Colorectal Cancer: We Are Debunking Myths & Addressing Screening Options

Our guest, Raye Arce with Exact Sciences joins us today as we discuss Colon Cancer or Colorectal Cancer. We will explore the various screening options available, including the non-invasive, at-home testing and the traditional colonoscopy. Ray will unpack the key factors influencing these choices, such as frequency, patient preferences, and the importance of early detection, which significantly improves survival rates. 

Additionally, Ray will provide insights into overcoming the barriers to screening and emphasize the importance of shared decision-making with healthcare providers. Tune in as we discuss how regular screening can make a life-saving difference and what you need to know to take charge of your health.

 Website: https://www. exactsciences.com

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Transcript

Darleen Mahoney [00:00:01]:

Hello, everyone.

 Ray Arce [00:00:02]:

Thank you for joining us today on this podcast.

 Darleen Mahoney [00:00:04]:

We are joined today by Ray Arcee. He is a family nurse practitioner with over 20 years of experience in multiple therapeutic areas, including primary care, wellness and research. Rae is a graduate of Florida International University and certified through the American Academy of Nurse Practitioners. Currently, Ray is a medical science liaison with exact sciences, and I'm excited to talk about that a little bit. Exact scientists sciences, sorry, medical affairs division covering Florida, the Gulf coast and Puerto Rico. He's super passionate about impacting patient lives with a focus of raising cancer awareness through education, leading to higher screening rates and promoting early cancer detection. Thanks for joining us on the podcast.

 Ray Arce [00:00:51]:

Well, thank you for having me, Darleen. I appreciate it.

 Ray Arce [00:00:54]:

Yeah, absolutely.

 Darleen Mahoney [00:00:55]:

I'm excited to dig in with you. I know that this subject is something that a lot of people may not really enjoy talking about, and they don't really kind of want to recognize it because I think that anytime you talk about cancer, it's always a really hard subject because you see cancer and you see everything imaginable that is not good. Just an awful diagnosis, no matter what it is. I mean, I even had a skin cancer diagnosis that freaked me out. So. And as well as it should, I mean, you have to be really conscientious of that. But so what you specialize in or what exact sciences specialize specifically is.

Ray Arce [00:01:39]:

Cholesterol.

Darleen Mahoney [00:01:40]:

Cancer, but also, I think, is more commonly known as just colon cancer. Am I correct on that?

Ray Arce [00:01:44]:

Yeah. Colorectal cancer, we really focus on early detection and impacting patient lives. We know that when we detect colorectal cancer earlier, the outcomes are going to be way better. And so the focus of exact sciences is to focus on early screening, screening when it's appropriate to screen screening with the best option available. And typically that results as a result of having a good shared decision making conversation with your clinician where choice is really practiced and that leads to higher adherence rates, where we can get the population screen just like it's recommended.

Ray Arce [00:02:26]:

Right. And I agree with that. And I think that it's something that it's correct. So colonoscopies or screening for colon cancer, I'm just going to call it that because I will never get the correct out properly. So it's something that isn't necessarily based on I have a symptom. But a lot of times that's put into as, especially as you get older, as something that you just start regularly screening for.

Ray Arce [00:02:53]:

Well, you made such an important point. Colorectal cancer really doesn't present until it's too late. So colorectal cancer can be developing and the patient is unaware. Colorectal cancer typically shows symptoms when it's in its more advanced stages, and that's really kind of where we have less optimal outcomes. So it's very important to treat colorectal cancer with the importance it needs, just like skin cancer. And there are recommendations on when to begin screening routinely. And so that's important because, like you mentioned, signs and symptoms are key. But in this case, with colorectal cancer, signs and symptoms can mean that.

Ray Arce [00:03:40]:

That the lesion or the tumor or the polyp has progressed to where it's now a significant problem.

Ray Arce [00:03:48]:

Right. So what are some of those signs that would really have you going into the doctor ASAP versus a screening?

Ray Arce [00:03:57]:

Well, some of the signs that are associated with colorectal cancer are going to be rather benign, and they rather overlap with other potential conditions. So they're subtle symptoms that can mean a slew of other things that don't necessarily represent colorectal cancer. So some of the things that someone can experience as a result of a sight and symptom of colorectal cancer is constipation, diarrhea, lower abdominal pain or cramping, weight loss. That's unintentional, of course, a loss of appetite, fatigue, bleeding, particularly when passing stool or blood in the toilet. A change in the shape of your stool can also inform someone that there's something going on and further evaluation is necessary.

Ray Arce [00:04:51]:

Yeah. So all those symptoms that you just said are. A lot of them are not something I would have ever thought of. I think when you think of it, you think of basically stool, blood in your stool, and that's pretty much, I think, in my mind, before you shared all that was really the only symptom. And that can be multiple different things, I'm sure, especially specifically for women that have given birth, if you know which road I'm going down. So that can sometimes hemorrhoids, I think, can definitely give the illusion that you're actually.

Ray Arce [00:05:28]:

And that's what makes it so difficult to detect from a patient perspective. A patient sees, well, I've got some blood in passing stool, and you directly and rightly so, can attribute it to hemorrhoids. Internal hemorrhoids tend to bleed and they're episodic, and so someone can clearly dismiss one of the most important signs of advanced colorectal cancer, which is bleeding upon passing of the stool.

Ray Arce [00:05:57]:

Right, exactly. So if you have any of these symptoms, clearly you need to seek your physician for a diagnosis. So it may be something very simple. And it may be something that's passing or whatever the case may be. So it's not a definite sign of colon cancer. So I'm always aware of people that go on WebMD or they go to Google because you could have, like, the simplest thing, and then all of a sudden, you have the bubonic plague by the end of your search, and you're freaking out and don't sleep. So, you know, always, you know, be cautious. Go see your physician.

Ray Arce [00:06:32]:

At the end of the day, that is the way to go.

Ray Arce [00:06:35]:

So that is the way to go. When in doubt, just seek professional help. It's always important to have those signs and symptoms addressed, and if it turns out to be nothing, then you're good. But what is important is that we can go ahead and report these signs and symptoms, eliminate the cause, and then move on with our normal lives.

Ray Arce [00:06:58]:

Right. So how common is colonized colon cancer? I feel like. I mean, and I'm just throwing this out there. Maybe it's just because I'm getting older that I'm hearing of it more and more than I used to, clearly, when I was younger.

Ray Arce [00:07:15]:

Yeah, absolutely. And so colon cancer is the fourth most common cause of cancer in both men and women in the United States. Fourth most common cause, yet it's the second leading cause of cancer death. This year alone, there were about 153 new colorectal cancer cases anticipated, and about another 53,000 patients were estimated to lose their battle with colorectal cancer. So, certainly impactful numbers overall. Lifetime risk of developing colorectal cancer for women in the United States is about 4.3%. That roughly translates about one in 26 women. In men, it's about 3.9%.

Ray Arce [00:08:02]:

And that roughly translates to about one in 23 men. So if you know one in 23 men, or if you know 23 men or 26 women, one of them is likely to develop colorectal cancer at some point during their lifetime. So, certainly impactful numbers. But although it is a relatively common colorectal cancer, it's still very treatable, particularly if detected early on.

Ray Arce [00:08:26]:

Right. So do you know why men would tend to have a higher rate of cloning? I mean, is there something in their lifestyle that changes those numbers, or is it just something that's occurring?

Ray Arce [00:08:40]:

Yeah. And so some doctors theorize a multifactorial approach. Some clinicians consider that it might be the microbiome associated with the male compared to gender. In terms of comparison to gender, also poor dietary habits. Mententa, as they age, tend to eat less conscientiously. And so that might be another reason. Also, the incidence of diabetes and sedentary lifestyle has a lot to do with that. And so that might lend to a higher rate of colorectal cancer in men when compared to women.

Ray Arce [00:09:17]:

But when you look at 3.9% compared to 4.3%, although there is a difference there, it's not terribly different in terms of statistics.

Ray Arce [00:09:29]:

Okay, so something you just mentioned that kind of, like, sparked my interest, is, are those types of lifestyle habits attributing to colon cancer?

Ray Arce [00:09:45]:

Yeah. And again, that falls back to what we see, particularly in younger patients. Younger patients are presenting with more advanced stage of colorectal cancer, and the incidence continues to grow at about 2% annually for about the past 20 years. And one of the reasons that's hypothesized is because of more sedentary lifestyle, less activity, poor dietary habits, so less exercise, poor diet, contributing to, of course, the microbiome, which is also important. What's happening inside the gut, that's one of the things that could be, of course, causing this. And that can tend to lead to, you know, with this digital age, all of the things considered, that's one of the reasons why we see colorectal cancer on the rise, particularly in younger patients.

Ray Arce [00:10:39]:

Well, I know that gut health, and I know we've talked about this on different podcasts here on the seniorlivingguide.com podcast, is Gut health. So is gut health. And I know that's becoming something people are getting more in tune to and really listening, you know, on probiotics and all these different things. Do you think those trends are going to be helpful in reducing the rate of colon cancer?

Ray Arce [00:11:03]:

Well, that's yet to be determined. We know that for the past 25 years, we've seen an increase in colorectal cancer in younger patients. And one of the reasons why we've seen a decrease in colorectal cancer in older patients is particularly because of the focus on colorectal cancer screening. So it may be that the microbiome or the gut health is a key component, but we're still going to have to wait a little while to see any benefits to focused treatment or better health in terms of the gut microbiome. Until then, all we have is screening and being able to get the right amount of exercise, eat healthier, and look after our health, particularly as it relates to colorectal cancer.

Ray Arce [00:11:50]:

Okay? So hopefully, those things will help reduce risk. Now, is colon cancer something that is considered one of the. I don't want to say one of the more hereditary or not hereditary, because I know there's clearly some cancers that you have markers for. Is this one of them?

Ray Arce [00:12:06]:

Yep. Absolutely. It's a great question. And so sometimes you'll have familial hereditary syndromes. We can use lynch syndrome, or familial adenoma is polyposis. And sometimes these conditions can be, of course, hereditary, and they can increase the risk of colorectal cancer significantly. And so screening for this particular patient population is usually done very specifically. It's done with colonoscopy at an interval that's decided by either a GI or, heaven forbid, if they have cancer.

Ray Arce [00:12:43]:

An oncologist.

Ray Arce [00:12:44]:

Yeah, absolutely. So we started off talking a little bit about how colon cancer screening is becoming something that you do before you get screened, so you catch it early so you have the better rate of survival. So what age does that? Typically, you start going to your physician. You know, when you're younger, you go to your physician, you go once a year, you get your little screenings, and you're in, you're out, all good to go. And as you get older, all of a sudden, all these different issues start. You know, they start coming up, and then all of a sudden, you're getting shots for things you didn't get shots for, and you're taking vitamins for things you never needed vitamins for. So which is this? Where does this fall into? What age range would you start, typically seeing the request for screening?

Ray Arce [00:13:28]:

So that's a great question. And up until recently, up until 2018, the screening age was 50. But since we've seen that increased incidence in younger patients, now the screening age has been dropped down to 45. And all guidelines recommend that routine screening begin at age 45 in average risk individuals. And that's an important piece. Average risk is important because not everyone qualifies for routine screening. You must be considered average risk to undergo routine screening. And by average risk, I mean someone without a person, history of colorectal cancer, or advanced statinomas.

Ray Arce [00:14:10]:

We touched on the familial hereditary component, someone without that component, and certainly someone who hasn't had a previous cancer, you know, an abdominal or a pelvic related cancer. And then, of course, someone who doesn't have a first degree family member. By first degree, I mean mother, father, sister, brother, son or daughter. If someone has any of these factors, they're considered high risk, and routine screening is not a possibility for them. They're going to be surveilled via colonoscopy at an interval to be decided by their specialist. And that could start at age 35. It depends. But for average routine screening, if someone doesn't have any of those factors that I just mentioned, they do qualify for colorectal cancer screening.

Ray Arce [00:15:02]:

So screening is good from age 45 to 75 at a regular interval, from 75 to 85. We have an individual based screening modality where it's based on a case by case basis. Can the patient have treatment for colorectal cancer? If found to have colorectal cancer, can they survive a surgery? What are the risks and what are the benefits from 75 to 85, and then colorectal cancer screening is typically not recommended and 85 year olds or older. And one of the reasons for that is, of course, the benefits don't outweigh the risks. Typically, colorectal cancer is a rather slow moving cancer, from benign polyp to distant metastasis. It can take anywhere from ten to 15 years. And if someone's diagnosed beyond the age of 85, you know, it may not, it may not be worth it, although, you know, of course, there are exceptions to the rule. Colorectal cancers can move rather aggressively in some cases, but typically they're rather slow movers.

Ray Arce [00:16:10]:

They can take anywhere from ten to 15 years to progress.

Ray Arce [00:16:13]:

Yeah. So when you start getting these screenings, does it start out like every three years, every five years, and then just kind of increases in the time, as far as less time in between screenings?

Ray Arce [00:16:26]:

Yeah, that's a great question. It depends on the screening modality. So let's say you have a colonoscopy and that colonoscopy is clean and negative. You're not next due again for colorectal cancer screening for ten years.

Ray Arce [00:16:41]:

Oh, wow.

Ray Arce [00:16:43]:

Let's say you have a fit test, which is a fecal immunochemical test. It's measuring the blood in the lower GI tract, where we commonly have colorectal cancer. Let's say that one comes back negative. You're due again for colorectal cancer screening the next year. If you have cologuard, which is the screening modality that we at exact sciences have, that test is good for three years. And so it depends on the screening modality that's going to dictate when you are due again for a screening test. And just because you're negative for one particular screening test doesn't mean you have to repeat that very same screening test the following year or the next ten years. You can choose whatever option best aligns with your preferences.

Ray Arce [00:17:31]:

Right. So you just touched on my next question. So there's different types of screening, and back in the day, it was the colonoscopy, which people absolutely dread, and it's clearly an option that some folks can take. And I remember way back in the day, it was, you would drink, like, this horrific Kool Aid for 24 hours, and you felt like garbage all day long until you actually had it. I think there's been some improvements with the protocol for that, but it's still somewhat of the same idea. I don't know if it's the Kool Aid stuff anymore. I think they may have changed it, but no, there are other options. And that's one of the things that your company does that I think is such a great option.

Ray Arce [00:18:21]:

So I really want to share that with our listeners that you do have some choices. One's clearly less invasive.

Ray Arce [00:18:31]:

Yeah, great point. And that highlights the importance of shared decision making and offering true choice, because, like you mentioned, colonoscopy may not be for everyone. There is a significant prep to colonoscopy. The bowel has to be cleansed completely, and so you have to ingest a solution in order to prepare the bowel. So the colon has to be clean and visible. And so that is one of the barriers to colonoscopy. Another barrier is that you're going to be sedated. Right.

Ray Arce [00:19:07]:

You're likely going to miss a day of work. You're likely not going to be able to drive yourself back. So a chaperone is likely needed. These are all important factors to consider when taking into account what screening options you have. So not every screening option aligns with every patient. Like you mentioned, Cologuard is an option for colorectal cancer screening. This is a stool based screening modality that you collect in the privacy of your own home. The kit is mailed to you, you collect the sample, and you ship it out, and your clinician gets the result.

Ray Arce [00:19:46]:

That's as easy as it gets. And it's a highly sensitive and highly specific test because it's picking up abnormal DNA shed from these lesions or polyps in the colon, and they come out in the stool. We're able to measure the abnormal cells in the stool as well as a blood component. So it's a highly sensitive, highly effective test and one that may align better with the patient preferences. Can they miss a couple of days of work? Do they have a fear of the procedure? You know, what are some of the drawbacks to having an invasive procedure, like having, you know, a colonoscopy? And so these are all important factors, and that's where true choice comes into play, where clinicians offer patients all of the risks and benefits associated with all of the choices. The patient can then express their preferences.

Ray Arce [00:20:42]:

Yeah. And correct me if I'm wrong, but I know that the physician actually orders the test and it comes for the one that you do at home and it comes to your home and then I don't think there's a charge for it. Am I correct on that? It doesn't cost anything to ship it back. Everything comes easy peasy.

Ray Arce [00:21:00]:

There is no associated cost with receiving or shipping the kit. Of course, it is covered on most of insurances, whether it be commercial or non commercial insurances. And if it comes to pass that the patient does not have any insurance or is underinsured, there are also recourses for the patient not to incur any costs associated with taking a, or submitting a cologuard test.

Ray Arce [00:21:29]:

I'm assuming that Medicare probably covers it. Just off the top. Off the top of my head. Okay, perfect. Because a lot of listeners, that's what they're utilizing for their insurance.

Ray Arce [00:21:38]:

And it's important to keep in mind as well that after any non colonoscopy screening modality, and there are various screening modalities, it has to be followed up with a colonoscopy. Right. So let's say we get a positive cologuard. It doesn't necessarily mean you have cancer, but a colonoscopy is required following a positive cologuard or positive fit or positive phobia or a positive CT colonography or flex Sig. That follow up colonoscopy used to incur a cost. It was considered part of the diagnostic process. Now, as of 2023, January 2023, there is no incurred cost for that colonoscopy. It is considered part of the screening continuum that does not incur any additional cost.

Ray Arce [00:22:33]:

So is that only if you've had a positive result from that's colonoscopy?

Ray Arce [00:22:39]:

Yeah.

Ray Arce [00:22:40]:

Okay. All right. All right. Good to know. So that's perfect. So how, how often? I think you mentioned this every about three years on the home test that you can send in.

Ray Arce [00:22:53]:

Yeah. So cologuard is performed every, at three year intervals. If found to be negative. So let's say you have a cologuard and it's negative. You can have another cologuard in three years, or you can have another colonoscopy in three years. You're good for screening for three years. Fit, which is another stool based test, that one. If negative, you're good for screening for one year.

Ray Arce [00:23:18]:

Colonoscopy. If found to be negative, you're good for screening for ten years.

Ray Arce [00:23:22]:

Okay. So really the pros and cons are with the one that you get at home, the cologuard, which is what your company provides, that is just every three years, because you're doing it at home. But if you choose to go the liquid route and the 24 hours and the sedation route, it's every ten years. So you just kind of have to, you know, weigh your pros and cons and what you really want to do. So if you want to do it in ten years, wham, bam, and you're out, then that colonoscopy would be the way to go. But if you don't want to do that, we just have to do a little bit more often. So that's, that's pretty much the big difference, right? In timelines.

Ray Arce [00:24:00]:

Absolutely. And so it has to, it has to. It boils down to how practical, how valuable is the test for the patient. So we know we touched a little bit. On the trajectory of a benign polyp to distant metastasis can take anywhere from ten to 15 years. So you're really having a large window. If you have a test done, say, every three years at three year intervals, you're not necessarily going to see a colorectal cancer growth, but you are going to see a precancerous lesion growth. So you're not going to develop colorectal cancer, but you can nip a precancerous lesion or a very early stage cancer within that three year window.

Ray Arce [00:24:39]:

So it's a sweet spot in order to not let ten years go by to where now something has had the opportunity to grow significantly. This is kind of like that sweet spot where, yeah, you're not going to see a colorectal cancer develop within a three year time period, or at least most colorectal cancers are not going to develop within a three year time period from benign stage to distant metastasis. But you are going to see the first sign of that. You're going to see a precancerous lesion, you're going to see a very early stage cancer where now it can be removed. And we know that if we detect colorectal cancer in its early stage, stage one, let's say there's a 91% five year survival rate associated with early cancer detection. If we're detecting colorectal cancer when there's more signs and symptoms, when we see that blood, when we're having those abdominal pains, when we're seeing that change in the shape of the stool, we know that there's about a 14% five year survival rate when detecting colorectal cancer. And it's distant phase of stage four. So there's a lot to be said in terms of the interval.

Ray Arce [00:25:44]:

Do you want to wait ten years to see if anything has grown, or do you want to have it at an intermediate interval, at three years, where you can detect a small precancerous lesion, but you don't have a colorectal cancer develop on you? Those are important factors to consider.

Ray Arce [00:26:00]:

Oh, 100%. I think anytime you can catch any type of cancer at the very earliest of stages, or even the pre cancer, which, you know, there are some of those is definitely key.

Ray Arce [00:26:13]:

Oh, yeah, yeah, absolutely. And one of the things that differentiates cologuard from its competitors is that we are able to have a higher sensitivity for precancerous lesions because they constantly exfoliate or shed DNA or shed it at a higher interval. And so if we're just looking at blood, earlier stage lesions tend not to bleed as frequently. They bleed more intermittently. So we're less likely to pick up a lesion that's bleeding when it's early phases, but we can pick up abnormal DNA at a higher relative rate.

Ray Arce [00:26:49]:

Yeah. Well, I absolutely love this because at the end of the day, it's super detectable and we don't need to have so many people. I know that I have friends who have lost very, very close, dear ones in their lives to colon cancer. And it's. It's. It's a hard pull to swallow when you know that it doesn't have to be. You just have to jump in there and do the uncomfortable things, which, you know, at the end of the day, we'll be honest, that's what a lot of probably reasons that some folks don't get it done because they just don't want to, because it's so uncomfortable. So get past it.

Ray Arce [00:27:29]:

Get over yourself. Because I'm going to tell you, if you. If you develop the symptoms and you actually do get colon cancer, it's not pleasant.

Ray Arce [00:27:42]:

It is not. And particularly when you really don't have. The only thing we have is screening because we're not going to feel early colorectal cancer. We're just not going to feel it. There's not going to be any signs and symptoms associated with early stage colorectal cancer. So all we have is screening. And that's good enough because we know that when we routinely screen at the guideline recommended intervals, we are going to detect colorectal cancer. And we know that when we detect colorectal cancer, particularly early on, we have good outcomes.

Ray Arce [00:28:20]:

Okay. Are there any barriers in that type of screening?

Ray Arce [00:28:25]:

Oh, absolutely. I think we've touched on a few of them. Right. Fear is an important patient reported barrier, fear of procedure, but fear of knowing they have cancer. So oftentimes, patients will abstain from colorectal cancer screening or cancer screening in general, because they're afraid to know they have it, and so it's better that they don't know. And so some people say ignorance is bliss, but, you know, there is some truth to, hey, if I don't know, I'm not worried about it. And I can continue focusing on being the provider for my family, I can continue focusing on that. And so there are barriers associated, of course, logistics.

Ray Arce [00:29:06]:

Access to colorectal cancer screening, particularly in underserved populations, can certainly be a challenge. We know that Native Americans, Alaska natives, followed closely by black Americans, are most highly impacted by colorectal cancer in this country. And oftentimes these patients are located in an underserved population. So access is also a big contributing factor to low adherence rates to colorectal cancer. We know that nationally, the guidelines recommend that colorectal cancer screening hit at least about 80% in every community in the United States. Not one state has yet to hit 80%. And so lots of work needs to be done. And one of the ways we can get over that is by reducing those barriers and offering choice of tests is going to be one of those things.

Ray Arce [00:30:08]:

Yeah. And education, just like what we're doing right now. I think it's so important to continue to educate people because knowledge is power. I think back to what you were just saying where you do put it off, and that's a little bit of my personality is, I call it my Scarlet O'Hara moment, where she's standing at the bottom of the stairs and she goes, I'll think about that tomorrow. And it's just kind of that same thing because life is so busy. You can get really busy and you don't want to ruin anything you might be looking forward to or the weekend or different things that are going on, or it might impact a family member in a way that maybe they have to take you or whatever the case may be, if you decide on a colonoscopy. But we really need to stop thinking that way. We really need to get it in our minds to be super proactive on cancer in general.

Ray Arce [00:30:57]:

But this cancer for sure, because it is so preventable.

Ray Arce [00:31:01]:

Well said. Well said. We just have to get past that, like you said, get past that. Push. Push past that and get screened.

Ray Arce [00:31:10]:

Yeah, there you go. Get screened. There you go. So just remind us again, so exact science sciences is something that, would that be something that you could request specifically from your physician or medical provider?

Ray Arce [00:31:27]:

Yeah, absolutely. So that's one of the shared decision making pieces that I've been talking about, is you can bring that to your clinician. Hey, you know, I've heard about a stool based test called cologuard. What are your thoughts? Would I be a good candidate for that? And that's where you get into that conversation. Of course, someone has to be at average risk for routine colorectal cancer screening. And if they are, they are a candidate for Cologuard.

Ray Arce [00:31:55]:

There you go. So can you share with us the website that folks might want to visit to just read and get some more information on their own?

Ray Arce [00:32:03]:

Sure. Exactsciences.com and you'll be able to find out more about exact sciences and of course cologne.

Ray Arce [00:32:11]:

Yes, and I will put that link in all of the copy content for the podcast. So just search there if you missed it or wasn't quite sure of what that was. Before we sign off, do you have any more tidbits that you would like to share with us?

Ray Arce [00:32:28]:

No, I just think that we've certainly reached a point where we know that we can impact colorectal cancer by screening. We've seen that in patients 65 years of age and older. We've seen a decline of about 1% the past two decades. So we know that we can have the same effect in younger patients. There's a relatively small study, it's very brief. It has three arms. One arm said you're going to get screened with a stool based component, the other screened with a colonoscopy. In the third arm, you can choose to screen with stool based or colonoscopy.

Ray Arce [00:33:08]:

And there's a 31% increase in screening adherence compared to just offering colonoscopy. So just offering two choices increases adherence, and that's something important to have with your clinicians is a discussion about choice.

Ray Arce [00:33:23]:

Yes. And I love to hear that the numbers or percentage, even if it's small, is going down among our senior population.

Ray Arce [00:33:29]:

Absolutely. There's been such a focus on screening in this particular age group, and we're seeing the fruits of that labor.

Ray Arce [00:33:36]:

Yeah, I love it. I love it. That's fabulous. Thank you so much for joining us today. This was such an informal podcast, and I knew that this was such an important topic that people don't talk about. You know, they call it kitchen table topics since it's probably not one of them. So much so. But I do think you need to educate and learn and understand your different options and risks.

Ray Arce [00:33:56]:

So I do appreciate you coming on today and if you enjoyed this podcast, please join us anywhere you listen to podcasts, whether it be Spotify Apple podcasts, good pods. We're now on babyboomer.org for over 80 other podcast topics and we really enjoy having everyone join our podcast and thank you for listening.