Intro 0:03
Welcome to Maximal Being, a podcast devoted to ditching fad diets and using real science to get you healthy and feeling great. I’m Doc Mok, a GI and functional medicine doctor who harnesses the power of gut health to get you achieving your goals. And I'm Jacky P, a well-informed layman who challenges the experts and ask the questions that you want. Don't forget to hit the subscribe button or leave a comment, and now onto the show. What's going on Maximal Beings, Doc Mok here with maximalbeing.com. Don't forget to hit the subscribe button. Leave us a comment, it does help us to get the word out. If you have any questions, you can email us at [email protected]. Enjoy the episode.
Doc Mok 0:48
Hello, hello, hello, Maximal Beings. It's i, Doc Mok, and you are tuning in to a solo-sode today, we are going to talk about advancements in colon cancer, a subject very near and dear to my heart as a gastroenterologist. Go ahead, if you haven't done so already, and hit the subscribe button and leave us that five star review. It really does help us to get the word out to other people about gut health, and that's gut health that's delivered by me Doc Mok, a Board Certified gastroenterologist and functional medicine doctor and I this is not woo, woo medicine that I'm talking to you about today. This is the real deal. For those of you that are tuning in for the first time, welcome so glad to have you again. I am a board certified gastroenterologist and functional medicine doctor practicing in Florida in the United States, and this is the Maximal Being podcast.
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Jacky P couldn't be here today. He is busy saving the financial universe, so we'll see him back in some upcoming episodes. But today I really wanted to highlight a couple of really useful articles. The first one is coming out of the New England Journal of Medicine, and this is published by Daniel Chung, who's at Mass General Hospital, and it's titled "The Cell-free DNA Blood Based Test for Colon Cancer Screening". And in this study, they highlight the importance of potential blood-based tests for colon cancer screening. They had about 10,000 participants, of whom 78,000 met the eligibility requirements. They all underwent a colonoscopy, which is the gold standard for colon cancer screening, for those of you that don't know out there, as well as a blood-based circulating DNA test. What they found is that about 83% of the patients that had colon cancer, had a positive test, and in fact, 87% of those patients it was diagnosed at stage one, two, or three. The only other thing I'll say is that only about 13% of the population who had precancerous polyps, so those are lesions that we find on colonoscopy and can remove, had a positive test. And in addition, about 10% of the patients who did not have colon cancer also had a positive test. So taking a step back, you know, colon cancer remains the third most common cancer in the United States, it affects both genders. The average age of individuals continues to lower over time, most likely due to our food system, environmental toxins, those sorts of things. You should start get getting screened at age 45 for most people, for people that are of African American and Afro Caribbean heritage, that may be lower, like in the 40s, for some reason, we don't really understand. Also, your family history is important. So if you have a family member that was diagnosed with colon cancer, you take their age of diagnosis and subtract 10, and that's when you should get screened, or 40. And this is individuals that are diagnosed under the age of 65. Usually, cancers that are diagnosed over 65 are unlikely to be genetically linked. There additionally, are people that are at higher risk than other populations. So that's things like Lynch syndrome, which is, you know, you have these things called micro-satellites, they scan your DNA, and when you get damage to DNA, say, with things like sun exposure, etc, they repair those damages. And so they don't really have all of those little proofreaders that repair the damage. And so as a result, they can get various sorts of cancers. Colon being one of one of the common ones, those people have a whole different screening modality, as do people with familial adenomatous polyposis or FAP, which they're just lacking. You know, certain characteristics along the polyp prevention pathway. You know there's a lot of buzz out there about stool based DNA tests, stool based DNA tests overall are about detective colon cancer in about 92% of cases. That's also New England Journal medicine article that's, you know, common, commonly, these tests will look at things like blood and stool as well as DNA products. We recently had an article with a brilliant scientist who created an RNA based stool test that's slightly better than these DNA based tests, ratcheting up to about 94%. So these are options, and of course, colonoscopy remains the gold standard. What's the benefit of a colonoscopy? Well, if you have a good bowel preparation, your colonoscopist, your gastroenterologist, has the ability to remove a precancerous polyp. So if they find a polyp that has the potential to turn into cancer, they can remove that right then and there, and therefore eliminate the risk of that polyp turning into cancer over time, which is what all these you know, really the most cancers are the result in the colon of a polyp that is mutated over time. I mean, your colon's got a hard job, right? It's, it's got to turn over the cellular integrity roughly about every three, four days. And so, you know, if you're doing that your entire life, one of those factory workers in there repairing the colon is just bound to malfunction and make something that isn't right, and then add time to that, and as the potential to turn into cancer, colonoscopy has like an ick factor, because people are have to undergo sedation, you have to take a bowel preparation, which is a pain in the butt. But you know, I will tell you, the volume of bowel preparations has gone down over time. The ick factor of the preparations has gone down. There are pill based bowel preparations that are pretty good. Prior iterations of that cause phosphate induced kidney injury. So I shy away from those a little bit. I'm a little bit dubious. I would like to see where these bowel preparations go. And you know, of course, you're placing an instrument through the anus, which just gets people icked out for some reason. You know, while you're sedated, you don't experience these things. And again, it is the gold standard in the right hands of a good gastroenterologist, which I assume pretty much everybody out there is, you know, your your gastroenterologist can also remove precancerous polyps. As far as the interval for follow up, that depends upon the size, number characteristic of polyps. And there are standard guidelines for practice available. But it's great to have another option. You know, I a lot of people ask me, Doc Mok, do you feel like intimidated by these stool-based DNA tests. Do you feel intimidated by this blood-based DNA test? I particularly don't. You know, as long as it gets more people screened, that's the most important thing. Roughly about 40% of Americans do get screened for colon cancer. So if that gets a few more people to us eventually, to get a colonoscopy or find a colon cancer, which is, you know, a very treatable cancer most of the time. You know that that is a very, very positive thing. So the more things we have in our armamentarium, the better. And that's why I wanted to make all of you out there aware of this really important article.
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Which brings me to our next study. And so this is long term aspirin use and cancer risk, a 20 year cohort study. It's published in the Journal of National Cancer Institute in 2024 April. The lead author is Charlotte Skriver. Charlotte Skriver is out of the Danish Institute of Cancer in Denmark. In this study, they used nationwide registries. They followed individuals aged 40 to 70, from 1997 all the way through 2018, they assessed their aspirin use. And this is low dose aspirin, defined as under 150 milligrams. Typically you're at 325 if you're, if you have something like a cardiac stint. And they also looked at high dose aspirin use as well, which they defined as greater than 500 in this case, they looked at close to 2 million individuals, about 400,000 of which were diagnosed with a cancer at follow up. And what they found in this group is that the low dose aspirin use did reduce the risk of cancer irrespective of duration of use, over the time period which people were taking it, and in particular, this reduction when used long term, About five or 10 years, was found to have a 10% reduction of certain cancer sites, including the colon, rectum, esophagus, stomach, liver, pancreas, small intestine, head and neck, brain cancers like meningiomas, melanoma, thyroid, non-Hodgkin's lymphoma and leukemia. They did find a slightly higher elevated hazard ratio for lung and bladder cancer, and they also found overall cancer reduction risk of about .89 and all these cancer sites that I listed. There's also some prior data about COX-2 inhibitors, Celecoxib being the primary one and their use. That data was published in the New England Journal of Medicine years ago. I've had a few patients approach me on this and it's willing to try that, but there are subsequent studies that have shown that Celecoxib actually has a slightly higher adverse event rate. So there's more people that have bleeding ulcers and cardiac events in that group for the prevention of cancer. So this is an interesting study. Aspirin, in my mind, is overall, you know, a little bit more benign of a drug, I think you know it's, it's pretty safe in general, especially in a low dose. It's relatively cheap, and it has been proven to have additional benefits, not just that of you know, cancer. How does this work? Well, we think, you know, platelet aggregation, or the ability for platelets, kind of stack on each other, is an important part of this, and mitigation of inflammation also may be a part. But there may be some growth factors that are acted on by this. And so, you know, it's something to consult with your doctor on and discuss a really exciting article, I think, in the colon cancer space. So, you know, pretty brief today, but I just wanted to go ahead and highlight these really important articles. I just thought they were really interesting. I wanted to talk to all of you about them. Again leave us that five star review. If you haven't done so already, go ahead and hit the subscribe button. I also wanted to let you know we've moved our website to thedocmok.com you can sign up for our email list. You'll get some goodies in there, and we're planning a webinar based teaching seminar and kind of like my method, my approach to functional medicine. So stay tuned on that and until next time, this is Doc Mok and I am here to maximize your health.
The content included is not intended to be used as medical advice and viewers should consult their physician or health care provider should they have additional questions. The viewers should not rely on information contained in these presentation for immediate or urgent medical needs. Additionally, if you think you have a medical emergency, call your physician or go to the emergency department or call 911 immediately. Never disregard professional medical advice or rely on seeking medical care or delay medical care due to information contained in this presentation.
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