Chapter 1: What is the main topic discussed in this episode?
Hello everybody. Welcome to Health Chatter. Today's show is going to be on early onset colorectal cancer. Got a wonderful guest. We'll get to him in a minute. Our crew is second to none. They help us with everything in order to make these shows successful and meaningful. Our research crew includes Maddie Levine-Wolf, Aaron Collins, and Deandra Howard, marketing Sheridan Nygaard.
She also helps with research. Our production person is Matthew Campbell, who does our recording and also gets it out to you, the listening audience, with nice music attached. Great colleagues, Clarence Jones and Dr. Barry Baines provide some useful insights, both from a public health perspective and medical perspective. Thank you to them. Great friends and colleagues.
Human Partnership is our sponsor for all these shows. Great community health organization. And they do a lot of work. wonderful, creative things in order to promote health in the community. Hugh Mann Partnership. You can check them out at Hugh, H-U-E Mann Partnership Alliance dot org. And you can check us out at Health Chatter Podcast.
You can listen to the shows, and we also have transcriptions of the shows on there as well. So thanks to everybody for making all our shows to this point wonderful and meaningful. Clarence, I'm going to turn it over to you to introduce our wonderful guest today.
Thank you, Stan. You know, I'm pretty excited about introducing Dr. Logan. He and I have been working together for, I don't know, three, four, five years. I mean, I met him through a project which was around prostate cancer and barbecue, which is very, very important for Black men. the conversation of prostate cancer, but also barbecue. And so we did a study on that.
And so it's been exciting for me to work with him and to get to know him. And so he's a pediatric cancer epidemiologist who specializes in the causes of childhood cancer. His work includes both traditional and genetic epidemiological approaches. He's been a PI or co-PI on nine National Cancer Institute-funded studies of childhood cancer.
He works in collaboration with colleagues and trainees locally, nationally, and internationally at the University of Minnesota. So he's also the immediate past chair of the Children's Oncological Group. So he's a very, very busy person, but also a very, very important person.
Currently, he's chair of CLIC, which talks about epidemiological studies of pediatric cancers from across the world to better ascertain their causes. And the ultimate goal of Dr. Specter's research is to enable the prediction, early detection, and eventual prevention of childhood cancer. And one of the reasons why I'm excited about him is that
uh, we had a conversation, uh, uh, not necessarily, uh, associated with this podcast where we started talking about colon cancer, uh, among that is getting, uh, hitting younger and younger people. I thought like we've had Dr. Logan on here to talk a little bit about that. So that's kind of an introduction to him. I think he has a very sparkling personality, which will come forth.
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Chapter 2: What are the statistics on early onset colorectal cancer?
Let's, let's get going. Let's be into, uh, uh, uh, invite Dr. Logan into this conversation. So, Dr. Logan, welcome to our program.
Thank you for having me, Clarence. And let me just say that that project we had together was one of the most fun things that I've ever done in science. So, You know, it's just a pleasure to meet you. Part of the fun is that, you know, half the sample is collected at the state fair.
And, you know, I'd just like to put a plug in for our research building at the state fair, the Driven to Discover building. It's at 1367 Cosgrove for those of you who live in Minnesota. Yeah.
Yeah.
You know, I can only imagine that, you know, some research on where barbecue is involved. You know, what can be bad, you know?
You know, if you allow me to ramble a little bit, you know, it's not the act of barbecuing that, you know, that's a fantastic like art. And I love barbecue. But it's it's burning things, you know. Yes. Yeah. Like, yeah. And and this goes all the way back to Mary Poppins. Did you ever see Mary Poppins? Yeah, sure. Well, there was an epidemic of of skin cancer there. in chimney sweeps, right?
Because they didn't really bathe that much back then. And, you know, the soot gets everywhere. We're all guys on this call, so I'll just go there. They especially were not washing their scrotum. And like, you know, there's ash up in there. They had an epidemic of scrotal cancer, a really skin cancer of the scrotum. And there's a guy named Percival Potts
who first made the connection to this burned material and the cancer there. So years later, when, you know, believe it or not, it was controversial about whether cigarettes cause lung cancer, they kind of reached back and said, well, we connected burnt material, to skin cancer in the chimney sweeps. And, you know, maybe inhaling burnt material could be unhealthy, right?
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Chapter 3: What factors are contributing to the rise of colorectal cancer in younger populations?
And, you know, same thing applies to burnt material when you eat it.
Yeah, yeah. I think there have been, I've read that, God, it was a while back, but the connection between it for sure. And it's interesting. Well, we're going to talk about colorectal cancer and I'll tell you, all right, for those of us who are on the podcast, you know, we get our colonoscopies and you know, it, it really got into my psyche.
Frankly, you know, when my, my physician said, Stan, it's time for you to get a, you know, a colonoscopy. And, um, And frankly, it was in, you know, the latter part, you know, when I was latter 50s, 60s, you know, etc. But then, you know, it never dawned on me that, wow, are we going to be asking patients or telling patients that they need to get colonoscopies earlier now at a younger age now?
So let's start out with what's going on here. It's like, you know, we're seeing this happening, but what's leading to it and what's happening in general?
Yeah, great questions. And first, we should kind of start with the numbers. You know, we track cancer incidents very well in this country. There's like a central cancer registry in every state, but also internationally. And basically everywhere in virtually every population, There's an increase in early onset colorectal cancer. We define that as less than 50.
And they came up with the name early onset because, you know, people in their 40s calling them young adults seems a little funny. Right. So a young adult is up to 40. And, you know, although I always say young adult is always like the limit is a year above my age. But, you know, I'm 52 now. So and definitely graying. So I probably shouldn't go on with that joke.
But anyway, you know, it's been rising for years and by about 50, the rates risen about 50 percent in early onset since the 90s. And, you know, there have been hints of this or like attention. But the thing that really got people's attention, all right, was Chadwick Boseman, the Black Panther. who died in 2020 at the age of 43 of stage three colon cancer.
And, you know, there's a man who was like ostensibly very fit. I mean, he was a superhero. And not only a superhero on screen, but I think he filmed like the movie or the second movie while he was in treatment, which is, you know, incredible. But like 43 and, you know, obviously a very fit and talented man, you know, it's just it was awful.
And then last year or earlier this year, James Van Der Beek, who was in Dawson's Creek and I think Friday Night Lights, you know, he just died at maybe 48. Unfortunately, these celebrity deaths are kind of what brings public attention to it. You know, so the rates going up, like I said, I got a paper in front of me looking at U.S. cancer statistics. And, you know, it really is in all groups.
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Chapter 4: How does diet influence the risk of colorectal cancer?
It's called IARC. It's in Lyon, France. It's actually a branch of the WHO that's just concerned with tracking cancer around the world and also – figuring out why people get cancer and then making recommendations to reduce cancer incidence, right?
And about 13 years ago, there was a guy in England who since was knighted for this, they realized that if you sequence a tumor, all right, like look at every DNA letter, You can find and then you compare it to the normal tissue. All right. The normal DNA. You can find what they called mutational signatures of of what might have that what that tumor might have gone through. Right.
So it's it's not exactly a fingerprint of the cause, but it is a fingerprint of it's like journey, you know, like we all. you know, we all have scars, whether they're physical or mental. And, you know, so think of it as like a scar on the tumor's DNA. And last year they published what they called a mutagraph study.
That was just looking at what the tumor looks like, but they collected them from, I think, a thousand colorectal cancers from different countries and at different ages. And what they found was in the young onset colorectal cancer, there was a very high proportion, much higher than in the older cases, of a mutational signature of what's called colobactin toxin. So we all have...
bacteria in our guts all right uh we call it the microbiome you know the microbiome is actually uh the the bacteria that live anywhere on you but you know usually we say microbiome people understand that to mean in the gut and um uh e coli you've probably all heard of it because uh sometimes uh Stuff gets into Bademikaska and they have to close it off to swimming, right?
Because there's E. coli and you don't want to catch anything from swimming in there. But E. coli comes, we all have it in our gut, but some versions of it produce a toxin. All right. And I mean, just the word toxin sounds bad, doesn't it? It directly mutates the DNA. And, you know, the fact that we find a high proportion of these mutations in early onset colorectal cancer is a gigantic factor.
clue to the to the cause here it really suggests that whatever people are eating uh you know um we are pretty sure there's a role for obesity because of course that's um rising um You know, it really suggests that the throughput, the reason that that's happening is it's changing the microbiome and tipping it to a worse one.
But, you know, that's great to know, because now we have something to, you know, attack or manipulate or improve, you know, intervention.
So, Dr. Logan, I want to ask this question. I mean, Let's talk about, we go around the term colon cancer. Let's talk about what exactly is that? I mean, for many of our listeners who need to know a more detailed explanation of what it actually is.
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Chapter 5: What are the current screening recommendations for colorectal cancer?
It's not really a single disease. It's a bunch of different diseases in that it can occur in different places in the colon. You know, we say colorectal and, you know, it really does go all the way down to the end. Although, you know, anal cancer is considered a different type. But also there are different ways we classify colorectal cancer.
So based on where it is, like in the length, you know, also to me, it's very odd. But whether it's on the left side of the body or the right side of the body, because, of course, you know, the colon just snakes like all throughout the body. I'm not even sure why that's so important. But, you know, when we get down to it, we look in some groups of people and it's mostly on the right side.
We look at other groups. It's on the left side. And then you get down to the molecular genetics. And I'm not going to bore you all with the particular genes, but I'll just say this. In cancer, we're getting down to the precise gene that went wrong or genes that went wrong to make that cell go crazy. And now we think that the causes will differ depending on your subtype.
But, you know, that's more of a matter of like how much something causes it. But, you know, diet and exercise and obesity and microbiome are going to be causes of all the subtypes.
So you think, you know, you keep using the word diet. So is it our foods that we're eating that it's causing us, you think, to cause this proliferation of diseases? Is it food?
Um, you know, like, uh, when you try to nail down a scientist to, to just say it's one thing, they're never going to give you a straight answer. Um, you know, it's, it's like, uh, all of it at once. And of course, like diet is complex too. Um, uh, we'll say that, uh, the, the things we think are healthy to eat, you know, uh, uh, at least until they changed the food pyramid in the last year.
Um, you know, it's, uh, it's, it's not really rocket science, right. You should, um, eat a lot of fresh veggies, you know, in a, in a variety of colors. Like, uh, we say eat the rainbow, you know, um, dark leafy greens are great, you know, um, and, uh,
minimizing uh meat you know not making it the the star of the show uh i enjoy meat too and um you know but it's uh it's not um it's not about saying no but it's about moderation and then uh clarence uh i uh actually um don't know about early onset cancer uh colorectal cancer but you know barbecue uh sorry burnt foods uh are associated with colorectal cancer too
We oftentimes on our shows talk about prevention and detection and then treatment.
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Chapter 6: What are the challenges in screening for early onset colorectal cancer?
So let's start out on the prevention side of things. You know, obviously you started that with, you know, good diet, you know, is good. So let's talk about overall prevention. What's your perspective on that as it relates to early onset colorectal cancer?
Yeah, I mean... So I came, you know, most of the people who are studying early onset colorectal cancer, they came from adult cancer, right? Which, you know, rises a lot after age 50. And they're maybe not thinking about the early life, what we call antecedents, you know, the beginnings. But for a lot of cancers that even occur in, you know, older people,
there are hints that they start much earlier than that. And in fact, like it surprises a lot of people, but there's an association between your birth weight and like a woman's risk of breast cancer or a man's risk of prostate cancer. And it's also true for colon cancer. And you might say, what, what does that mean? And yeah,
Uh, we, we don't exactly know, but there's a couple of possibilities, you know, um, one is to get to a bigger birth weight. You just need to have more cells, right? Uh, cancer always starts in a cell or a group of cells that get that mutation. All right. And they can, they can, uh, go along without turning into cancer for decades, right?
But if you have a mutation while you're in utero, while you're a fetus, you have a lot of growing to do. And so if that mutation happens early, it can expand. And then you have a large part of your colon or your prostate or whatever tissue that's at risk for transforming, we say it. That moment when it tips into cancer, that's called transformed.
And, you know, so really beginning from birth, like healthy life, healthy diet and exercise are important. And now I have kids and my son, who's almost six, I think he eats nothing but quesadillas and, you know, chicken nuggets. And we've tried really hard for him to, you know, love broccoli. But, you know, I know how hard it is to get kids to eat healthy. Yeah.
There's also a lot of change in the body during puberty. There is some evidence that the amount of physical activity that teenage girls have affects their later life risk of breast cancer. So, you know, but the real challenge is teenagers think that they're going to live forever. Right. And they, they don't. And, you know, you can eat whatever you want when you're 15. Right.
The illusion of immortality.
Yeah. Just getting them to understand like what you do now is going to affect their your health for the rest of your life, that is tough.
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Chapter 7: How can lifestyle changes impact colorectal cancer prevention?
Yeah. Yeah. Yeah.
You know, it's interesting. You know, if you really ask them what's important to them, they'll say, you know, how they look.
Yeah. So some people have had success like showing them pictures of what happens if you smoke for 30 years.
Right, right, right, right, right, right. So let me, so all right, as part of this, and then I want to pull Barry in on this conversation too. But screening. So, you know, for those of us who have had, you know, colonoscopies. Hello. There's also there's actual colonoscopies and then there's new techniques where you can do it at home. You know, these types of testing.
So let's talk about screening a little bit and what it also means for patients. frankly, for telling younger people that they have to get checked out.
Yeah. So screening and the optimal age of screening and targeted screenings in high-risk populations, that is a matter of a lot of debate. Probably the public has seen they've moved around the ideal age of mammograms for breast cancer. Um, and, uh, absolutely the, uh, recognition that, you know, early onset colorectal cancer is epidemic now.
Um, we, we, we say epidemic when, uh, you know, even if it's not an infectious disease, if something's just kind of risen everywhere all at once and, um, But it's a tough situation because when you screen a population, all right, if the incidence is not that high, you get more false positives than true positives, all right?
Meaning you're going to worry a lot of people, you know, many more people than – than are going to get saved. And so it's really like a numbers game. And, you know, even though it's been rising by 50%, that's the relative rise, you know, and in absolute numbers, early onset colorectal cancer is still pretty rare. All right. At least compared to the, you know, over 50s.
And so really science has to do better with the method of screening. So when a disease is rare, like if your screening test isn't, just spot on, then you will just worry a lot more people, the so-called false positives. And that can have real consequences. You surely know about the prostate cancer screening. They moved to the PSA test, the prostate specific antigen test.
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Chapter 8: What future developments are expected in colorectal cancer research?
So, Barry. Yeah, I mean, I can wait.
Dr. Barry.
Yeah. I guess, you know, there's so many things, you know, to talk about here, certainly. I'd like to just touch on a few of them quickly and then, you know, have, you know, Logan kind of, you know, chime in as well, because we talked about a lot of aspects of things and the idea of, well, what's causing this change to happen? And And it's multifactorial. I mean, we kind of touched on that.
But that doesn't mean that there's correlation between some of these things as opposed to say, this is the cause and that's what we have to do. But it is, we suspect, it's genetics, it's diet, it's activity, it's your weight, et cetera, et cetera. And the next step for that, when we talk about some of the screening pieces is,
Not to get into the weeds, but it is the problem with a lot of tests is if it says it's negative, is it's truly negative? And if it says it's positive, is it truly positive? Because even though a 50% increase is incredibly large, and yet in terms of the total population, it's small. And one of the issues when you look at public health and individual health is
Decisions that you make from a public health perspective compared to, well, if you're a person that has early onset cancer, you want to make sure that you don't get it and what could you do about it. Whereas from a public health perspective, people generally don't appreciate cancer.
that having a false positive test, and then you go through the medical complex of lots of procedures and things, and what rarely gets the spotlight on it is that there are complications from having all of these tests. And if you wind up having to send hundreds of thousands of people through these tests. Number one, can our medical system actually deliver that?
I remember from a few years ago, they said, well, if everybody who's supposed to have a screening colonoscopy would have it, there wouldn't be enough physicians in the country to do that service. I mean, it gets to be a supply and demand kind of thing.
But one of the two things I wanted to point out is with screening, what's been amazing is within a very short time span, like maybe 10 to 20 years, the recommendations for colorectal cancer screening has plummeted by about 10 years. I think from what it used to be, certainly for anybody who's potentially high risk, that's one thing. And the thing that's more concerning to me
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