Latest / The YMyHealth Podcast | Wellness and Healthcare Insights for Millennials / Advancing Equity in Colorectal Cancer: Early-Onset Trends, Disparities, and the Power of Prevention with Dr. Fola May
Transcript
- 00:41 Melissa Schenkman So on today's episode of the YMy Health podcast, we're going to be talking about some really interesting aspects of colorectal cancer when it comes to research and health inequities and policy, because there's so many different aspects to making advances in prevention and care. And we are so fortunate to have Dr. Fola May here with us. 01:00 Dr. Fola May Thank you. 01:01 Melissa Schenkman Yes, welcome. Who is an associate professor of medicine at ucla. So welcome to the podcast. 01:08 Dr. Fola May Thank you for having me. Excited to be here. 01:10 Melissa Schenkman We're excited to have you here. And I want to just kind of first start out with what brought you into the field, because at this point, you've done so many things in the field and have been such a wonderful voice for us and for fellow millennials, really, when it comes to colorectal cancer prevention and research and all things colorectal cancer. But kind of what made you decide to go into gastroenterology in the first place? Yeah, way back. 01:33 Dr. Fola May You know, it's kind of funny because I always say it was meant to be. When I was doing my pre medical training and even in medical school, I was fascinated by the abdomen. I used to call it the black box. Like, what's going on in there? 01:44 Melissa Schenkman Like, someone's a good one. 01:46 Dr. Fola May Like, but where is it coming from? So many organs. So I knew I was going to do something either in colorectal surgery or and gastroenterology. And then I, you know, went towards more medicine than surgery. So I ended up in gi and then there came an area in my training where I had to pick a research focus. And at that time, believe it or not, no one was really talking about colorectal cancer. No one was talking about young early onset, because that hadn't been recognized yet. And certainly no one was really talking about disparities. So it seemed like a great area to focus in. The ironic thing about the story is that right after I Declared that my research area was going to be colorectal. I found out that I had family members that were affected by the disease. 02:28 Dr. Fola May So that's why I say it was meant to because it ended up being very critical that I studied it and it helped my own family. 02:36 Melissa Schenkman Very, very cool. I did not realize that. Wow. Wow. And what about far as you were saying that's so interesting, Both young onset was not being talked about and the disparities, inequities. So that's my other thing I'm wondering is because you're in both of these spaces and there's such an interesting interconnectedness and mix between the why disparities and health inequities was a place that in terms of research, you said, this is where I want to go. 03:01 Dr. Fola May Yeah. I think for me, you know, I wasn't sure. I knew as a disease there were several areas you could focus in because we hadn't really learned about early onset yet, but we still knew it was a number two pancreas. So I think I went into it knowing that there were probably several different aspects of colorectal cancer I could eventually focus in. But what really struck me was that when you looked at the statistics, even back then, and this is early 2000s, black Americans were more likely to get and die from it. I had never heard that in medical school. And that was shocking to me that as a black American, as a medical student, I had never heard this. And it was so clear in the literature and in the statistics. 03:44 Dr. Fola May So as an individual who's interested in improving health outcomes for everyone, but particularly communities that like mine, it just made sense for me to have at least part of my research focus on the disparities. 03:55 Melissa Schenkman That makes complete sense. And speaking of what you're talking about, I actually was going to ask you. So there is a statistic and I know there are many out there, but that really illustrates what you're talking about is talking about how colorectal cancer cases and deaths are 20% and 40% higher respectively in blacks compared to whites. When it comes to health disparities and health inequities in colorectal cancer screenings. Can you describe for us what that landscape looks like geographically when we're looking in different regions of the country? Because I think there's a lot people don't know there. And then also racially and ethnically and also age wise, just for us. So we can kind of go through, start geographically, what are we looking at around the country? 04:36 Dr. Fola May Yeah, I think what I like to remind People with colorectal cancer is when we talk about disparities, there's many types of disparities. And you're picking up on this, right? Yeah, we have racial disparities, we have ethnic disparities, which is more about Latino health. We have age disparities, we have regional disparities, we have urban, rural disparities. So all of us kind of focus on different areas. And what I really love is that through my research career, I've been able to dive into a lot of these areas. When we look at racial disparities, the big two that come up are black white disparities, and then also a Native American or American Indian white disparities. Actually, Native Americans have the highest rates of colorectal cancer in the United States and black Americans are just under them. So those are the two most impacted groups. 05:21 Dr. Fola May They have the most cases, the most decks, and then unfortunately, their screening rates are lower than other groups when we look at Latinos. So this is more about ethnicity in the United States, actually our Hispanic population has lower numbers of cases and deaths from colorectal cancer than white individuals, but they have some of the lowest screening rates. And when you look at early onset, it's the Latino population that's having a bigger impact of early onset disease. So that's why we focus on that disparity, not because of the incidence and mortality details, but because of the low screening and the early onset. So race and ethnicity, it's complicated, but we look at them quite differently. As for regionality, it's really the southern United States where we see the biggest impact of this disease across all ages. So we look at that southern belt. 06:11 Dr. Fola May We used to call it the obesity belt or the metabolic belt, but it's also a cancer belt. So whether you're looking at white individuals, black individuals, it's going to be in that region of that of the United States where we're going to see the biggest impact. So we're trying to really attack all these different disparities at the same time. And then as you mentioned, for on top of that, in the last few years, we've really been focusing on early onset and people under 50. Yeah, it gives us a lot of work to do and it gives us a lot of incredible research that we can be doing to figure out how to reach these different populations. 06:42 Melissa Schenkman Oh, I bet. No, that is quite a picture that you're painting. First of all, I will say about the south, that's the first thing that comes to mind, of course, is diet. 06:50 Dr. Fola May Yes. 06:51 Melissa Schenkman As you're saying that So I can see that. But that's very interesting that's where it is. And as far as the ages, you got to put that on top of. Layer that on top of everything else. Yeah, there's a lot of work. 07:02 Dr. Fola May Absolutely. And you realize in the south, that's where we have the largest density of black individuals. So the rates are going to be higher because we know that's the group that has the highest rate. So it all kind of interplays together. I do work out of Los Angeles, so it's not in the South. So we do a lot of focusing on our black populations, on our Latino populations. You have a very large population of Latinos in the, in California, but I also have projects that are in South Dakota. So that's Native American communities and would love to do some more work in the south as well. 07:32 Melissa Schenkman That would be awesome. And what do you see kind of in terms of challenges as well as opportunities here, knowing that this is what the landscape looks like and what different populations are experiencing? 07:42 Dr. Fola May Yeah. You know, I think what's so tricky about this disease is that, you know, some of us have been doing work in this area for some time and we've had successes. When you look at individuals that are over 50, rates are down, deaths are down. When we look at individuals under 50, though, the rates are going up, the deaths are going up. So we still have a lot of work to do. I think the biggest challenge, honestly, is getting the information out there. You know, I am dealing with colorectal cancer every day, so to me, it just seems like everybody should notice. But I'm sure, as you see, we running into people who have no idea what we're talking about and don't even understand that colorectal cancer is the number key killer. 08:21 Dr. Fola May So a lot of it is us getting over the stigma, talking about it, getting the information out there, and then, you know, making sure that everyone knows that, number one, they have to be screened at age 45. But also the nuance to that is that if you develop symptoms and you're not 45, you get screened, you get a test earlier. And a lot of people don't understand that. They think that they're supposed to just wait till 45. So there's just a lot of misinformation and misunderstanding that we've got to correct in addition to getting screening tests in people's hands. 08:50 Melissa Schenkman Yeah, no, absolutely. And yes, I have found that. And it has really shocked me because it seems like to me, as you're saying with you, such common knowledge, or what's common knowledge to me, is not common knowledge to another. Another person. And speaking of the younger millennial age population, you know, in terms of research, I know you were doing in the process of doing some work looking at different, like testing different types of interventions and trying to see what interventions resonated most with which age groups. And so I was curious if you could talk a little bit about that. 09:24 Dr. Fola May Yeah, I could talk a little bit about it. We have a publication that's, I think, just about to come out. So I don't want to ruin the surprise, but what I'll say is that on my team at ucla, we are doing research across the board. But one research question that came up a couple years ago when they changed the screening age to 45, was the health system was saying, okay, we looked and we have 25,000 people who are between the ages of 45 and 49. 09:50 Melissa Schenkman Wow. 09:50 Dr. Fola May How do we capture these people? Because overnight, I got the information that you're supposed to screen at age 45 now, but there was no real instruction on how to get those people screened. So we came up with a really amazing study where we said, okay, let's take that group of 25,000, let's split that group into four groups, and let's try four different things. So for one group, we sent them a fit kit in the mail. We didn't even announce it, but they just one day opened their mail, and there's a big kit. For one group, we sent them an emr, an electronic medical record message through the portal that said, would you like to have a colonoscopy? For the third group, we sent them a similar message in the portal that it said, would you like to have a fit test? 10:33 Dr. Fola May And then for the fourth group, we said, there are two ways to screen fit and colonoscopy. That are the most common ways. Which one would you like? So it gave us the opportunity to look at all four of those types of inviting someone to get screened, and there was a clear winner. And the publication will be out hopefully in the next couple months. Fingers crossed. And people get to read about which method won. 10:56 Melissa Schenkman We definitely will. Very, very interested to see that. And that what brilliant idea. Because then you can find out, is it the messaging and then somebody taking their own action, or do they need it delivered right to the door to do that? Very, very smart. 11:10 Dr. Fola May And we knew that all of these methods work in different populations in the U.S. But we just don't know what works for this younger group. 11:17 Melissa Schenkman Yeah. 11:17 Dr. Fola May And as you know, this younger group isn't always getting medical care. They're not in doctor's offices often. So we have to find ways to speak to them that doesn't require them to come into the hospital or that. 11:28 Melissa Schenkman Exactly. 11:29 Dr. Fola May And that's why a lot of it is about mailed outreach, messaging them through the portal. So we're really excited about the study. Thank you for asking about it and I look forward to sharing about more about it when it comes out. 11:38 Melissa Schenkman Absolutely. 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Your voice won't just be heard, it will be deeply understood. 12:35 Melissa Schenkman So, and in terms of kind of looking at the, exploring the why behind these rising numbers which we all talk about, I know you are involved with ICRC's colorectal cancer care initiative, which is very exciting and does some things brings together a lot of different voices, I think is one of the most unique aspects that I hear about it. So I was just going to have you tell us a little bit about that initiative. 12:59 Dr. Fola May Yeah, this is an incredible initiative that fight colorectal cancer has been working on actually for years. And what's amazing is they've done it in partnership with important stakeholders. We've had patients, survivors, caretakers, people involved in policy and research all coming to the table to understand where are the continued challenges in colorectal cancer care and how can we set up metrics that as a country we can all aim for. So in this initiative, we've announced several goals. Some of them seem obvious, like we want to increase the number of people screened in the United States to 80%. We haven't been able to do that. Other cancer screenings perform better than colorectal cancer screening. So we have some work to do. 13:45 Dr. Fola May And very importantly, we also highlighting in this initiative that when people get a non-invasive screening test, like a stool test, and that test comes back abnormal, they then need to have a colonoscopy to make sure that there's no cancers or colons. But we're really bad at that currently in the United States. So we've also set a goal that 80% of people need to have a follow up colonoscopy within three months if they had an abnormal test. 14:10 Melissa Schenkman Great goal. 14:11 Dr. Fola May And then importantly, the initiative goes beyond screening to talk as well about cancer care. There are goals in there about patients who have been diagnosed with colorectal cancer and making sure that they get their genetic testing that they needed, make sure that they get treatment and the treatment started in a timely manner. So it's really looking across the whole spectrum of disease from screening to treatment for those who are diagnosed. And that's why I'm really excited about the initiative. 14:37 Melissa Schenkman That's. I can, I can see why. No, that's a fantastic initiative. And those goals, just having those specific goals with numbers. That's what I was about to say. Numbers are very important to reach. And I agree, you would think 80% like this is doable. This is very much doable. But no, that's very excited that you're involved in that. And speaking of which, you know, part of by CRC so much is about advocacy, you know, advocating for policy. And I know that is a big part of your role with them and also just across the board within your career. 15:10 Melissa Schenkman And so I'm curious if you could talk about kind of how that advocacy part, that advocacy role fits in with your seeing patients in clinic, doing research, you know, in the lab and out obviously in the system, in the real world data and things like that. How does that all fit together? Because I think a lot of people are kind of either just in the clinic or in research or in both, but you don't necessarily see them in the advocacy space always. And so I would love to talk about that. 15:38 Dr. Fola May Yeah, I think you're right. I think it's unfortunate. I think that there need to be more researchers and clinicians who are involved in advocacy. I would say this has been a major highlight of my career and something that I discovered probably about a few years ago and wish I had discovered earlier. And that's the fact that the best way for us to get the public to Understand, our research is to partner with people who are directly impacted by disease. So what I love about the work I do now is that I'm, you know, in a clinical setting taking care of patients one one. I'm in my lab, working with my team, developing research and evaluating things and publishing. But the advocacy gives me the opportunity to talk to people like you. 16:23 Melissa Schenkman Yeah. 16:23 Dr. Fola May Talk to other people who are invested on the patient side. That helps us push the research towards developing policy. Because I don't see the point of research and publishing a lot of papers and getting a lot of grants if it's not changing how we deliver care in the United States. And to me, that's the most important part. So what I. What I'm so excited about is that by being involved with organizations like bite, crc, and being an advocate as a physician scientist, we've been able to push our research to policy and to actually elicit change that way. 16:53 Melissa Schenkman That is absolutely wonderful. And I think it really, for those who are listening, who are in the clinic or in research or in both and haven't had that experience yet in advocacy, this helps them to know how important it is and how much their role would impact that. So I really appreciate that. And, you know, one of the things that I think I don't know if there's a policy change for. I wish there was, you know, some way to do that, but is primary care. Because as we get into this, everyone understands why I said I wish there was a policy change, but of some kind that would help. Because we've talked about before, and I've talked with several other people, is that a lot of millennials don't have that established primary care. Dr. 17:33 Melissa Schenkman And it's one of those really first points of care when it comes to, and you have said this before, colorectal cancer education and awareness. That gets missed. And so I'm curious for those who are out there, both fellow millennials and those our. Our friends who are Gen X, we appreciate everyone engaging with us, you know, who are out there and they're practicing and they're hearing about this because I talk with people in primary care all the time who. They're hearing about this, and they don't really know what's their role. And so I'm wondering if you have some recommendations for things that they should bring up in that annual appointment with somebody who's, you know, just standard, really. 18:11 Melissa Schenkman And that's why I say a policy change or guideline would be awesome, but, you know, who's not coming in with symptoms Per se, who maybe now is 38, 39. They're not there at the 45 mark. Like, what to be on their mind. 18:25 Dr. Fola May Yeah. 18:25 Melissa Schenkman Help in this space. 18:26 Dr. Fola May I think what I try to. To remind my, you know, my friends, my family, who are kind of at that later Gen X, early millennial phase, is that it really is important to establish care with a professional provider. I think what happens is that you feel young, you feel healthy, you feel like you don't need a doctor. We know statistically women are much more likely to have a doctor. 18:48 Melissa Schenkman Yes. 18:48 Dr. Fola May That is usually because, you know, we have babies. And when you have a baby, you suddenly are involved in the healthcare system and then you're like, oh, there's benefits of health care and you stay in. So we. We get women that way. But I think for men, it's really hard to get young men attached to care, especially primary care. So I agree. I almost wish there was like, a policy or a rule that, like, you have to have. Yeah. A primary care doctor, or you have to have someone who you belong to who can take care of you. So that's the first step is increasing the awareness that everyone knows that even if you think you're healthy, you need to have a primary care doctor. You need to have someone you see once a year to talk about things before you're sick. 19:25 Dr. Fola May So that's number one. And then I think number two, when you get into that primary care doctor's office, you have to be honest about your health. You have to be vigilant about your symptoms. You have to report them. You can't be embarrassed if something's going on, not to tell your doctor. I promise you, they've heard it before. People are always telling me, like, I'm embarrassed to say, and I'm like, I'm sure you're not going to say something I haven't heard before. So having that honesty and that open connection with your doctor. And you know, even when you're in your late 30s, you should be talking about colorectal cancer screening because you should be talking about whether you have a family history. Because if you have a family history, we're going to start you screening at age 40. 20:00 Dr. Fola May You should be talking about if you have a family history of lynch syndrome, which we know causes colorectal cancer, because those people be screen Even before 40. Okay. 20:08 Melissa Schenkman Yeah. 20:08 Dr. Fola May And then, you know, I even tell my friends who are in their early 40s, like, maybe you don't have a family history. Maybe your average risk. Yeah, maybe you're not going to screen until 45. But it doesn't hurt to talk to your primary care doctor in your early 40s, start discussing the different tests and what's going to best for you when the time comes. So I still think like late 30s, early 40s, this should be in the discussion with your primary care doctor and you should have a plan. When you hit 45, you're ready to go. 20:36 Melissa Schenkman I think that's an excellent idea. And I hope that we'll see more of that the more that this gets out there. I hope as a case, I really do. 20:44 Dr. Fola May I really hope that this country can focus more on preventive health. 20:47 Melissa Schenkman Yes. 20:48 Dr. Fola May I really hope that this country could understand that health, there's a right and that we can continue to give people access to that right. We have incredible technology here. We have incredible systems of care and we need to make sure that all of our citizens have access to it. 21:03 Melissa Schenkman Absolutely. I couldn't agree with you more. And one other last thing that I want to ask you, and you have lots of things happening, I know whether it's the month of March, colorectal cancer awareness, or throughout the year. You know, what are some things you're excited about in terms of research, in terms of your advocacy work that you have coming up that are on the horizon for you? 21:24 Dr. Fola May Yeah, absolutely. Thank you for that question. I'm really excited about a couple papers our lab has coming out. Can't talk about them just yet, but we're talking about one of them. So that's great because again, as we can get our research out into the literature, we can talk about it, we can share it, we can even share it with policymakers. The other thing that I'm really excited about is that I recently joined a panel with the ncqa. This is a national group that makes all the metrics for quality of care. And one of the metrics we're going to be making is how many people in your health system that had an abnormal screening test got follow up care. So this is a metric that doesn't exist right now. 22:04 Melissa Schenkman Wow. 22:05 Dr. Fola May I'm a true believer that if you don't measure things, you don't know there's a problem. And if you don't know there's a problem, then you can't have research and other solutions. So this is the first step is making the country measure this problem and then we can come up with better solutions. So it's such an honor to be on that panel and it will take us a few years to get through all the steps. But I'm really excited about that coming soon for everybody. 22:27 Melissa Schenkman That is very exciting. That is very exciting. It'll be very. It'll be interesting to see what those numbers when they come out and how they compare around the country. Oh, my goodness. 22:38 Dr. Fola May Exactly. There will definitely be differences. Yeah. 22:41 Melissa Schenkman Oh, for sure. I'm very excited to see that. Well, thank you so much for having us. This was awesome. 22:47 Dr. Fola May These are great questions. I hope that they help everyone. 22:50 Melissa Schenkman Absolutely. I know that they will. Thank you.