Early Detection Better Protection - Colorectal Cancer Screening in the Workplace: A Panel Discussion

Quest Webinar: Colorectal Cancer Screening - Workplace program: A Panel Discussion

Title: Early Detection Better Protection Colorectal Cancer Screening in the Workplace: A Panel Discussion

0:09
Sure.

0:09
I think you're up.

0:11
Good afternoon everyone.

0:13
Was going to give people a few minutes to get logged in and everything, but we are going to go ahead and get started.

0:20
Hello, welcome to Early Detection Better Protection, a panel discussion on colorectal cancer screening in the workplace.

0:29
We have just a few announcements before we begin.

0:33
Throughout this presentation, we invite you to post text based questions by selecting the Q&A submission box on the top right of your screen.

0:41
Your question will not be viewable by other attendees at the end of today's presentation.

0:46
There will be time for the presenters to address your questions in your presentation console.

0:51
You may resize any window and interact with all elements.

0:54
We've included some helpful links and materials in the Resources section in the bottom left of the console.

1:01
This presentation will be available for on demand viewing 24 hours after its conclusion And after this event, you will receive a follow up e-mail with the On Demand link.

1:11
Thank you for joining today's presentation.

1:14
It's my pleasure to introduce our presenters for today's webinar.

1:18
Acting as our panel moderator today is Doctor Alicia the Single, the Senior Medical Medical Director for Advanced Diagnostics and Women's and Reproductive Health for Quest Diagnostics.

1:29
Next up, we have Doctor Kruzel who serves as Medical Director of Oncology at Quest.

1:35
Additionally, let me introduce Doctor Brasil, the Director of Medical Affairs at Pack Health of Quest Diagnostics Company.

1:42
Finally, we are also fortunate to welcome Allison Rosen, a patient community policy and research advocate in the colorectal cancer community.

1:53
Thank you so much to our panel of speakers for being here today.

1:58
So what can you expect to learn from today's discussion?

2:01
Here's an overview of what we'll talk about.

2:04
Doctor Cruiselle will address questions on the landscape of colorectal cancer and the importance of screening and early detection.

2:11
Next, we'll discuss some facts and myths of in home screening options.

2:16
Then Dr.

2:17
Brasa will talk about her experience as an oncology nurse.

2:21
Finally, and this is the part I'm looking forward to the most, we'll introduce you to Allison, who is both a cancer survivor and advocate.

2:28
She will share her powerful story.

2:31
Then we'll leave you with a few key takeaways and next steps so that you'll leave this conversation empowered to take action within your organization.

2:39
Finally, we will wrap up with AQ and a session.

2:42
Please remember you may submit your questions through the Q&A dialogue box in your presentation console at anytime during this presentation.

2:50
OK, let's dive right in.

2:51
Doctor Alicia will be leading our discussion today as our moderator.

2:55
I'll turn it over to you, Doctor Alicia.

2:57
Great.

2:58
Thanks, Shay.

2:58
And you know, to the audience, thank you all for showing up.

3:01
This is a very, very important issue that impacts all the people that we're responsible for taking care of.

3:09
Doctor Grisel, you, you've been around oncology for a long time.

3:13
Thank you so much for, you know, being the lead off batter here.

3:17
So tell us you know about colorectal cancer screening.

3:21
Why is this so important?

3:23
Sure, thank you, Pat.

3:25
Thank you to the audience for attending today and and thanks for having me today.

3:29
I think we need to start with the understanding the importance of colorectal cancer is specifically as a disease and then understand that'll lead us to understand really why screening is so important.

3:40
Colorectal cancer really is a disease that can strike almost at any age.

3:47
In adulthood.

3:48
We're seeing that one in five adults are diagnosed with colorectal cancer under the age of 55.

3:53
It is consistently the third leading cause of cancer death among adults behind breast and lung and prostate in men.

4:04
And it is the the 4th leading cause of death.

4:08
Sorry, third leading cause of cancer incidents and 4th leading cause of death amongst patients.

4:13
However, the bright side is that when caught early and when we really stick to our screening protocols, the survival rate of of early stage colorectal cancer can be over 90%.

4:25
However, if you have spread to metastases, that survival rate does go down significantly and to somewhere around 13% depending on the literature you'll read.

4:35
So the importance of screening is, is that this is a very survivable disease.

4:40
You just have to find it.

4:42
It's an easy disease to screen for as well as we'll, as we'll talk about in just a moment.

4:48
So picking up on that, the screening.

4:52
Screening obviously is going to involve feces or your poop.

4:55
Nobody likes to talk about poop, you know, but it's one of those things that's critically important if you're going to catch it early.

5:01
And again, if you catch it early, 90%, you know, if you catch it late, not so much.

5:05
So tell us about the screening.

5:07
Take us through the process.

5:09
I hope it's easy.

5:10
Yeah, it's, it's, I call it the oh factor, right?

5:13
And we, we all go to the bathroom, we all have bowel movements.

5:16
But, but no one wants to talk about it and certainly no one wants to touch it.

5:20
And the gold standard before and above is still colonoscopy.

5:24
However, some patients have a lot of reservations about having colonoscopies performed.

5:28
So there are options out there that really help you to have a test prior to a colonoscopy that might indicate that you really should get a colonoscopy.

5:38
Or if, if the test results come back as as negative, you can, you can, you know, put the colonoscopy off for, for a period of time though the way and the what we're talking about, particularly at Quest Diagnostics is a product called Ensure one and ensure 1 is a really nice approach to screening for colorectal cancer.

6:03
And I say nice specifically because if you can watercolor a painting, you can form this test.

6:08
It has no manipulation of the stool at all.

6:11
You're not touching the stool and there's no free pre medications to, to take.

6:18
There's no medications or dietary restrictions to perform this assay.

6:22
You just go to the bathroom and you simply swirl the, the, the included brush in the toilet water.

6:28
You don't have to touch the, the the stool at all.

6:30
And then paint that water onto the included brought and included paper and send it off.

6:38
And that's it.

6:38
And the, and the short time later you'll get your, you'll get your results.

6:43
And so it's so easy to do.

6:45
It really does save lives.

6:47
As I talked about earlier, the, the, the survival rate of an early detection is over 90%.

6:53
So these patients have a lot of, lot of hope and a lot of opportunity to, to beat this disease.

7:00
So take home message there, you know, paint the water, put it on a card, send it in the mail, you get the results back.

7:09
So Kelly, I know that you're an oncology nurse, but you also have a personal story.

7:16
I think that that to share with the audience.

7:18
We all have personal stories, but we'll let you share yours because I think that'll that'll be enough.

7:23
So tell us, I think about your husband taking the test.

7:28
Yeah, absolutely.

7:29
Screening starts at home, right?

7:31
We have to practice what we preach.

7:32
And we're very fortunate that our employer provides the testing for individuals within our company who meet the screening guidelines.

7:41
And so each year, my husband receives a kit in the mail.

7:45
And he was like, what is this?

7:47
What is this all about?

7:48
And you can imagine he was a bit hesitant around this.

7:52
He's from Ireland.

7:53
So he's like, what exactly are you trying to do to me here?

7:57
And I said, you know, this is a great simple way for us to just get a first pulse check on how you're doing and what might be happening in your body that we can't see.

8:08
So I had to give him a lot of coaching and support to get him to take the test.

8:13
But once he did, he said, you know, it wasn't as bad as I thought.

8:17
I don't really want to talk too much about it, but in the mail it went.

8:20
And as a result of that, we have feedback and insights that tell us that thankfully he's he's healthy at this point.

8:27
But we also have a baseline from switch to screen on an annual basis.

8:31
So grateful for the opportunity to start practicing at home.

8:35
And as Doctor Cruzell said, a very simple process that even my husband, who's does not work in healthcare, was a bit squeamish about.

8:44
The concept was able to successfully execute And and thankfully now we're on the right path to knowing year to year how he's doing.

8:54
Thanks Kelly.

8:56
Again, no preparation.

8:58
It's easy.

8:58
It's never going to be normal.

9:00
It's always you know going to be a little whatever, but it's easy.

9:04
And I think that that's that's the most important take home point Mark Kelly mentioned about, you know, employees.

9:12
What does Quest do is since we're a large employer, what does Quest do in terms of employee screening?

9:18
Can you talk a little bit about that?

9:20
Yeah.

9:20
So obviously we have a very extensive program to actually screen our employees, but also to provide follow up care to those employees that might get a positive result.

9:29
And we do that with a Quest virtual app where we can really enter engage with the with the patient that has a result that might be concerning and might require some follow up.

9:41
And it really can help guide the individual to the right next steps, right.

9:46
We can really help them to coordinate.

9:48
This is something you need to go see your PCP about and, and, and provide the helpful opportunities for engagement down the road as well.

9:56
Kelly's company as well is, is Pack Health is very well poised to provide patients with the necessary engagement to follow through not only on their screening, but then also follow up on their appointments with their clinicians as they need one.

10:14
So I think that, you know, Kelly, you made a great point.

10:16
You have a baseline now that's negative.

10:18
That's very important.

10:20
The other thing is, if it's positive, it doesn't necessarily mean that you have cancer.

10:25
It means that you do need to be evaluated because, you know, blood in the stool, stool can cause, you know, because any number of things, it can be a hemorrhoid, it can be a fissure.

10:34
It's not necessarily a cancer, but you want to get it evaluated.

10:38
Mark, you're going to say something.

10:40
Yeah.

10:40
And I think that's an important call out here.

10:43
And, and I'm, I'm kind of looking at some of the Q&A questions coming through.

10:46
And there there was one that just recently popped up around what is what are we exactly testing for in this this assay specifically looks for blood and looks for blood in the in the toilet water in the stool.

10:59
And there are multitude of reasons, one of which one of the primary reasons can be a a bleeding ulcer within the colon, which is a precursor to or can be part of the colon cancer process.

11:14
But there are others, fissures, hemorrhoids, things that other, but all of those require some medical follow up.

11:21
So I think the important thing here is, yes, we're focusing on colorectal cancer, but really this can identify several other states that that would need some medical follow up.

11:31
OK, great.

11:31
Love the fact you're taking questions in real time, even though we said we're going to hold them to the end, never follow orders.

11:37
That's good.

11:38
OK, so let's switch gears here for a minute now, Kelly, you're a nurse.

11:47
You you work at a big time Cancer Center.

11:50
You've worked in the clinic, you've worked on the floors.

11:54
This is a tough disease.

11:55
You know, if you're cut, if it's caught late, what does it look like?

11:59
You know, and I because the objective here is to catch it early, you know, but even if you catch it a little bit later, doesn't mean that, you know, life as you know it is over.

12:10
But what does it what does it look like for you?

12:14
Yeah, absolutely.

12:14
And thank you for for allowing me to respond as a healthcare professional.

12:18
And certainly will defer to Allison for her lived experience as a survivor as well.

12:24
But as a healthcare professional, understanding the difference between early detection and later stage identification of colorectal cancer is significant.

12:35
It's significant both in the terms of the types of treatment that people may need in order to address their colorectal cancer and its progression.

12:45
So to give you an example, clinical practice guidelines which we as providers follow to determine what treatment is best, instruct us that at a lower stage disease, particularly disease that hasn't spread to the nodes in the body, lymph nodes, we're able to often treat that presentation of colorectal cancer with surgery only and then active surveillance to see if there's any additional spread that would require additional intervention.

13:15
Once the disease has spread to the nodes, then we're looking at a scenario where we really have to go to chemotherapies and other types of therapies and that can be very intensive.

13:27
The difference in symptoms that occur with surgery only versus surgery plus chemo can really make a huge difference and the published literature reinforces this message for us.

13:39
It shows that individuals who are survivors of colorectal cancer often are struggling with late and long term effects that continue even beyond their treatment.

13:50
One of these is neuropathy.

13:52
That's a particular type of experience where you may lose sensation in your hands and your feet, and this can be persistent and is related to chemotherapy.

14:02
So if we can avoid chemotherapy, we can potentially alleviate one of these symptoms.

14:07
So I think to your point, Pat, that you're asking about really early detection is the difference between the types of treatment people are going to receive, the long term side effects they may experience as a result of that treatment.

14:20
And then for our employer teams on the call, how, when and with what modifications an individual may need to return to work.

14:28
If you can imagine surgery happening, maybe a quicker return to work then with persistent chemotherapy, for example, I think that's really important.

14:38
And I think that, you know, for the audience, we want to really focus on the medicine, you know, the money, the finances, you all are certainly going to be aware of, you know, because care is it really is the core of what we're doing in this discussion.

14:53
It's pretty clear if you catch diseases early, it's, you know, cheaper than if you have to, you know, manage patients in the late stage of disease, whether that's in dialysis or heart disease or whatever.

15:06
We have a tool here that can be used to screen these populations and identify them early.

15:12
So I want to make sure that we separate the money from the medicine.

15:15
And I know that people aren't, you know, are going to be asking about that later on.

15:19
And for that, I'm going to probably refer you to one of our, you know, product specialists or whatever, because I want to keep this focus on what we do as healthcare professionals, which is really care.

15:30
And Kelly, I think that you you've seen you've seen that now I think the most important, you know, part of this discussion is really next.

15:39
And that's Allison.

15:40
And Allison is a real treasure.

15:43
She's was a young woman when she was, you know, diagnosed with colon cancer.

15:50
She was working and she's a survivor now, but she's not only a survivor, but she's an advocate.

15:58
And she really had said inspires us to do better for everybody.

16:02
So I'm not going to ask Allison a whole lot of questions or maybe any questions.

16:06
I'm just going to let her start and tell her story, the audience.

16:10
And then we're, you know, and when we close on this after Allison, we're just going to ask, you know, 3 messages.

16:17
And then we're going to open up to you all because I think that, you know, we can be on the firing line here.

16:22
We want you all to ask questions of us and we'll answer them as best we can.

16:26
So with that as a preamble, Allison, it's all yours.

16:30
Thank you.

16:32
Well, first of all, thank you so much for allowing me to be here to tell my story and help educate and, and and hopefully prevent colorectal cancer.

16:42
So like I said, I'm, I'm Alison Rosen.

16:45
I'm a 12 year early age onset colorectal cancer survivor.

16:49
I was really knowledgeable when I was diagnosed.

16:52
I was working in the Cancer Research lab, but I, I really, you know, it doesn't matter where you live, where you work, who you are.

17:00
Colorectal cancer can happen to anyone.

17:02
I started experiencing symptoms that were sort of unusual to me.

17:08
Change in bowel habits, unexpected weight loss, I thought was from Zumba.

17:12
Used to do Zumba all the time, still do it now.

17:16
Severe fatigue, which also I thought was from my working out because I literally was at that point the happiest and healthiest I've been in my life.

17:25
So I started experiencing weird symptoms.

17:26
Blood, there was blood in my stool, a little bit of blood in my stool, which was probably the, the biggest thing that that alarmed me.

17:33
Besides when I ate, I felt like food was stuck inside me.

17:37
So I luckily I had, I had a great doctor.

17:39
I talked to my doctor.

17:41
She, she said, OK, well, let's do an X-ray.

17:45
We did an X-ray.

17:46
It looked like I might have some sort of blockage in my GI tract.

17:50
She gave me something to drink to help clear that up.

17:53
It didn't quite do that.

17:54
So we moved to colonoscopy.

17:58
And so it was, I think a week after that X-ray that I went in for a colonoscopy.

18:04
And, you know, we, we talked about screening and people talk about the dreaded prep.

18:08
You know, I, I knew I had to do it.

18:11
I knew something was wrong and, and it was no big deal for me.

18:14
But the thing that that stands out to me the most from from the beginning of my, my cancer journey is I woke up from my colonoscopy and my, my doctor said, well, we found something growing inside you.

18:25
We don't know what it is, but it's blocking anything from moving down your colon and in about, you know, two or three days, we'll let you know.

18:34
So two or three days.

18:36
But she didn't mention did the other thing she did say I don't think it's cancer.

18:40
She said that.

18:40
So she used the word cancer, which I talk a lot to healthcare providers about empathy and conversations and way to way to talk to, to patients or whatnot.

18:49
Now, I don't know if if you know if it would have made a difference if she had said cancer or not.

18:54
But you know, the next two days were kind of a blur for me.

18:57
Again, I worked in a research lab across the street and I had heard the word cancer.

19:01
So two days later, when she called me and asked me to come to her office to give me the news or just, you know, to talk to me, basically it was like, can you come over?

19:09
I have some news for you.

19:10
I walked over to her office from I was in the middle of doing an experiment in the lab, But obviously I stopped what I was doing, walked over there.

19:18
I was on the phone with my mom crying because I knew my life was about to change.

19:22
She had mentioned cancer.

19:24
She just, I just had this, you know, this idea in my mind and I knew I wasn't feeling well.

19:30
And even as someone that worked in oncology and Cancer Research lab, I had gone to Google and I looked up different things.

19:36
It could have been so many different things.

19:37
But I walked into her office, she put me in a room, told me I had colorectal cancer.

19:43
She didn't know the stage yet because the biopsy results, it looked like there was inflammation in my lymph nodes.

19:50
But I needed to find an oncologist.

19:51
I need to find a surgeon.

19:53
I also needed to find a new GI doctor because she was leaving her practice and and that sort of began my cancer journey.

20:01
The fortunate fortunate for me, I did work in the Texas Medical Center.

20:05
I had access to amazing care.

20:07
I reached out, had multiple different opinions from multiple different people.

20:11
And 12 years ago, standard of care for for someone like me that they knew it wasn't stage one, but they thought three.

20:20
They had they They suspected Stage 3.

20:23
I had chemotherapy, I had radiation, I had surgery, I had chemotherapy again and then another surgery that was sort of like the first year of my treatment.

20:34
When they went in for my first surgery, they they went in and my colon was just all sorts of there was, it was disease, it was, it was inflamed.

20:41
It basically fell apart in the surgeon's hand.

20:45
So they gave me, again, standard was a temporary ostomy and I don't know if anyone knows what an ostomy is, but essentially they take part of your intestine and essentially you have a bag that's attached in, it's on the outside part of your intestine.

20:57
It's called the stoma.

20:58
They put a bag on you and essentially your stool empties through that.

21:02
So they gave me a temporary ostomy, allowed me to heal and then reverse me again.

21:07
But that sort of began a lot of of issues for me.

21:11
You're supposed to like get better.

21:13
Essentially for me, I, I just got worse.

21:15
I had infections.

21:17
I went into septic shock a few different times.

21:20
Luckily, you know, I had medical care around the around the street.

21:26
So I was in the ER and in the hospital quite a bit.

21:28
But the the side effects for me from all my treatment were not great.

21:36
Eventually, after a year of sort of struggling with infections, I had a a shared decision making, amazing conversation with my surgeon and we decided to make an ostomy permanent.

21:46
And as a young woman, I was trying to prevent that from happening.

21:50
I didn't want that.

21:50
I didn't have enough knowledge to know that my life would be the same.

21:55
I had just again, I didn't have a chance to talk to anyone my age.

21:58
I didn't psychologically, I wasn't necessarily in the mindset to to be like, yeah, let's do it.

22:05
But once I had it and I realized I started getting better.

22:09
So I have a permanent ileostomy now.

22:11
I started feeling better.

22:12
I started gaining weight.

22:13
I started being able to eat what I wanted to eat.

22:15
I started being able to, to, to work out again.

22:19
I started to be able to travel again.

22:21
So I started to get my life back.

22:22
And then I found a colorectal cancer community of advocates.

22:26
When I found advocates and other patients like me, I realized I wasn't alone and I realized my story mattered.

22:33
And so I started getting involved in patient experience committees.

22:36
I started getting involved in policy work, going and making sure there's more funding for research.

22:43
And I started talking to the community on social media about screening and early detection.

22:47
If I had known a little bit more, if I had gotten screened earlier, potentially I could have prevented myself from having to go through all the things that I went through.

22:56
We talked about long term side effects.

22:58
Unfortunately, a lot of times after you're done with treatment, it's in the invisible disabilities that people don't necessarily see.

23:07
You see in the picture, I look perfectly fine.

23:09
You know, I'm, I'm happy, but I'm not necessarily the most healthy.

23:13
I mean, I'm able to, to do everything I want now 12 years later, but I still deal with chronic infections.

23:20
I have osteoporosis, fertility.

23:23
My I was post menopause after my radiation.

23:26
So I no longer can have the option of having children.

23:29
So I think with some of those things, osteoporosis, menopause, neuropathy, I have chronic neuropathy.

23:36
Chemotherapy gave me what I call chemo brain and what people call chemo brain.

23:41
So my mind, you know, I still have, I think, a sharp mind, but I switched careers from working Cancer Research to work in public health.

23:49
That was partly, partly because I was an advocate and I really wanted to help educate community and people about the importance of colorectal cancer screening.

23:56
But also I didn't, I didn't think I was really able to do my job anymore.

24:00
So cancer really affected me in a lot of ways, but also I wanted to take a negative and turn it into a positive and use the story and use everything that I went through to tell people about the importance of screening.

24:12
And I often hear people say colonoscopy, colonoscopy.

24:16
And I'm like, wait a second, there are other options besides a colonoscopy.

24:20
You can do all these tests beforehand and then yes, if there's positive or there's something that pops up, you still will have to do a colonoscopy.

24:28
But if I hadn't gotten screened and so many people that I've talked to within the community hadn't gotten screened when they did, they wouldn't be alive.

24:35
My oncologist told me flat out when I went to him, he said my cancer was so aggressive that if I'd waited even a month or two to get screened, I wouldn't be alive.

24:44
I wouldn't be here talking to you right now.

24:46
So my life and my purpose is to help people educate about the importance of screening and no other options.

24:54
First of all, know the signs and symptoms, but no other options because oftentimes you don't have any signs or symptoms of colorectal cancer and a screening is what picks that up.

25:03
And then you can potentially be saved from having to go through chemo and radiation and surgery and all the long term effects that I had to go through.

25:10
I don't want anyone else to have to go through what I went through.

25:13
And that's why screening is so, so vital and so important.

25:18
When I worked in the Medical Center, my institution offered screening.

25:23
It was just like when we got the flu shot.

25:25
So we got the flu shot, which was required to work in healthcare.

25:28
We got an option to have a screening test.

25:31
And I think I don't know the stat because I left before that, before the first year of that was done.

25:37
But I know that I've heard from my Co workers that work there that it picked up, you know, pre can't, it picked things up.

25:44
People got colonoscopies and cancer was prevented.

25:47
And I think it's so powerful.

25:48
It's such a powerful tool because people often don't want to take off work, don't have the time to leave, you know, their families and travel to help their system so they can get screaming through their employer.

26:00
And it's, you know, it's it's rewarded for getting screened.

26:03
You can help save a life.

26:04
And that is a fact.

26:06
I mean, I know that from experience.

26:08
I know that that the people on here talking know that from experience.

26:11
And I think you have such an opportunity here to save lives and save lives like me, your mother, your sister, your brother, your cousin, your best friend and people that, that, that work for you.

26:24
So I think I'll end I'll end my story saying that, you know, I, I deal with long term effects, yes, but I'm alive and I have a purpose in life.

26:34
And that is to help share my story, share my experience and all the things I did have to go through to get to where I am at at now.

26:41
You know, an amazing job, amazing set of friends, amazing family and amazing platform to share my story again in an effort to help you save lives.

26:54
Just to the Allison, I don't know what to say.

26:57
Just to the audience is the first time I had ever heard Allison's full story.

27:03
And I wasn't aware of the osteoporosis, the neuropathy, the menopause, infertility.

27:09
And I think what you the take away here is you're seeing the face of courage here.

27:13
And I and Allison, I can't thank you enough for sharing that story with us because again, we can pick these up early.

27:23
You know, we, you know, and I think that's the message here.

27:27
You know, you're living your purpose and you're sharing.

27:29
You're going to save some lives today because we're going to be talking about colorectal cancer screening.

27:35
And this isn't about us selling a test.

27:37
I want to get that off the table.

27:39
This is about us as employees and our employers providing something that's incredibly important to our employees.

27:49
They rely on us.

27:49
They're incredibly important to us.

27:51
We provide them, you know, care in a lot of different ways, but this is a simple test.

27:56
Like Doctor Crussell said, it's water coloring using toilet water, you know, and it's on a, a small card that you send in a small envelope and it comes back.

28:07
If it's positive, get a followed up.

28:09
If it's negative, you have a baseline.

28:12
I want to stop there, you know, for just a moment and, you know, have you all assemble, begin to assemble your questions.

28:24
And then I'm going to ask, you know, Mark, Doctor Grisel Kelly, Doctor Brazil, and then certainly Allison, you know, for the messages you want us to leave with before we get to the Q&A.

28:41
We've heard from a medical expert, a nurse, and one of the most incredibly courageous women I've ever seen or met or heard.

28:52
We have his employers have responsibility and we at Quest and all the other, you know, organizations that provide these services are here to serve you.

29:02
So, Mark, what do you want us to remember?

29:07
Doctor Grisel, what's your message?

29:08
Yeah, I think, I think first and foremost, one in five under 50 is is such an important statistic.

29:15
And then the testing is easy.

29:17
It's it's an easy thing to perform.

29:22
Kelly, early detection saves lives.

29:26
You heard Allison say it.

29:28
And this is a simple, easy way that we can support the communities that we live in, working and serving to have a really positive impact.

29:41
And then Allison, my take away is younger and younger and people are getting colorectal cancer and is preventable through screening.

29:50
So if you have a colon, you're at risk.

29:53
I say that often, and you can help save lives by offering screening.

29:59
And then I'll just say that as employers, you know, we have a responsibility.

30:04
Maybe it's my Jesuit upbringing or whatever, but we've been given a lot.

30:07
We've been given this platform, and we have a responsibility to take care of those that depend on us.

30:13
And finally, you know, as healthcare professionals and providers, you know, we're here to serve.

30:20
Care really is at the core of everything we do and you all give us an opportunity to do that.

30:26
So with that, I think we'll go to the Q&A and I'm not exactly sure how that's going to work, but I know we've got great people, you know, in the background helping us with that.

30:36
So take it away from here.

30:41
Thank you so much, Doctor, Doctor Alegia, and thank you all.

30:45
Thank you to Allison.

30:46
Thank you to Doctor Brassell, to Doctor Cruiselle and Dr.

30:49
Alegia for for their presentations.

30:51
We do want to take some time to answer some of your questions.

30:54
We've already seen lots of submissions, so just truly appreciate you taking the time to submit those.

31:00
I'm going to go ahead and address address the group with some of their questions that we've received so far.

31:09
So I'm going to start out with one question that we received and I believe this would be for Doctor Cruzell.

31:16
The question is this, how does this test compare to other options that are entering the market, for example, the shield blood draw screening?

31:27
Yeah, so that's a great question.

31:30
I think, you know, blood is definitely going to be our future.

31:33
We're seeing that across the board, particularly in oncology.

31:37
However, blood is dependent how frequently a tumor sheds into the bloodstream.

31:43
And so tumor shedding increases with stage.

31:46
So the higher the stage tumor, the more likely you'll find it.

31:49
Unfortunately some tumors don't shed, but the earlier stage tumors are are really finicky about being present in the bloodstream.

31:59
So when you look at those blood based assays that are coming out on into the market, you really need to look at something called advanced adenomas.

32:09
Those are the precancerous lesions that occur in the colon that will lead eventually to develop into a tumor and those are usually very low.

32:20
The sensitivity of that is very low, whereas the sensitivity on something like this goes way up.

32:25
You're really looking at the source.

32:30
Great.

32:31
Thank you so much.

32:31
Doctor Cruiselle, the next question that we received I think is also for you.

32:40
They asked what is the low limit of detection and or quantification of hemoglobin in the toilet water.

32:49
Yeah, that's a that's a very technical question.

32:50
Someone's very savvy in the audience.

32:52
So I appreciate that as well.

32:54
This particular assay is 50 micrograms of of hemoglobin in the in the feces.

33:00
So up to that or down to that limit we can detect it with this particular assay with a 99.3% degree of accuracy.

33:14
Thank you.

33:15
Next question is related to cost and I will just, you know, preempt that by saying this is we're, we're talking about the employer offering here.

33:26
Obviously costs will vary greatly depending on the offering.

33:29
But for the employer offering, are you all able to share is what is the cost per person and, and be approximate please that we we probably can't share anything specific.

33:45
Doctor Kisell, you want to take out a really, you know, I wanted to, not that I want to stay away from that.

33:50
I think that's more of a technical question that could let's just, you know, leave that for the Q&A at the end.

33:56
I mean, it's, it's, I just want to make sure we give you the right number because I know once you throw out a number, that's what everybody, you know, sticks to.

34:06
So just to be fair, it's, it's an inexpensive test and I'll, I'll leave it at that.

34:11
And I'm not trying to be evasive here.

34:13
I just want to make sure you get the right answer because the offer might be, it might be different depending on the employer, might be different depending upon whether it's a consumer initiative test.

34:22
I just want to make sure we're giving you the right number.

34:25
OK, Absolutely, absolutely.

34:28
And just confirmed with our product expert for the employer offering, again, just speaking to that one, it is under $70.00.

34:35
So let's see next question.

34:38
That's great.

34:41
Next question we received is what is about the likelihood, what is the likelihood of developing colorectal cancer with a family history doctor Cruzell, are you are you able to address that one?

34:53
Sure.

34:53
And I think I think Kelly can also chime in here.

34:56
You know, there are there are syndromes that run and in in families and we know that cancer is a genetic disease in its very nature.

35:06
There are some syndrome, something called Lynch syndrome that has a very strong familial history around those patients that are positive for Lynch really developing colorectal cancer.

35:18
If you have a family history, you as detailed a family history as you can get that will really help drive your your screening protocol.

35:30
The the rule of thumb is you should start testing ten years prior to the earliest onset of colorectal.

35:40
So for example of colorectal cancer, for example, if you have a patient, if you have a parent who was diagnosed at 53, you should really start testing yourself at 43.

35:50
Now that is a unique case.

35:51
The guidelines are very specific and and I think Kelly can comment specifically on on what guidelines are, are, are are at today.

36:02
Yeah, I, I think to supplement and I'll, I'll also tag Allison in here because she knows this exceptionally well.

36:09
The current kind of threshold for entry for screening, not considering advanced risk is typically 45 years of age and then that age is modified based on the risk factor.

36:21
I think it's important to note that while family history can certainly influence likelihood of occurrence, it doesn't mean that occurrence is definitive for you.

36:32
So I do want to provide that assurance there.

36:35
There is kind of an algorithm approach to this.

36:38
And Allison, you may have additional detail you'd like to add here as well from your experience.

36:44
Yeah, So what you just said, Kelly, from Average Risk and that's no signs, no symptoms, no family history starts at 45.

36:54
So it's really important that that message is out there because people think, oh, if I don't hurt or there's no blood or there's no family history, I don't need screening.

37:03
By the time you have symptoms, if you're over 45, it might be later stage.

37:10
And and that's what's really a take home message that the importance of screening.

37:13
Research shows that the screening age was lowered recently from 50 to 45 because of the increased incidence and mortality of that 45 to 50 age.

37:23
But you also have what was just said, you have a family history.

37:26
It's 10 years earlier than that first degree relative.

37:30
And then if someone comes and has signs and symptoms, this is the best thing to give them this screening test, a screening test, so they can then hopefully if it's positive, move on to colonoscopy.

37:42
So no matter what age, if someone comes in and this is what I say, I be your own best advocate for people.

37:48
If they have changed their bowel habits, unexpected weight loss, severe fatigue, all the symptoms that they not necessarily is colorectal cancer, but there's an easy accessible, affordable screening test.

38:01
So they can then go ask their doctor for that.

38:04
They should have access to that.

38:05
And then again, if that's positive, they move to colonoscopy.

38:09
So again, average risk 45 and above, no signs and symptoms, no family history, no genetic mutation.

38:16
And then after that, it's, you know, a family history, it's that 10 years earlier.

38:20
And anyone signs and symptoms should see their doctor, you know, and to pick up on that a little bit, I think the, you know, the doctors and healthcare professionals, you know, also need to be aware of this.

38:34
So I'm an OBGYN and a surgeon by training.

38:37
And, you know, in my practice, you know, we started talking about, you know, screening at age 50 now.

38:44
And it used to be a different kind of screening.

38:46
This was, you know, 10 years ago when I was in practice.

38:49
Now with this, it's much easier.

38:51
You give them a card, you say go home, swab the water, you know, send this in and we'll get a result back.

38:59
So the, you know, in addition to the patients asking for it and the, you know, organizations providing it, the doctors also have a responsibility to inform their patients.

39:09
This is an easy, easy test to do.

39:11
You can do it in the privacy of your home.

39:13
You know, we can, you know, have, you can have the kids here in the office, we can send it to you or whatever.

39:18
But it's easy, it's simple and it's going to help you.

39:21
It's going to help you and your family.

39:24
So all of us, you know, have responsibility here.

39:30
OK, we have another question here.

39:34
Yes, yes, we have.

39:35
We have a few other questions.

39:36
Thank you.

39:38
The one of the questions that's kind of related to this is have, have there been an increase in aggressive colorectal cancer since COVID?

39:50
I can take this question if you like, Shay.

39:54
Thank you, Monica.

39:57
Thanks for your question and it's actually an outstanding question to ask.

40:00
So while all of the data isn't yet revealed in terms of whether or not there are increased cases of.

40:08
What I would describe is later stage diagnosis of colon cancer since COVID.

40:12
There was a lot of literature at the time of the intense period of COVID noting that people were often not getting their regular screenings because of access to healthcare, etcetera.

40:24
So there are there is guidance from organizations like the National Cancer Institute, the American Cancer Society that suggests there could in fact be an uptick of later stage diagnosis because of missed screening at regular intervals during the COVID.

40:42
And I think that's all the more reason why getting people back to a baseline right now is so important.

40:47
Getting people back to a first screen, like I talked about with my husband, to make sure that we have a baseline knowledge of what's going on so that we can then make the additional recommendations that are needed based on the information from the screenings.

41:01
It's a great question.

41:02
And Doctor Cruzell, I don't know if you want to add any additional detail as well.

41:06
I think I think you, you highlighted it nicely.

41:08
The, the take away message.

41:11
There's we, we took a pause from care, but cancer never pauses.

41:15
And so we're seeing, we're seeing increased rates, not because of COVID, the virus, but because we did not have access to care for, for a period of time.

41:29
Thank you.

41:32
Another question that we received is does if someone has a family history of Crohn's disease or non cancerous polyps, does that change when they should be screened?

41:50
So let me pick up on that.

41:51
You know, Mark, do you want to answer that or you want me to?

41:54
No, go ahead, go ahead.

41:55
So Crohn's disease, you know, inflammatory is an inflammatory bowel disease that infects the, you know, affects the small bowel, you know, and you know, and also can affect the large bowel.

42:05
I think that when you have Crohn's disease, you're going to be hopefully seeing a gastroenterologist or if you have polyps, you're hopefully going to be seeing a gastroenterologist.

42:14
You know, I'm not sure what the, you know, correlation is between Crohn's or inflammatory bowel disease, polyp and non cancerous polyps and colon cancer.

42:23
However, the gastroenterologist, you know, follow this very, very closely.

42:27
And if you're under the, if you have Crohn's disease, you should definitely be under the care of a gastroenterologist to make sure that you're getting the appropriate screening because, you know, doing colonoscopies and patients with inflammatory bowel diseases is challenging.

42:42
And, you know, therefore, I think that and also given that you're going to have inflammation, you're also going to see blood in the stool, you know, from time to time.

42:50
So being under the care of a specialist is the way I would answer that.

42:58
No, I think you answered it perfectly there.

43:00
Usually those patients with those chronic diseases are being cared for by by specialists in that particular disease state.

43:08
So they will they will help guide how frequently screening needs to occur.

43:18
Thank you.

43:21
Related to that, there was another question about the testing and it's does does ensure one detect early stage cancer since it only captures blood, they're saying that usually indicates late stage cancer.

43:34
Just kind of can you just speak to that a little bit what what the test is testing and what that means?

43:40
Yeah.

43:40
So I think that's a common misconception that only late stage tumors bleed, right.

43:44
So colon cancer in particular can bleed at an earlier stage, at earlier stages as well, maybe not as profusely as as some of the later stages, but but yes, it can.

43:58
And so you are able to detect those earlier, earlier stage tumors.

44:07
Great, thank you.

44:09
I think, I think the presence of blood coupled with some of the other known symptoms, bloating and change in bowel habits can really lead, lead someone to, to seek care.

44:24
Great.

44:28
So I'm, I'm looking at a question here and this is from Tom Robbins and I love it.

44:32
I said, do you know why it is recommended to people who are 85 years of age do not get any further colonoscopies?

44:38
I don't know why they don't, but I was, you know, both my parents, one who's passed away and one mother who's still living, were diagnosed with one with colon cancer, one with rectal cancer at age 85 and 86.

44:54
So I don't know why we're going to, you know, why we stop.

44:58
I'm sure it's a, you know, statistically based recommendation.

45:03
They are rare.

45:04
They're the, you know, outliers.

45:06
But it's usually based on statistics and demographics and epidemiology that drives these considerations.

45:13
You're exactly right.

45:16
I'm sorry, what?

45:17
You're exactly right, Pat.

45:18
I think, I think the reason we, we taper the, the screening at, at patients over 85 is because when you look at the statistics, some of the therapies, some of the surgeries that might be required might be more harmful than the disease itself.

45:39
So the net benefit is decreased and I'll add to what Doctor Cruzell is saying that there is some evidence that suggests there's an increased risk of perforation in older adults making the colonoscopy procedure potentially more risky.

45:56
And again, that can be determined at an individual level with your provider.

46:03
There's another question here, there's another comment.

46:05
We're going to take just a couple of more questions.

46:09
There was a question about if there is racial prevalent.

46:13
Is if a racial prevalence risk factor with colorectal cancer, is that something that we have knowledge about?

46:22
Yes, I can speak to that.

46:25
The American Cancer Society statistics suggest that there's a 20% increased likelihood of colorectal cancer and a 40% increased likelihood of mortality from colorectal cancer diagnosis.

46:41
And this is really attributed.

46:42
It's multifactorial, but access to screening and Healthcare is one of the reasons that potentially contributes to that statistic.

46:51
So Dynasty, it's a great question to ask.

46:54
I think the focus here is particularly as we we think about the diversity of the workforces that we serve, again, making this type of service available to individuals.

47:06
It's a great way to kind of overcome some of the barriers that individuals may face in, in accessing either through their primary care provider or other healthcare venues.

47:16
But you're right to ask that question and and there is a correlation between race and risk as well as outcomes.

47:25
Thank you.

47:27
And then probably last question, just knowing that there are, you know, multiple tests similar to this one, a fit test available.

47:38
What makes this test ensure one?

47:40
How is that different from other fit tests?

47:46
Yes, so I can take that and I'm sure some of the others might be able to, to chime in.

47:52
I think #1 the idea of, of no stool manipulation is, is 1 by far and away the, the, the big advantage here.

48:03
There's no need to manipulate the stool.

48:05
There's no need to, you know, touch it in any way, shape or form.

48:13
You're really just stirring the water and, and painting the card.

48:17
So I think that sets it apart significantly over anything else in the market.

48:26
Yeah, I'd say ease of use, you know, no manipulation of the stool.

48:30
It's painting the water, painting the card, and you're done.

48:36
And most people, even those of us who have the yuck factor can get you can push through that and paint, paint the water.

48:44
Perfect.

48:48
Thank you.

48:48
It sounds like we we may have time for one more.

48:51
Someone asked about the age for beginning screening and just just to confirm, is it they asked, is 45 years of age the age which most people should get their very first colonoscopy or I assume have any other type of: screening?

49:09
Kelly Guidelines, Mark guidelines.

49:12
I can, but I think Allison also has great knowledge of this alternate to her.

49:16
OK, great.

49:17
We're A-Team.

49:18
Yeah, let's go.

49:19
It's 45.

49:19
Average risk, no signs, no symptoms, no family history, no genetic mutation, no diseases like Crohn's, colitis.

49:28
45 is when people should start screening.

49:31
But again, you mentioned if there's genetic mutations, if there's a family history and if you have signs and symptoms is earlier.

49:41
OK.

49:41
Jay, can I pose just a quick follow up to Allison based on Lori's question, I think this is particularly relevant.

49:51
Allison, Lori asked, with the younger demographic being diagnosed more frequently now, what recommendations are coming forth or considerations for changing of the guidelines for a screening of individuals under age 45?

50:05
And Lori specifically asked, should employers screen individuals younger than age 45?

50:11
I mean, it's a tricky question because of course I want to say, yes, everyone should ask have access to screening because I was 32 when I was diagnosed.

50:19
But we need the data.

50:20
So a lot of what the policy work that I do is to provide more research to figure out why.

50:26
If we can have more data, then we can go to the right organizations or institutions and potentially get that screening lowered.

50:33
My, my caveat to that is if someone younger is having signs and symptoms, they should be offered at the screening test.

50:40
And often younger people that I've, that I've interacted with decide they'll pay out of pocket if their insurance for some reason won't cover it.

50:47
If they're having these, then they'll pay out of pocket.

50:50
So it's what we talked about earlier.

50:52
The providers need to have knowledge of this increased incidence and mortality in the younger population and the younger population.

50:59
So it's sort of education on both sides of the fence so that like everyone can be informed and know if something doesn't seem right, it probably is not right.

51:07
So, you know, there's a, there's tons of people like me that are advocates that again, that are telling our story.

51:14
And I've had so many messages from people saying, oh, because of you, because I heard that, you know, you had these symptoms.

51:20
I talked to my doctor about this and they got screened and it potentially prevented colorectal cancer.

51:27
So really it's education and awareness.

51:29
So there's a lot of efforts for community outreach to go where where people are in the community to educate them and again, the providers having that knowledge and education as well.

51:40
So it's a two way St.

51:41
share decision making.

51:43
But essentially the screening is accessible and affordable versus cancer and cancer treatment.

51:51
I mean, I if I didn't have my parents help me, I would have gone bankrupt.

51:55
And I don't even know if I'd have a house.

51:56
It was, it's so expensive even with insurance.

52:00
So the the difference between a screening test and cancer treatment is huge.

52:04
So Shay, just before you know, we, we wrap here, I want to, you know, point out two comments from one's from Kathy and one's from Jacqueline.

52:15
And Kathy said, thank you, Allison for sharing.

52:18
This is so powerful.

52:19
And from Jacqueline, appreciate your story, transparency and for keeping it real.

52:25
You're a blessing and I'd say that you really are a blessing and I hope that you know, we're going to save some lives here today.

52:31
So with that, I'm going to turn it back over to Shay.

52:34
Let you closeout Shay and thank the audience for your engagement.

52:40
Questions are absolutely brilliant and we're here to serve.

52:44
So Shay, with that, I'm going to turn it over to you and let you close this out.

52:49
Thank you so much, Doctor Alicia.

52:51
And and that concludes our webinar today.

52:53
Everyone, thank you so much for taking the time to attend.

52:56
We really hope that you found it valuable.

52:59
If you have questions, don't hesitate to get in touch with us.

53:01
You can send an e-mail to the address on the screen, and we do have real people checking that inbox.

53:06
We promise we can schedule a consultation with our team of experts so that you can learn more about colorectal screening for your specific population.

53:14
We would love to speak with you and work with you.

53:17
Just thank you so much for taking to the time to join today, and we hope you have a wonderful day.

53:22
Thank you.

53:23
Thanks, everybody.

53:25
Thank you, Allison.

53:26
Yes, thank you.

53:27
Bye.