Latest / The YMyHealth Podcast | Wellness and Healthcare Insights for Millennials / Advancing Colorectal Cancer Prevention through RNA-Based Screening Innovation
Transcript
- 00:02 Melissa Schenkman Welcome to the YMyHealth Podcast, a healthcare podcast created by millennials for millennials. I'm Melissa Schenkman. And I'm Julie Woon. We're two members of Gen Y on a mission to tackle the health challenges unique to people in their 20s, 30s and 40s. With inspiring survivor stories, plus insights and practical advice from experts across the country. We've got you covered. Whether you're navigating a chronic condition, cancer, or challenges to your mental health, or you're trying to manage our complicated healthcare system and your prevent or just want to make smarter healthcare choices, this is the podcast for you. Let's get started. 00:40 Melissa Schenkman Welcome to the YMyHealth Podcast. It's your co host, Melissa Schenkman here and we're going to be talking about a topic that is so important to our generation, which is colorectal cancer awareness and screening options today. Because this is something we've talked about a lot. And with YMyHealth, we do a lot of advocacy work. And the numbers that are predicted, just for one example, by 2030 for people under the age of 50 is 27,400 people are predicted to be diagnosed. And so it's so important that we know what our screening options are that are out there. And as always, we love to stay cutting edge. And today is very cutting edge. We are super excited to have Dr. Erica Barnell here with us. 01:21 Melissa Schenkman She is the co-founder and chief medical officer of Genioscopy and she earned her MD PhD at Washington University School of Medicine and was focused in molecular genetics and she has led the development of ColoSense, which we're going to talk about today. It is the first FDA approved RNA based stool test for colorectal cancer screening and approved for Those who are 45 and up, which the oldest millennials are about to know that age very soon. And she's done a lot of work in the RNA technology space. And so we're really excited to have you. Welcome, Dr. Barnell. 01:57 Erica Barnell Thank you so much for having me. Please call me Erica. 02:00 Melissa Schenkman Okay, absolutely. Erica. 02:02 Erica Barnell Thank you. 02:03 Melissa Schenkman Will do. Well, just wanted to start off when you knew you were going to pursue medicine. There's so many different areas of the body that you can specialize in. What initially drew you to the field of gastrointestinal health? 02:16 Erica Barnell Yeah, I think there's really two types of medical students. There's the Grey's Anatomy, Meredith Gray, who has known they wanted to be a surgeon since they were four years old. 02:27 Melissa Schenkman Right. 02:27 Erica Barnell And then I think there's a lot of people out there that go to med school that are maybe more like me, like the Eliza Thornberrys, who just are kind of nerds and love science and spent a lot of time in their undergrad learning organic chemistry in the basement of their favorite library. And so when I went to medical school, I kind of really didn't have a vision for what I wanted to be when I grew up. But I've been doing a lot of research in gastrointestinal health. I had been doing a lot of clinical rotations as part of my medical training, and I actually met a woman who presented to the hospital with stage four colorectal cancer. She was just over 50 and she had kids and she had a job, and she was too busy to get screened. 03:14 Erica Barnell And I thought to myself, in the era of precision medicine, where we can sequence a genome in 24 hours, where we can provide individuals with so much comprehensive care, why are we offering colonoscopy as our only screening option? So at that point, I kind of founded geneoscopy with the hope to build diagnostic tests that could integrate with the lives of our patient more effectively and get patients screened where they are. 03:40 Melissa Schenkman Absolutely. That is really. I can see how that made such an impact and really kind of helped you in finding your path to where you can make such a difference. And you are making such a difference. You're welcome. And kind of, as you progress in your medical education, I'm really curious, with your years of research and training, what information was shared with you as a student, as a graduate student, about early onset colorectal cancer? And is there anything in particular that has stayed with you about that? 04:09 Erica Barnell Yeah, I think when you get trained as a medical student or even as an undergrad, you know, they're starting earlier and earlier with good reason. We're trained on what is healthy and what is disease, and we're being trained by physicians who have been in the business their whole career. And they're teaching you. A lot of what they're teaching you is maybe a little outdated. Maybe it's reflective of, you know, the culmination of their career, which could have started 60 years ago. And so I think what was really great for me is that I had the opportunity to join Sling health here in St. Louis. I had the opportunity to engage with a really robust ecosystem, startup healthcare ecosystem here in St. Louis, where I wasn't just learning from physicians, I was learning from entrepreneurs. I was learning from people in the healthcare industry. 05:02 Erica Barnell I was learning from people who engage with the FDA and engaging with payers. So I think being able to build the business not just from the lens of trained physician, but with kind of an integral entrepreneurial ecosystem. I think it made our business model and the ultimate development of geneoscopy really successful. 05:22 Melissa Schenkman That's wonderful. Absolutely wonderful. And as a physician scientist, kind of, what are some of the challenges and opportunities in medical care and research that you see when it comes to colorectal cancer in people under the age of 50? Absolutely. 05:36 Erica Barnell I think healthcare is a multi trillion dollar industry and everything is broken. So just kind of point and fix is my mentality. But, you know, I think especially our generation, you're talking about the millennials, we haven't thought about colorectal cancer. You know, I always say to myself, like, it's weird because this woman is born in 2010 and she's a young mom and I'm like, but I was born in 1990 and I'm also a young mom, you know? Right. 06:03 Melissa Schenkman And you got to. 06:04 Erica Barnell Don't view yourself in the same way. I don't view myself as coming up to an age for colorectal cancer screening. 06:10 Melissa Schenkman Is what I would say. 06:11 Erica Barnell So I think being able to start educating the community that colorectal cancer screening is for you. Colorectal cancer screening is for people who are under the age of 50. 45 is the new 50, and I think soon 40 is going to be the new 45. So trying to educate the community, trying to educate our generation that screening is important as we're starting to see a rise incidence and diagnosis of late stage disease in patients that are not 60 and up, but are 50 and under. 06:45 Melissa Schenkman Excellent points. Because it's true. It's very hard for us to see ourselves at that. Right. At that point. 06:51 Erica Barnell Right. 06:51 Melissa Schenkman I think that's a big barrier to things too, that people don't talk about enough. And in terms of kind of some of the biggest barriers. 06:57 Erica Barnell Right. 06:57 Melissa Schenkman When it comes to testing. So you had mentioned one of them, but time, which you were talking about time, the cost. I think when it comes to colonoscopy in particular, drinking the prep is a well known one. Yes. Which is just delicious. And yes, definitely. And honestly, I think knowledge about which test offers what and what tests are even available. 07:18 Erica Barnell Right. 07:19 Melissa Schenkman And as a fellow millennial who is an expert in science and colorectal cancer screening, kind of walk us through what today's landscape looks like in terms of our colorectal cancer screening options, because there are a lot, and I think a lot more than people realize, honestly, including wonderful Colisense. So, yeah. 07:38 Erica Barnell I think, you know, traditionally we've offered colonoscopy, right? Not only does that require you have active primary care visits, your physician's educating you on it, you get a referral, you go to the gastroenterologist, you consent onto the procedure, you do the prep, you complete the colonoscopy. So many barriers there, right? And a lot of people that are working, a lot of people that have young kids, a lot of people that are in school, a lot of people who, you name it, doing whatever it is that life brings, can't get that done. So I think we now have a number of non invasive options that have been FDA approved. I think that brings about what humans want, which is choice and opportunity. We provide a stool based test that is delivered directly to your home. 08:28 Erica Barnell So you can go on our portal, you can get a telehealth visit, it comes directly to your home. If you're qualified for one of our tests, you can complete the test in the comfort of your own home. We've mitigated a ton of barriers in terms of generating, producing a sample. So while most stool based tests require you to manipulate your stool and do a little science experiment there, our test does not require that you just poop and ship back. We've also mitigated a lot of that in kick factor. So you don't have to go talk to the FedEx person, right? It has a prepaid label, you just drop it off in that box and it comes right back to our lab. 09:08 Erica Barnell So I think at every touch point we've tried to make it really easy for patients and try to integrate into their busy schedules so that they can get screened with a test that they know is accurate and is going to provide them insight into their health. We without really interfering with their day. 09:26 Melissa Schenkman To day life, which is I think what makes things so effective. And you also have to have what you do and your team does, the knowledge of what those other barriers are to be able to design something in that way. And I think that for our generation that just works so well because of all those barriers easily being able to be overcome. And let's talk about rna. So, so ColoSense uses RNA technology. And so for our friends and listeners who are not in the science world, and maybe the last time they interacted with RNA was biology class many years ago. And that's okay. That's totally okay. I know that'll be the case for many in our audience. 10:08 Melissa Schenkman Kind of like tell us a little bit about what RNA is and what it can offer as a tool in research and to develop a test Generally speaking, how is RNA really useful in this way? 10:19 Erica Barnell Absolutely. And I'll say my favorite topic is actually Star wars, but I am more than happy. RNA is a very, very close second. And you're right, people kind of don't know the difference in terms of what it means for your health and what it means to your healthcare, but hasn't really changed since your seventh grade biology class. Right. So RNA is the messenger of the cell. I learned that on House of Rock or whatever it is. But it provides you with real time insight in what's happening in your cells, in your GI system. And so while there are a number of different DNA mutations or changes that can cause precancerous development or malignant transformation, a lot of those changes converge on a universal signature that we detect in stool samples. 11:11 Erica Barnell So whether you have an adenoma or a cancer that developed from a various pathway, all of that looks really similar to us. And that's how we can improve the accuracy of our tests and make sure that patients that are positive are going on to get a colonoscopy to have lesions removed. 11:28 Melissa Schenkman That's really fascinating to hear and super helpful. I think people are going to have a better understanding of why this is so important and so innovative. So my next question for you was about how does genoscopy's close sense test differ from the other colorectal screening test options that we talked about earlier? I know you've talked a little bit about some of the barriers that it has eliminated, which are awesome, but when you think about some of the others, if you could talk a little bit about that. 11:56 Erica Barnell Absolutely. So as mentioned, we're very different than colonoscopy. A lot of patients recognize that. But when it comes to kind of all the non invasive tests, I think it's not a one size fits all. Where I say our test really shines is in the younger patient population. So since we're leveraging RNA based markers for diagnosis of disease rather than methylation based markers, which can be correlated with age, we've maintained accuracy in the younger patient populations where other tests have not. Right. So I think especially for patients that are younger, our test may be more suitable just because of the biomarker that we're leveraging for diagnosis. The second big difference that we have, I kind of mentioned that it's kind of a touchless test. Right. 12:47 Erica Barnell You get the kit, you do what you normally do, you close it back up and you text US or text FedEx and they come pick it up from your door. I think when you look at some of the instructions for use for other tests. 13:02 Melissa Schenkman It's confusing. 13:03 Erica Barnell You're like, I gotta do what? I think I felt that way with COVID Right. I have two doctorates and I'm trying to get on a plane, and I'm like, wait, what do I have to do? And you don't want to mess it up, and you don't want to do anything wrong. So our lab has taken on the entire burden of handling the sample, and we've left the patient with just doing what they know how to do, which is going to the bathroom every day. So I think that's one of the biggest differentiators from us, from other tests. 13:30 Melissa Schenkman Absolutely. And I think that just makes such a difference. Cause I do. I know what you're talking about with the COVID test. Everybody's still. And you're like, oh, my God. And different companies, some are even harder than. Even more complicated than others. But, yeah, I think taking that out is really just more of our style, our generation style, I think, as well. And this could not come at a better time, as you know, because, like, even there are all of these. I feel like I don't even know what the frequency is these days, but either, like, every three months, sometimes. Sometimes it feels like more than that. There's either a study that's come out, you're hearing news stories more than, I think, over the course of the past 10 years, and you've heard before with regularity about the rise in cases. 14:10 Melissa Schenkman And the most recent one this month is there was, like this new study published in the Journal of the American Medical association, and it was based on data from the Dana Farber Cancer Institute, and it was talking about a lot of different types of GI cancers. But when it came to colorectal cancer, it was again pointing out that there's this alarming rise. But it also, at the same time, was Talking about the 45 to 49 year old group of people in our country and how that fewer than one in five get screened even though they're eligible for screening, yet you have this rise in cases. 14:44 Melissa Schenkman And so in your view, why is it important knowing all this as we continue to see these things as we approach our 45th birthday, which for most people who have reached this point, or about to reach this point, for the most part, is going to be happening in 2026 for a lot of them, and some, of course, second half, I think, of 2025. Why is it important for those of us, once we reach this milestone, to make colorectal cancer screening A priority. 15:09 Erica Barnell Yeah. I think you can't open the news without seeing something, especially in healthcare. Colorectal cancer is the second leading cause of cancer related deaths. It's the leading cause and going to be the leading cause of cancer deaths in men and women under 50, which is unbelievable. Unbelievable. And the reason it's unbelievable, it's the most preventable but least prevented cancer out there. Right. In the same way that if you didn't necessarily smoke, you have a less likely chance of developing cancer. In that kind of same way, if you get screened, you have almost a negligible chance of getting a late stage cancer. 15:50 Erica Barnell You know, it's not zero, but when I see things like Chadwick Boseman or James Van Der Beek getting colorectal cancer and again, they look my age and individuals that have probably great access to healthcare, so you start thinking about what's available to the general population, what's available to people our age, and how again can we integrate screening into our very, very bus. So I think the message again is just trying to convey how easy it is to get screened just to ensure that you're good in the same way that you're able to brush your teeth every morning, you drink your cup of coffee, you go use the restroom. It's that easy. 16:33 Erica Barnell And that's what I just kind of want to convey to people is not putting it off and making sure you get screened because we are seeing it and it's a part of our reality, unfortunately. 16:44 Melissa Schenkman Yeah, absolutely. Excellent point. And I think too it's hard because it's something that isn't necessarily visible. People don't visibly look sick. You're so right before you're diagnosed, like you have no idea. And so I think pointing out, and I agree is we each see these individuals who have had these unbelievable careers and I think the same thing as you like, oh, they have amazing access to healthcare. The cost isn't an issue. I'm sure they can take off, time to go do it. And so I think looking at all of that and realizing, and also it affects everybody. 17:17 Erica Barnell You're so right. And I think what's really great is I think relative to prior generations, I think we do care about our health. You know, we are such health conscious, we're such a health conscious generation and we very much care and very much spend a ton of time, resources and energy taking care of our health, that this is just one easy thing. There's no patient out of pocket costs. It's covered under the Affordable Care act, whatever insurance you have or even if you don't have insurance, we provide ways to help people pay for it. So I think again, just the easier we can make it for patients to get it done, the better our outcomes are going to be. 17:56 Melissa Schenkman Absolutely, completely agree with you. And one of the other things that comes up and I'm sure has come up in conversation with you before, it comes up in conversation with us every time. Of course we go also to fight CRC's call and Congress event in March. This is a topic of discussion is the age. And I have talked to many people about this. So I would love, and I know our listeners would love to get your view on this and kind of what you're doing, how that may change what that age is to. And your research is going to contribute to that very much as well, I think. So basically the screening age was lowered to 45, is lowered back in 2021. It's only a couple years ago, which is a huge triumph in of itself. Absolutely. 18:37 Melissa Schenkman But then we sit back and we say, okay, that's awesome. But when we look at the millennial generation, the first person that's going to reach that age or the first group is really later this year and then all in 2026 and that's one year's worth of people out of say 16 years worth more. 18:56 Erica Barnell Right. 18:57 Melissa Schenkman Unfortunately. So progress. But as we all know, there's more to go. In your view, what role do you see RNA based tests and also ColoSense specifically, especially with great data that you got in on it so far in the 45 to 49 age group, what role do you see in it? Possibly lowering that age? Because I know that's something that a lot of people want and also and ultimately more people who are younger getting screened. And I know there are a lot of factors that go into lowering the age. I want to say before you start, like I realize this is just one. 19:32 Erica Barnell From our perspective, we're like just do it right? What is the problem here? And I think if you think about it from the perspective of the people making these decisions who are doing the risk benefit analysis, it becomes a little bit more nuanced, right. The people that are making these decisions, it was colonoscopy first, non invasive test. If not right. The paradigm for that has completely shifted. If we're saying colonoscopy first, there are serious harms lowering the screening Age to 30. Right. The incidence of adverse events is very high. Those procedures are incredibly expensive. You can perf the colon, you can cause bleeding from removing polyps. The incidence in that patient population was relatively low and they didn't really have good non invasive screening options to triage to colonoscopy. 20:26 Erica Barnell So if you think about it, we don't have enough colonoscopy appointments, we don't have enough GIS to service an entire population 30 and up. We do have enough non invasive tests to service that patient population. There are truly no adverse events associated with collecting a stool sample. The biggest risk is accidentally sending patients to a colonoscopy to get a test and then ultimately it's no findings on the colonoscopy. So I think as the paradigm shifts in colorectal cancer screening to say non invasive tests first, especially for patients that where incidence is lower or where they have a lower risk and then colonoscopy as needed, I think that paradigm shift will cause the risk benefit calculations to change. And I think that is happening right now. So I think my anticipation would be that screening age is going to creep lower and lower. 21:24 Erica Barnell And especially if you have some risk factors like a family history or anything else that might contribute to an increase in disease, that's not a red flag symptom. I think we're going to start providing these non invasive tests in the same way we do for patients 50 and up or 45 and up. 21:40 Melissa Schenkman That is incredibly exciting. It makes my day to hear this. I honestly, after being an advocacy space for so many years and reporting on it's just wonderful to hear that. And I think so many other people who are listening are going to be very excited to hear that because there is no doubt that the majority of people really want that screening age to change and to not only hopefully get that in itself, but to get it with a non invasive test, which is like a billion times easier to do on so many levels in so many ways that you've talked about, is a real win. So very excited to hear your thoughts on that. 22:16 Melissa Schenkman And as a person who's been working in cutting edge research in the gastrointestinal health and diagnostics space, what are you most hopeful about in addition to what were talking about? But you know, what are you most hopeful about when it comes to early onset colorectal cancer in our generation? 22:32 Erica Barnell You know, I think again, colorectal cancer is the most preventable but least prevented cancer of our generation. And I think we have the opportunity to kind of prove cancer wrong. Right. I think we know that when patients are adherent to screening that outcomes are good. We know that we can eliminate colon cancer screening or colon cancer if patients are screened. And I think we're starting to get the ammunition to actually do that. We're starting to have a number of non invasive tests that are available to patients, whether it's a blood test or a stool test, whether it's a fit test or a molecular test. We're starting to have multibillion dollar companies that are directing every single one of their resources to advocacy, to education, to provider education, to convincing payers that this is important. 23:22 Erica Barnell And so I think after having built that army, that infantry, that battalion to attack this disease and specifically address the rising incidence in younger patient populations, I think were really just at the forefront of that battle. And I feel very hopeful and very confident that five years from now, 10 years from now, we're not going to be having a conversation of how can we educate people to be screened. We're going to be having a conversation of how can we screen even earlier, or how can we do multiple cancer screenings in a single bowel movement or whatever it is. So I'm hopeful that the transition will happen where we're not talking about compliance and we're talking about improvement of the existing technology that we have to address whatever else might pop up. 24:11 Melissa Schenkman That's very exciting to hear and something to very much look forward to. Very positive to think about. And as we wrap up today's episode, is there anything on the Rising with genoscopy work that you would like to plug and how can our audience connect with you? 24:28 Erica Barnell Absolutely. So I think I have been building Colisense for the last 10 years, you know, since I met that woman with colorectal cancer as part of my clinical rotations. But I'm an inflammatory girl at heart. My roots are inflammation. And I think I'm really excited to get back to our pipeline products which are in the inflammatory bowel disease and irritable bowel syndrome spectrum. So we're also building non invasive tests in the same way that we built for colorectal cancer screening for patients with gastrointestinal distress to again, give them a lot more insight into the inflammation in their GI system and how we can potentially address it. So that's what I've been working on recently. And I think the combination of inflammation and oncology will really hopefully serve our patients and provide a comprehensive assessment of their GI health. 25:20 Melissa Schenkman That's awesome. That's very exciting. I know there are a lot of millennials who have inflammatory bowel disease and so I think are always looking for solutions with that. So it's wonderful that you are developing diagnostics for that very exciting. Well, thank you so much for joining us. This is so exciting to hear about the cutting edge technology you have, the tests and really just I think so much of the time we hear so many stories about the rising cases and like you said, we're so for most people so proactive about our health and we want the tools and it's finding those tools. And so talking with you, it gives me a lot of hope. I know it will give others a lot of hope as well. 25:56 Erica Barnell Thank you so much Melissa. It was a pleasure being here today. 25:59 Melissa Schenkman Thank you. Thanks for tuning in to the YMyHealth podcast. We hope you're leaving inspired and informed. Be sure to follow us on your favorite podcast platform so you never miss an episode and share YMyHealth with your friends. 26:11 Erica Barnell Have a story to share or a question for us? 26:14 Melissa Schenkman Connect with us @ymyhealth on social. 26:16 Erica Barnell Media or visit our website at ymyhealth.com 26:18 Melissa Schenkman until next time, remember, your health journey starts with the right information. Stay healthy.