us
high quality endoscopists so that we canbe assured that the exam we do is
the best possible and it confers thebenefit for our patients that we like to
believe is up to ten years andmaybe even longer. So I think those
(16:30):
are really important factors and something thatwe always discussed with the patients that again,
these tool tests are not one hundredpercent, and certainly for advanced atonomas
there's sensitively much more. Yeah,but what I'm also hearing is is that
in the right hand, if it'snot done in the right if it's not
done the kolonoscopy in the proper hands, that the sensitivity there is not one
(16:51):
hundred percent either, that it couldmiss something as well. So you really
need to be done in expert handslike yourself and someone like yourself in your
team. At NYU. The anesthesiais still the same. You have to
be sedated for the colonosco by ISOO. You have to be out for that.
You're not you're not going to beawake for that right and circumstances will
(17:15):
do it awake, but it's notvery comfortable. So to make patients comfortable,
they get sedation, and we currentlyuse what's considered deep sedation, so
it's called MAC or monitored anesthesia,and it's essentially group of falts. So
people are in deep sleep during theprocedure and they don't remember anything and they
(17:37):
don't feel anything. Yeah. No, I had mine about two years ago
and I had the best sleep I'vehad in years, to tell you the
truth, and I don't remember itat all. Yeah. The prep,
Yeah, the prep was a littleyou know, I mean, I guess
I had to take off maybe ahalf a day or something like that.
But at the end of the day, just to have that peace of mind,
knowing that you know you're good foranother ten years, I think is
(18:00):
really worth it. And as yousaid, if you have a poll up,
which I want to talk to youabout, if you do the colonoscopy,
do you tell people who are onblood thinners that they should stay off
the blood tinners just in case theyneed a biopsy or they can still take
the blood thinners. Absolutely, Soit depends what the blood tinner is.
Afrin is no longer a risk factor, so they can continue the aspirin.
(18:22):
In fact, we want them tocontinue the aspirins, especially if it's for
heart disease or other reasons, butfor other antithrombotics. So for instance,
is taking warfrin or one of thesewhat are considered duex these newer oral antiquagulans.
Then we have protocols of when theyshould stop their last dose, and
(18:45):
then we can resume it after thecolonoscopy, and certainly with plavix in most
instances, we do want to holdit so that if you find a polyp
you can confidently remove it and notworry about risk of competing. And if
you don't find polyps, then wouldmake recommendations to better resume the antithrombodic pretty
(19:08):
much right away, right after theprocedure. So it's basically again just the
review. It's the colonoscopy, it'sthe stool test. I do remember a
couple of years ago there was acamera test. Is that in vogue?
Is that out now? Where peoplewould swallow a camera? Is that no
longer used? There was a cameratest called and it is approved in patients
(19:30):
unwilling or unable to undergo the othertests. It's largely fallen out of use
because again the sensitivity is pretty lowand the concern about a false negative is
pretty high, so it's fallen prettymuch out of out of use. There
is a new exciting class of teststhat's coming up, which is potentially a
(19:55):
blood test to look to screen forcolon Well, that's exciting. That would
be great. Where are we?How far away from that? Great a
year? So we're a year awayfrom that, within a year from a
blood based test. There is onetest that's completed its trial and is in
(20:15):
front of the FDA for considerations andafter FT eight would need Medicare approval,
and another test that's expected to releaseits results in the next two months.
And then there's three or four othercompanies with similar promising tests that are kind
(20:36):
of in different stages of completing theirstudies. I think that's awesome. I
agree of screening tests, that's amazing. Can you tell us the name of
the test? I'm sure people arelistening on like they're going to start googling
blood tests for colon cancer, butyou know they're going to come up with
probably the CEA test, which isthe test that we use for monitoring colon
cancer. But what are I forscreening? Is there is there a name
(20:56):
for it yet or not yet?Yeah, it's a test by aany called
Garden. It's called the Shield test. It's not approved yet, it's in
front of the I say, okay, but something people can keep on their
radar. Yeah. Absolutely, andwe did the principal investigator for the prenome
(21:17):
study. So again, you know, we're really looking forward to seeing results
and the study. We designed itto be able to be generalizable so that
we can have confidence and the resultsthat we find. So we're excited to
see what we find. Well,congratulations on that, and congratulations on your
(21:37):
research and bringing it to the forefront. I mean, I think that would
be a huge and maybe not notfor everyone. No test it is,
and maybe for higher risk people youstill need the colonoscopy, but then if
you get a negative one, maybeyou can just go with the blood test
or something like that. I thinkthat would really be a great improvement.
We just have a Yeah, wejust have a few minutes las I we
(22:00):
kind of glossed over just concerning arethere any concerning signs or symptoms that people
should be aware of they shouldn't waiton, you know, can you just
give us a little snapshot of that? Absolutely, so record bleeding is the
is the one thing that we usedto and even now quite often ignore,
saying it's him, or is thereit's something else, or nobody really wants
(22:22):
to talk about it or get itinvestigated. So record bleeding should really be
evaluated. Talk to your clinician,your provider about what it might be and
your other risk factors. And anemiaunexplored, changing vowel habits or you know,
changing some which has unprompted things thatyou know suddenly seem to have shifted
(22:48):
or a new patron is definitely worthinvestigating. Yeah, maybe some abdominal pains
and bloating things like that could alsobe a sign. Perhaps, And then
yeah, and a saying Poland cancersare asymptomatic, So it's really important to
think about prevention. Meaning I don'thave any symptoms, I don't need to
(23:08):
worry about it. It doesn't applyto me that we really need to change
that into have I been screened ifI'm over forty five or above forty,
if I have a family history,and that should really be something that you
know, every primary care visits weshould be focusing on. Yeah, and
perhaps even people that are smoking.What about people that were down at the
(23:33):
World Trade Center. I certainly seea lot of prostate cancer patients. Is
that one of the risk factors forcolon or not? Yeah, it is.
There's higher polan cancer in firefighters andthere's still ongoing studies about after the
Worldforce Center the different cancers that youknow, first responders were diagnosed with.
(23:55):
But the idea is, you know, there were a lot of carcinogens that
increased risk of many cancers. Coolit is definitely one of them for sure.
So if you were down there theWorld Trade Center and you were in
near early twenties or even thirties,and you know you haven't been screened,
absolutely get screened. I'm going togive doctor Asthma show cuts one last phone
number here if you haven't you didn'twrite it down. If you want to
(24:18):
make an appointment, it's two onetwo two six three three zero nine five
two one two two sixty three threezero nine five in the last minute,
Asthma, any final thoughts about preventionany ways that we can potentially reduce our
risk of calling cancer. Get ahealthy diet, healthy weight, reduce red
meats and you know smoking cessation,and ask about your family history and encourage
(24:45):
your family members to undergo screening.Yeah, that's great advice. And also
not only for colon cancer, butas you mentioned, uterine ovarian perhaps breast
cancer or other cancers that are runningin the family h that this could be
an inheritable genetic thing. Well,you are a terrific guest and giving us
lots of information about screening and detection. We didn't get into treatment. We'll
(25:10):
get into that at another time,but certainly this is very important and you
did mention at the top of theshow how it is occurring. It is
a very common cancer in both menand women and younger men and women,
and so we really need to bevery aware of this condition. Azma,
thank you so much again. Hernumber is two one two, two six
three three zero ninety five, oryou can always check her out or any
(25:33):
of my guests out at the NYULand Going website. Azma, thank you
so much. I really wish youa pleasant day and I appreciate you and
we'll have you coming back on theshow. Thank you so much for having
me. Yes, it was mygreat pleasure. Well that's the end of
the show. Everyonet hope you havea wonderful day. Tune in every Sunday
here on Katz's Corner. We'll beback next week with a great show.
This is doctor Aaron Katz. You'vebeen listening to Katz's Corner. Come back
(25:56):
every week to hear more straight talkon a whi range of men's health topics
and advice on how to live yourhealthiest life. The proceeding was a paid
podcast. iHeartRadio's hosting of this podcastconstitutes neither an endorsement of the products offered
or the ideas expressed.
The following is a paid podcast.iHeartRadio's hosting of this podcast constitutes neither an
endorsement of the products offered or theideas expressed. The following program is brought
to you by NYU Land Going Health. It's Kats's Corner with doctor Aaron Katz,
your trusted expert in men's health,providing straight talk on a wide range
(00:21):
of men's health topics and advice onhow to live your healthiest life. Now
on seven to ten WOOR. It'sthe Chairman of Urology at NYU Land Gone
Hospital, Long Island. Here isdoctor Aaron Katz. Well, good morning
everyone, and welcome again to CATS'sCorner here on wr iHeartRadio. So glad
(00:43):
you could join us this morning.We have a very interesting show for you
and March is Colorectal Cancer Awareness Monthand does put the spotlight on this very
common form of cancer that affects bothmen and women. And we're going to
have a very nice discussion this morning. With the first time are here on
(01:04):
Katsus Corner, I've invited a realexpert at NYU doctor Asthma. Shakatt Asthma
is a professor in the Department ofMedicine UH and also a professor in the
Department of Population Health at the NYUGrossman's School of Medicine. And she has
(01:26):
an expertise in the area of coalerectal cancer and its implications on population health.
And I thought that since March wasthe awareness month, that we should
have a wonderful expert here on Kats'scorner. Thank you so much, Ozma
for joining us this morning. Reallyappreciate that for you coming on, thank
you, thank you so much forhaving me. I'm very excited. Yeah,
(01:48):
it's our pleasure. And you knowbefore the show, you were telling
me about some of the statistics theepidemiology of how much how common colon cancer
is in the United States. Maybeyou can tell our audience about that.
So March's colon Cancer Awareness month,and colon cancer is a big deal.
It's a common cancer and it's alethal cancer. It's the third most common
(02:12):
cancer in both men and women inthe US, and it's the second leading
cause of cancer related death in theUS. Ten percent of all cancer debts
are from colorectal cancer. And thereason, you know those figures are alarming
is because colon cancer is we feellargely preventable and treatable. So our goal
(02:34):
is to reduce the burden of thisdisease by early detection and even prevention.
And maybe you can tell us aboutthe people that obviously age is a major
risk factor for both men and women, but beyond just you know, age
of maybe over fifty and maybe maybewe are seeing younger people, which we'll
talk about, But beyond age,are there what are some of the other
(02:58):
risk factors for call cancer? Yes, as you pointed out, age is
the largest risk factor, and therisk of colon cancer goes up with age.
In general, every US adult whoseaverage risk has about a four and
a half to five percent lifetime riskof developing colon cancer. But you know,
we are seeing colon cancer in youngerand younger individuals, and that's another
(03:21):
alarming trend that we are trying tounderstand and hopefully to curb. So scholon
cancer is increasingly diagnosed in people youngerthan age fifty, and traditionally we didn't
use to screen people younger than fifty, and hence, in the last few
years we've all changed our guidelines tostart screening at age forty five for average
(03:42):
risk men and women. So youknow, in younger individuals, any symptoms
such as rectorld leading an emia needto be taken very seriously and evaluated,
perhaps with a colonoscop In general,other risk factors besides it are being male,
having a high BMI or individuals thathave obesity have an increased risk,
(04:02):
and then a diet that's high inred meat also have been linked with colon
cancer, and cigarette smoking is oneof the biggest risk factors. So some
of those, as we know,are not modifiable, but a lot of
them are so. In particular cigarettesmoking. Reducing weight and keeping a healthy
(04:24):
BMI and also getting screened at theappropriate age is extremely important. Yeah,
I didn't know about smoking, actually, I mean, certainly it makes sense
diet and weight or it would berisk factors for colon cancer. The things
that we incorporate into our diet everyday, they're going through our intestinal track
(04:46):
and winding up in the colon andif there's carcinogens there. But I wasn't
aware of the smoking. I guesssmoking gets into your lungs and into your
bloodstream and all those toxins I guesscan wind up in the colon as well.
Are there any what are your thoughts? Absolutely so the colon is one
of the largest organs in our body. After skin, our GI tract has
(05:08):
the largest surface area. And inthe colon, the cells are also very
rapidly dividing, so you know,we estimate that the entire colon sheds it's
lining almost every five to seven days, so there is really high rapid cell
turnover, so carcinogens that are inthe bloodstream over triggered due to inflammation.
(05:30):
We think also the gut microbiome hasa role in this cascade, so they
can very easily produce some of thesemutations or early changes that can get perpetuated
very quickly because these cells are sorapidly dividing, so there's a lot of
chance for error, and some ofthem, those you know, neoplastic or
dysplastic cells can grow over time,fortunately slow growing, but still you know
(05:58):
the fact that there's such an archlining and so much potential for sales to
go somewhat abnormal is what's alarming,and that's thought to be implicated with both
diet, smoking, and other environmentalrisk factors. And you mentioned that the
earlier age of onset that you're seeing, and I know that you deal with
(06:18):
lots of different populations of patients andor you go to the VA, you
work in Brooklyn, you work inManhattan, and seeing a lot of patients,
what do you think is going onthere? Was it always there that
in younger patients and we just weren'tscreening, or is there something new going
on in the environment or other toxinsthat may be causing colon cancer to develop
(06:40):
in younger people. Yeah, that'sa very important and somewhat unanswered question.
So it really is a new trend. These aren't just cancers that just happen
to be there, and because nowwe're doing more colonoscopy or looking more acutely,
we're picking them up now. Sothat does not seem to be the
case. There actually seems to bean increased number of these cancers. Not
(07:03):
only that these cancers seem to beappearing in younger people at advanced stages,
which also means that you know,they're not just indolent cancer that if we
had screened at fifty or sixty wewould have still found. So, you
know, that's an important area thatwe need to understand better the risk factors.
So far, again, we don'tknow exactly what's causing this change,
(07:26):
but it seems it's almost a birthcohert effect, So individuals born after nineteen
seventy and later seemed to carry thisincreased lifetime risk of developing colon cancer compared
to coherts that were before that betweenthe nineteen forties and nineteen sixties. And
some of the prevalent theories at themoment are again the obesity epidemic, because
(07:49):
right around when obesity started becoming increasinglyhigh in adolescence is kind of this age
group that's now grown are now thirties, in their thirties and forties, so
obesity, metabolic syndrome, early onsetdiabetes are all implicated as well as gut
dis biosies due to a lot ofantibiotics. Use I mean, this is
(08:11):
a generation that also got a lotof antibiotics. As you remember, we
used to be very liberal with antibioticsor just about anything. So the idea
is perhaps that early exposure to antibioticskind of triggered a dys biosis that changed
the microbiome and over time proliferated thisinflammatory senotype in the colon that led to
(08:35):
some dysplastic changes. And then theother factors are kind of being worked on
at the moment. Clearly there's environmentalfactors, there's more environmental pollution, and
also diets have gotten poorer, sothose kind of go hand in hand with
this epidemic. Some of those thingsare obviously difficult and out of our hands,
(08:58):
and you know, viruses and certainthose things can all play a role.
So now that you're seeing younger peoplewith it, you mentioned earlier that
you've changed your recommendation for screening,and I want to get into screening,
and of course many people dread thecolonoscopy. So let's just first talk what
are the current guidelines for screening?When should When should people get screened for
(09:20):
colon cancer? So the guidelines usedto be starting at age fifteen average risk
men and women, and by averagerisk we mean individuals that have no current
symptoms and have no significant family historyof colon cancer or related cancers. However,
you know, seeing this worrisome trendpretty much since about twenty fifteen.
(09:43):
Over the last ten years or so, we have now changed our guidelines and
every society, including the US PreventedServices Task Force, which is the guideline
that Medicare follows, have all changedtheir guidelines and dropped the screening age to
start at forty five. So whatthat means is now mediicare as well as
(10:07):
all commercial payers cover screening starting atage forty five. So that's one of
the things that has changed in orderto try to pick up these cancers early
and prevent them from either becoming moreadvanced age or growing larger. So that's
one of the changes in the guidelinethat's occurred. However, if an individual
(10:31):
has a family history, which meansa first degree relative such as a mom
or a dad that was diagnosed withcolon cancer or uterine ovarian cancers in women,
then screening should start at age fortyso even younger because those individuals are
considered at somewhat increased risk and whichseems higher than the average risk. So
(10:56):
knowing your family history is really important. And then you know, asking your
clinician or provider what is my screeningage and when should I think about arranging
a screening test is extremely important.Yeah, and those are thank you very
(11:18):
much for that. So it's nowforty five years old for the average risk,
but if you're a higher risk,you're going to go down to forty.
So you know at NYU are westill I assume that the kolonoscopy is
still the gold standard in your practiceat NYU. Is that true? Is
(11:39):
there anything new with the kolonoscopy andare there maybe any other other tests that
people can do instead of the colonoscopyor is it still the kolonoscopy that people
should do. Yeah, so klunoscopyis in the guideline recommendations and it's the
most common test in the US that'sdone for screening. Allows for not only
(12:03):
ability to detect early stage cancers,but also look at all these precursor legions,
these polyps and we call them adenomasthat can grow larger over time before
they can turn into anything worrisome,so we can detect it and remove it.
So it's a one stop for detectionand prevention. And then if a
(12:24):
colonoscopy is normal, we can actuallyconfidently give people a ten year pass.
That's how durable we think the colonoscopybenefit is. Our technology has rapidly improved.
We at NYU have been doing someof these studies using some new computer
(12:45):
assisted detection tools as well as betterpreps to improve our yield at colonoscopy,
so we can be even more confidentthat we've gotten a good look at everything
and have missed any worrisome visions.But there are other options. Not everybody
wants to opt for a colonoscopy,even if you know we recommend it.
(13:07):
So we offer a colonoscopy first.But there's tool tests now available, and
there's either a fit test or acolo guard test. They are both tool
tests that patients can do in thecomfort of their own home and mail the
specimen in. Again, they're bothcovered, and if the test is negative,
(13:28):
then they're good for one year orup to three years in case of
cologuard. And if that test isabnormal, suggesting there's some microscopic blood or
other markers in the stools that needinvestigations, then we schedule them for a
colonoscopy. So I like to tellpatients to think about it as a one
step test such as a colonoscopy,or you know these two step tests,
(13:50):
which is doing a tool test firstand if that's positive, then doing the
colonoscopy. But all the roads leadto a colonoscopy down the line. And
as a matter of you know whatpeople are comfortable with now if you do,
and by the way, if you'rejust waking up in the morning.
We're talking with doctor Asthma Shakatt,who is professor in the Department of Medicine
in the NYU Land Going System.She also is a professor in public health
(14:13):
and an expert in colorectal cancer screeningand detection diagnosis. If you'd like to
make an appointment with her, I'mgoing to give you the number and I'll
announce it again at the end ofthe show. It's two one two two
six three three zero nine five.It's two one two two six three three
zero nine five. So let's saythat you decide, you know what,
(14:35):
I don't want to do the colonoscopy. I don't want to do the PRAP
and I want to miss a dayof work for whatever reason. And you
do the stool test to call aguard let's say, or another stool test,
and it comes back negative. Well, if it comes back positive,
obviously you're going to need a colonoscopy. But if it comes back negative,
how reliable is that negative? Howhow can you know? Can people just
rest assured, Okay, I'm good, I don't have to do this for
(14:58):
another I guess you said year orso. Is there a false negative rate?
With those stool tests, yes,absolutely. So with these tool tests,
you know their sensitivity is getting prettygood, but it's not one hundred
percent. And sensitivity for a onetime FIT is seventy four percent. For
cologuard it's about ninety percent. Butagain, none of these tests are one
(15:22):
hundred percent, and that's sensitivity forcolon cancer. For advanced tereinomas, these
kind of precursor lesions, the sensitivityis much lower, and that's why these
tests need to be done more frequentlyevery year in case of FIT, and
every three years in case of cologuard. So really the most sensitive and specific
(15:46):
test is a colonoscopy, and thecholonoscopy also is highly effective, but it's
operator dependent. So some of theother work that we do is understanding how
to make cholonoscopy as effective as possible, and it requires high magnification klonoscope,
an endoscopist that has a good trackrecord of finding these prepersillusions called aeronomas,
(16:07):
And we make sure that we holdourselves accountable to certain metrics that make us
high quality endoscopists so that we canbe assured that the exam we do is
the best possible and it confers thebenefit for our patients that we like to
believe is up to ten years andmaybe even longer. So I think those
(16:30):
are really important factors and something thatwe always discussed with the patients that again,
these tool tests are not one hundredpercent, and certainly for advanced atonomas
there's sensitively much more. Yeah,but what I'm also hearing is is that
in the right hand, if it'snot done in the right if it's not
done the kolonoscopy in the proper hands, that the sensitivity there is not one
(16:51):
hundred percent either, that it couldmiss something as well. So you really
need to be done in expert handslike yourself and someone like yourself in your
team. At NYU. The anesthesiais still the same. You have to
be sedated for the colonosco by ISOO. You have to be out for that.
You're not you're not going to beawake for that right and circumstances will
(17:15):
do it awake, but it's notvery comfortable. So to make patients comfortable,
they get sedation, and we currentlyuse what's considered deep sedation, so
it's called MAC or monitored anesthesia,and it's essentially group of falts. So
people are in deep sleep during theprocedure and they don't remember anything and they
(17:37):
don't feel anything. Yeah. No, I had mine about two years ago
and I had the best sleep I'vehad in years, to tell you the
truth, and I don't remember itat all. Yeah. The prep,
Yeah, the prep was a littleyou know, I mean, I guess
I had to take off maybe ahalf a day or something like that.
But at the end of the day, just to have that peace of mind,
knowing that you know you're good foranother ten years, I think is
(18:00):
really worth it. And as yousaid, if you have a poll up,
which I want to talk to youabout, if you do the colonoscopy,
do you tell people who are onblood thinners that they should stay off
the blood tinners just in case theyneed a biopsy or they can still take
the blood thinners. Absolutely, Soit depends what the blood tinner is.
Afrin is no longer a risk factor, so they can continue the aspirin.
(18:22):
In fact, we want them tocontinue the aspirins, especially if it's for
heart disease or other reasons, butfor other antithrombotics. So for instance,
is taking warfrin or one of thesewhat are considered duex these newer oral antiquagulans.
Then we have protocols of when theyshould stop their last dose, and
(18:45):
then we can resume it after thecolonoscopy, and certainly with plavix in most
instances, we do want to holdit so that if you find a polyp
you can confidently remove it and notworry about risk of competing. And if
you don't find polyps, then wouldmake recommendations to better resume the antithrombodic pretty
(19:08):
much right away, right after theprocedure. So it's basically again just the
review. It's the colonoscopy, it'sthe stool test. I do remember a
couple of years ago there was acamera test. Is that in vogue?
Is that out now? Where peoplewould swallow a camera? Is that no
longer used? There was a cameratest called and it is approved in patients
(19:30):
unwilling or unable to undergo the othertests. It's largely fallen out of use
because again the sensitivity is pretty lowand the concern about a false negative is
pretty high, so it's fallen prettymuch out of out of use. There
is a new exciting class of teststhat's coming up, which is potentially a
(19:55):
blood test to look to screen forcolon Well, that's exciting. That would
be great. Where are we?How far away from that? Great a
year? So we're a year awayfrom that, within a year from a
blood based test. There is onetest that's completed its trial and is in
(20:15):
front of the FDA for considerations andafter FT eight would need Medicare approval,
and another test that's expected to releaseits results in the next two months.
And then there's three or four othercompanies with similar promising tests that are kind
(20:36):
of in different stages of completing theirstudies. I think that's awesome. I
agree of screening tests, that's amazing. Can you tell us the name of
the test? I'm sure people arelistening on like they're going to start googling
blood tests for colon cancer, butyou know they're going to come up with
probably the CEA test, which isthe test that we use for monitoring colon
cancer. But what are I forscreening? Is there is there a name
(20:56):
for it yet or not yet?Yeah, it's a test by aany called
Garden. It's called the Shield test. It's not approved yet, it's in
front of the I say, okay, but something people can keep on their
radar. Yeah. Absolutely, andwe did the principal investigator for the prenome
(21:17):
study. So again, you know, we're really looking forward to seeing results
and the study. We designed itto be able to be generalizable so that
we can have confidence and the resultsthat we find. So we're excited to
see what we find. Well,congratulations on that, and congratulations on your
(21:37):
research and bringing it to the forefront. I mean, I think that would
be a huge and maybe not notfor everyone. No test it is,
and maybe for higher risk people youstill need the colonoscopy, but then if
you get a negative one, maybeyou can just go with the blood test
or something like that. I thinkthat would really be a great improvement.
We just have a Yeah, wejust have a few minutes las I we
(22:00):
kind of glossed over just concerning arethere any concerning signs or symptoms that people
should be aware of they shouldn't waiton, you know, can you just
give us a little snapshot of that? Absolutely, so record bleeding is the
is the one thing that we usedto and even now quite often ignore,
saying it's him, or is thereit's something else, or nobody really wants
(22:22):
to talk about it or get itinvestigated. So record bleeding should really be
evaluated. Talk to your clinician,your provider about what it might be and
your other risk factors. And anemiaunexplored, changing vowel habits or you know,
changing some which has unprompted things thatyou know suddenly seem to have shifted
(22:48):
or a new patron is definitely worthinvestigating. Yeah, maybe some abdominal pains
and bloating things like that could alsobe a sign. Perhaps, And then
yeah, and a saying Poland cancersare asymptomatic, So it's really important to
think about prevention. Meaning I don'thave any symptoms, I don't need to
(23:08):
worry about it. It doesn't applyto me that we really need to change
that into have I been screened ifI'm over forty five or above forty,
if I have a family history,and that should really be something that you
know, every primary care visits weshould be focusing on. Yeah, and
perhaps even people that are smoking.What about people that were down at the
(23:33):
World Trade Center. I certainly seea lot of prostate cancer patients. Is
that one of the risk factors forcolon or not? Yeah, it is.
There's higher polan cancer in firefighters andthere's still ongoing studies about after the
Worldforce Center the different cancers that youknow, first responders were diagnosed with.
(23:55):
But the idea is, you know, there were a lot of carcinogens that
increased risk of many cancers. Coolit is definitely one of them for sure.
So if you were down there theWorld Trade Center and you were in
near early twenties or even thirties,and you know you haven't been screened,
absolutely get screened. I'm going togive doctor Asthma show cuts one last phone
number here if you haven't you didn'twrite it down. If you want to
(24:18):
make an appointment, it's two onetwo two six three three zero nine five
two one two two sixty three threezero nine five in the last minute,
Asthma, any final thoughts about preventionany ways that we can potentially reduce our
risk of calling cancer. Get ahealthy diet, healthy weight, reduce red
meats and you know smoking cessation,and ask about your family history and encourage
(24:45):
your family members to undergo screening.Yeah, that's great advice. And also
not only for colon cancer, butas you mentioned, uterine ovarian perhaps breast
cancer or other cancers that are runningin the family h that this could be
an inheritable genetic thing. Well,you are a terrific guest and giving us
lots of information about screening and detection. We didn't get into treatment. We'll
(25:10):
get into that at another time,but certainly this is very important and you
did mention at the top of theshow how it is occurring. It is
a very common cancer in both menand women and younger men and women,
and so we really need to bevery aware of this condition. Azma,
thank you so much again. Hernumber is two one two, two six
three three zero ninety five, oryou can always check her out or any
(25:33):
of my guests out at the NYULand Going website. Azma, thank you
so much. I really wish youa pleasant day and I appreciate you and
we'll have you coming back on theshow. Thank you so much for having
me. Yes, it was mygreat pleasure. Well that's the end of
the show. Everyonet hope you havea wonderful day. Tune in every Sunday
here on Katz's Corner. We'll beback next week with a great show.
This is doctor Aaron Katz. You'vebeen listening to Katz's Corner. Come back
(25:56):
every week to hear more straight talkon a whi range of men's health topics
and advice on how to live yourhealthiest life. The proceeding was a paid
podcast. iHeartRadio's hosting of this podcastconstitutes neither an endorsement of the products offered
or the ideas expressed.
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