Good evening and welcome to Doctors on Call.

I'm Dr.

Mary Owen, associate dean of Native American Health and Director for the Center for American Indian and Minority Health at the University of Minnesota Medical School.

I'm also a family physician for the FondeLac Band of Lake Superior Chipua.

And I'm your host for our show tonight on cancer prevention and diagnosis.

The success of this program is very dependent on you, the viewer.

So, please call in your questions tonight or send them in to our email address, askpbsnorth.org.

The telephone numbers can be found at the bottom of your screen.

Our panelists this evening include Dr.

Brett Friday, an oncologist with Essentia Health, Dr.

Krishna Cullandel, an oncologist with the Spry St.

Luke's, and Dr.

Sandy Stove, a family physician with and faculty member at the University of Minnesota Medical School.

Our medical students answering the phones tonight are Justine Aosta from Blaine, Minnesota, Ian D. Roof from Duth, Minnesota, and Carolyn Lee from Portland, Oregon.

And now on to tonight's program, cancer prevention and diagnosis.

Welcome to the show.

Thank you.

Thank you.

So we before we get some questions, I'm assuming they're coming in fast.

Uh what what are some things that you are you thought would be of interest to we were just talking about one for instance, the testing that's out there now for cancers?

some testing that you can do over the counter apparently.

Well, I think um we were talking about this a few minutes ago that like uh I think historically there have been certain cancers we can screen for pretty well.

You know, breast cancer we do mammograms and colon cancer we do colonoscopies, but there are a lot of cancers that are just less common or harder to screen for.

We've never had screening tests for them.

And so in the last 5 to 10 years, there's been the development of bloodbased tests that look for cancer DNA in the bloodstream.

And the amazing thing about these tests, they can actually screen for 20 to 30 different types of cancers.

And so these tests are out there.

They're approved.

And actually, you can actually go get them now.

I do think they have some issues in that the tests at this point, I don't think are quite good enough to sort of roll out to everybody.

Um, but they're interesting tests and I absolutely believe that at some point in the future the whole thing of cancer screening will change a little bit to to really just maybe doing a once a year blood test that will screen for all types of cancer.

So I think it's a very interesting exciting area.

I'm just not sure it's ready for prime time yet that everybody should be doing.

And how much do they cost?

Dr.

Coen Dave, what are your thoughts?

So how much do they cost?

I think privately it costs around $800 to$1,000.

Wow.

My patients can't afford that.

Yeah.

And but even sometimes we do in people with diagnosed cancers sometimes if you don't have enough tissue to run gene tests sometimes we draw blood samples sometimes we do know patients have cancer but the test comes back negative because there is not enough DNA so I don't know how much we can like uh rely on it not at this point maybe in future when we can streamline and better things then maybe it can become you're saying that they might make they might miss a diagnose or miss a diagnosis for a patient or they might overall a diagnosis That is true because we do know like now because we do do these tests in the clinic but for a different reasons because we primarily don't do screening.

We see cancer patients and sometimes we need additional tissue for like gene testing.

So instead of a biopsy sometimes we do it in the blood and it sometimes it'll come back the cellfree DNA we call it's like very less.

So when the percentage is very less it won't say us anything.

So but these tests but each company has different parameters and stuff so things will be different but that is this is I don't think this is a single test we should rely on and take comfort in saying oh maybe I don't have anything if you have symptoms just follow the regular guidelines yeah and I think that's what we talked about at the beginning of the show one of the worries is that people might take that blood test and think oh I don't need to do my regular screening like our mammograms or pap smears well I think also it with screening it's important if you have a family history risk that you screen for those specific things.

It's much more sensitive a test.

Screening for something, you know, there's there's a lot of things that are on those screening tests that are pretty rare.

And so there are false positives sometimes and it can be scary if a screening test comes back positive, but it's it's not actually there.

And that's the reality of all tests that we do.

There's always there's potential for for some something to be a false positive or a false negative.

So they miss something.

Yep.

Good.

All right.

Which cancers uh Dr.

Stover, which CA um vaccines can lower the risk of certain cancers?

Ah my very favorite vaccine which is the first vaccine that came out that actually helps reduce uh significantly reduce the risk for cervical cancer and that's the HPV vaccine.

So that's a vaccine that's given to men and women starting at the age you can give it as early as like 10.

Most people will start it more at like 10 to 14 age 10 to 14. and it can be given up to age 45 at this point in time.

Excellent way even if people do test positive for HPV, having the vaccine reduces the risk of it of it progressing to cancer.

And so it's it's a very lowrisisk vaccine that I'd encourage all people to think about taking.

So young men as well as young women.

Young men and young women.

Yep.

Yeah.

Great.

Thank you.

What any other vaccines?

The hepatitis B vaccine is a well-known one.

I think it has decreased the cancer risk significantly.

Which cancer?

The liver uh liver cancer.

So chronic hepatitis B nowadays I think is after the vaccination it has been at least in this part of the world has been drastically reduced.

We rarely see liver cancer due to hepatitis B anymore.

Great.

Any others?

I think those are the main ones.

Unfortunately many cancers aren't driven by viruses.

So we don't always have vaccines for all of them.

Yeah.

Yeah.

Okay.

Justine in Duth.

What food should I eat more of or less of to decrease my chances of developing cancer?

Who wants to take that one?

That freebie?

I could take that one if that's okay.

Okay.

Um, you know, I think I think that's an area where if you do some research and and look out there, there's a lot of information about a whole bunch of different things that may or may not prevent certain cancers.

I I think that it is very clear that people who eat healthy do better have coffee for breakfast or um I don't always follow everything.

So teasing, but but I think from a a cancer perspective, I think that there are clear things that being healthy and eating healthy will help reduce your cancer risk.

And I think that is is all things most of us kind of know.

You know, more more white meats and red meats, less processed foods, less saturated fats, more fruits and vegetables.

And I think if we all did that, there would be lower cancer risks.

But I think it's hard to say eat this very specific thing and that that's going to lower your cancer risk.

And so it's it's eating healthy in general.

I think clearly has has some benefit to lower cancer risks.

Also a little bit harder for some populations that can't afford to always eat all those fruits and vegetables.

I mean they are expensive and the white meats versus Yeah.

Yeah.

versus processed.

Yeah.

That's a challenge too.

Yeah.

Anything to add to that as far as dietary?

I think there's one thing when we talk about fresh fruits and vegetables are nice, but there's other ways of getting fiber which can help for for reducing risks of colon cancer.

I also think you brought up just at the very clip of what you're saying is processed foods.

So things like bologoney and um processed meats are less healthy for us, less triggering and inflammatory and inflammation is what sort of drives cancer in a lot of body tissues.

Uh so things be good be good to your colon and and the other one is actually weight management.

So the eating the kinds of foods that are less likely to lead to just fat and lipid development in our bodies but eating eating healthy foods to echo what you said eating healthy foods that that um represent those freshness freshen as much as possible.

Dr.

Colandel want to add anything?

Yeah because primarily weight for a long time people thought uh fat is like invar an inert substance but now we know it's like it causes chronic inflammation.

So I think metabolic disease is a major risk factor because if we are able to maintain the weight I think that is a 20 to 30% reduction in like uh uh cancer incidents and now with the newer drugs the GLP ones which are unfortunately expensive but we do see significant cancer reduction already in early studies.

Yeah.

Wow.

That's fascinating.

Hadn't even thought about that.

One thing I didn't hear you mention but I know that it's a big deal for my population in Alaska.

eat a lot of smoked fish and smoked food gastric cancer is on the rise for um a lot of populations some populations more than other and those smoked foods can be linked to that as well so true yeah I think primarily fish eating smoked fish charred fish came from Japan so that's why Japanese they have very high incidence of gastric cancer so they have like better treatments or big surgeries all right if I have pancreatic cancer okay you got the easy one so now Dr.

D colon Dave if I have pancreatic cancer now what lifestyle and dietary habits should I develop to help me battle it pancreatic cancer so once someone develops cancer this is a very common question we get in our clinic after developing cancer what can we do to improve but once cancer is developed unfortunately we cannot reverse it but we can take steps to have like a good quality of life so primarily uh less processed food uh good sleep more plantforward word food primarily plantbased food you you can do have meat in like uh moderate portions and exercise.

So all these things help uh this helps with like the morbidity the side effects from the chemo is better managed and two if it's early stage cancer if you attempt for curative in treatment we do know exercise and good diet and stuff it helps in cancer risk reduction too but it is very hard to like practice uh but that definitely we do see decrease in recurrences.

Why does exercise we already talked about uh foods and u but why does exercise help decrease cancer risk?

I think it's a very complex we do know it helps for sure but the mechanism one of the mechanism is we have like our innate immune system to prevent uh it it kind of finds cancer and kills them the white cells in our body.

I think exercise helps to promote our immune system better.

Uh good metabolic health, decrease in insulin resistance.

All these things and also decreases inflammation in the body.

So all these things uh prevent the recurrences.

Anything to add?

I think exercise also helps reduce stress and we know there's a link between stress and and and mood things but also stress and cancer and uh back to the inflammation that that may be stirred into that pile.

Dr.

Freddy, no, I I kind of agree with that.

I think it's a very complex interaction with exercise in our bodies and what exactly it does to help.

It helps you know we know that for sure.

Um I think I think actually some of those inflammatory stress hormones are really the changes happen in our bodies when we're healthy and happy and exercise is a big part of that.

So I completely agree with that.

Endorphins are good.

All right.

Dr.

Stove, family doctor.

How early should I start getting screens for pancreatic cancer?

if I have pancreatic cancer, how should my family members also get screened?

That's a good question.

Uh, it's not on the routine screening that we do on a regular basis.

Um, if if some it's it's kind of a little different if you screen for something or look for something in a when there's a strong family history, uh, you do want to screen with at least 10 years before that person that was your primary relative actually came down with the condition if possible.

Uh so like with colon cancer if someone got colon cancer at 50 you your the primary family members so siblings um parents children should be screened 10 years before that for pancreatic cancer the screening is primary blood based at this point am I correct on that well it's challenging there's not one we'll either do CT scans or endoscopy where we kind of go down and look from the inside at the pancreas from the inside and that's an invasive test and has some risk and so unfortunately there's not a great simple test to screen for pancreatic cancer.

Right now I think that's kind of but um I think of surveillance maybe when people have a a strong family history you start looking a little bit where you wouldn't with average person as we do want to screen for colon cancer we do want to screen for breast cancer cervical cancer prostate cancer is there's thoughts about you know of at what age that starts too yeah because there are certain high-risisk genes which can run in families the BRCA 1 2 if you have those genes and if anyone in the family is diagnosed nosed with pancreatic cancer then those patients will be eligible for screening either with MRI or like Dr.

Friday told endoscopic ultrasound and based on what they find it'll be like every two year or every year they watch it closely so what you're saying is that once some were you going to say add something to that Dr.

Right.

Once somebody in your once somebody develops the disease, then you start looking a little bit closer at the genetics and then their family members as well.

You start checking on their family members as well.

And you were talking specifically about the what we call the BA BA genes.

Yeah.

Yeah.

Because anyone with pancreatic cancer is eligible for the these testing of these genes.

They can meet a genetic counselor.

They can talk with their primary physician and they can get these are blood tests and many times insurance covers it.

And if they find any genes then all the firstderee relatives all family members again become eligible.

So that's how we find family trees.

Yeah.

And I think that's the population of that question was my family member had pancreatic cancer and if they did a gene test and found that they had one of the bracka genes then potentially they can be eligible for screening and there's different ways of doing it and it's just a matter of talking with the doctor and figure out what's what's the best route for that individual patient.

It's not something we routinely screen in all people in the country, you know, unlike some other, you know, more common cancers that we face.

Breast cancer.

Correct.

Right.

Colon cancer.

Dr.

Freddy, you mentioned uh another really good point and I think sometimes our patients have the perception that we just go in and get a test for whatever you know that that all these tests are benign.

And you mentioned or that they're not going to harm you.

And you mentioned that the ERCP or a test that we can do for for uh pancreatic cancer isn't always benign that there are some risks.

So just reminding our patients that we're balancing those things and and I think this is that's particularly true for this discussion about cancer screening you know screening you know is really looking for cancer and people are healthy you know unaffected and so anything we're doing to look for cancer should not cause any harm you know so getting a blood test causes little harm um you know going down and looking in somebody's stomach requires some anesthesia there's some slight risks if biopsies are taken so it it's a procedure that has risk and so I think We always have to balance particularly for screening the potential benefits of the screening but also the risks across the population that's being screened.

And so they're kind of challenging questions to be honest when you think about it from a more of a population standpoint, right?

As opposed to an individual level.

And for screening, it's really population-based thought.

Right.

Recognizing that the individual sitting in front of you might have a few things that help define your decisions.

Right.

Right.

So we do both.

Yeah.

Um and this person points makes a good This is related to that.

This caller had HPV squamous cell anal cancer.

However, her diagnosis was delayed for five months because her colonoscopy returned returned with non-cancerous despite rectal bleeding.

This patient wants to know how accurate colonoscopies really are at diagnosing.

So that fear that we all have and this is an interesting question because there's human papilloma virus HPV is directly related to colon cancers and lingial cancers at higher numbers than they had been.

um to do a colonoscopy for screening for for an HPV related cancer is harder because it's at a cellular level until it grows a polip or something that's more visible.

So having a rectal cancer that would be superficial might not be caught because that's not what the scope was developed to look for.

So there is another ca another kind of a test called an anal pap or an hpb for the anal area.

It is being done in duth.

It's something you can ask for.

It's not done commonly uh because there's a little different technique to it, but it is it is something that can help just like we are checking for HPV in cervixes.

You can check for HPV in a in a rectal or um low low rectum area.

Uh so something to think about if people have risk there's actually recommendation if women have HPV to think about checking the the anal area as well.

Anything to add to that from our oncologist crew?

I think it was a lot of that.

Thank you for that answer.

I mean, and that was a lot to think about for anal cancer.

Question also about if we're going to do a colonoscopy, is it really going to find something?

Colonoscopy is the gold standard to look for colon and rectal cancers.

And the estimates from my memory are about 95% if there's a cancer there, it's going to find it.

Um, so pretty darn good.

Um, unfortunately, no test is perfect.

And so there's always, you know, things that can be missed, but colonoscopy really is absolutely still the best test to to look and screen for colon or rectal cancers.

And so I think agree about the answer of anal cancer and HPV, but of thinking more about the colon part and the rectal part, colonoscopy is very good and sensitive test to find cancer and saves lives.

Absolutely.

Saves lives.

Yeah.

Because it's stopped right there.

As soon as you find the lesion, you get it.

Yeah.

The nice thing with the colon colon colonoscopy is if you see polyps, which some polyps are precancerous, that can also tell you you're going to be surveilling or watching in a different way over the years to make sure that more polyps don't come that are risk for future cancer.

Okay, on this same topic, I just had a positive colog test.

Next week, I'm getting a colonoscopy.

How accurate is Colagard and what causes it to be positive?

So colard test looks for um like cancer DNA and also like previously we had like the blood test.

So initially it was looking for like uh blood and ion but now the colard is looking for like precancerous or cancer DNA.

So it's when the test is positive definitely you need a colonoscopy.

Uh is it 100% accurate?

No.

But I I think I don't I don't remember the exact sensitivity of it but it is it is reasonably like high.

If it is negative then you don't need a colonoscopy but if it is positive you need absolutely need a colonoscopy because colon cancer takes like a few years to develop because it's goes from one stage polyp uh and then finally it develops invasive cancer.

So catching it early can have like you you it can save your life one and it can be just done with initial if it is in the polip it's just like it can be done at the same time or if it's early stage just the surgery will take care of it.

anything to add?

And that was a good great answer.

The only thing I'd add because I've talked about this quite a bit with some patients is the if you get a positive test like this question, there's only about a 4% risk of having cancer.

And so it's pretty low actually.

Most of the time it's sort of a false positive.

And so I actually I think the Colig Guard is a good test.

It's a great test particularly in people who are hesitant to do a colonoscopy.

If it's negative, that's a you know very low likelihood of cancer.

If it's positive, it's still a pretty low likelihood of cancer.

So I actually look at the colig guard is not really a cancer screening, it's a colonoscopy screening.

And so you know if you get a positive it just means you need a colonoscopy.

It doesn't necessarily mean you have cancer.

And the risk is actually pretty low only about 4% with a with a positive test.

And how often do you have to get it?

It there's still debates about that every two to three years.

And I think um I think it's it's a helpful adjunct for screening for colon cancer.

Again, I think I said a few minutes ago, colonoscopy is still to me by far the best test.

Um but especially if if patients are hesitant um colig guard's a pretty good test.

If it's negative uh I think you're in pretty good shape then if it's positive you do a colonoscopy and for some people you can kind of alternate and every three years you know in high-risisk patients do a colig guard once and then the next one do a colonoscopy.

So I think it's a very helpful test.

I think we're still trying to figure out exactly how to use it in screening across you know the country.

I think one of the benefits of it is it's less expensive as an individual test.

Admittedly, you do it more often, but it's also something you can do in your own home, which is sometimes difficult for our patients to get to a place that has a colonoscopy.

There can be long waiting lists or just a difficulty physically getting to that colonoscopy, missing a day of work, all those kinds of things.

So, it's another alternative that can still help in deciding, do you need to get that full colonoscopy like you were talking about?

Yeah, I actually like that they're doing it at home part because I I was just at a meeting this week and there was a discussion about cervical cancer screening rates um in particularly the Somali population and in the Twin Cities are very very very low and so they did home uh testing or self- testing and um the rates were much higher by doing that.

So it's just I think certain things I think some people might be more comfortable doing on their own and the the uptake might be better by doing it that way.

Mhm.

I know that I have a lot of my patients who just can't afford to miss work and so that's why they're or the gas to get to, you know, an hour and a half or two hours to the closest for our rural communities.

Yeah.

I want to get through these ones because there's some good questions.

How can environment affect cancer risk?

Specifically thinking of the three to four super fun sites in the in the St.

Louis River.

Any thoughts on that one?

Anyone to jump in on this one?

Um it's kind of an interesting one.

don't know as much about water toxins, but the water toxins get into the fish that we eat.

They get into the birds that maybe, you know, all kinds of things like that.

We, a lot of our environmental gifts that we've given the earth have come back to haunt us a little bit.

Um, one of the other areas is forest fires or building fire, structure fires have more toxins in them, but even the difficulties with health that come from forest fires.

And the uh particularly for people already have something like asthma or or any kind of lung condition, but it that that burden of a number of of the things in in a burned form are more toxic or more inflammatory than things in their natural form like a regular campfire.

Uh and so that that can increase a risk of contact or or burden that gets into the lungs.

Um but in terms of ingesting things that have a have toxins in them, I think more about fish or u other things that we eat from the from the from the Yeah.

So much so that we limit the amount of fish we recommend particularly for pregnant women.

We do.

Minnesota is one of the better states for giving guidance for that.

So you can look at the Department of Health Minnesota Department of Health website and there's a wonderful guide for all the lakes in Minnesota and what's a safe amount of fish to eat.

I think the St.

Louis River is once per month if I remember correctly.

Wouldn't surprise me.

Yeah, just I think it is that what's the best way to screen for skin cancer Dr.

table u have a dermatologist visit first the no the best way first thing is from a patient perspective I think they should they should watch for any lesions in skin any change does it uh does it change fast does it grow so they should be aware of all the moles on the body uh so that is one and two like prevention best prevention is uh sunscreens sunscreens are like SPF more than 30 uh anytime even if it is not very bright sometimes the ultraviolet rays can cause like skin cancer.

So always sunscreen, hats, widebrimmed hats.

Um so th those things definitely help with prevention and like screening anything pointed to your primary care physician initially and then if they are worried then they can take a biopsy they can freeze it and they can send you to dermatologist.

They ask about um some of those blood tests but I think the answer correct me if I'm wrong would be you might do those but you still need to do that skining with your with your physician.

Yeah.

You can't just rely on it.

Yeah.

Okay.

Can fasting help cure my cancer?

I'm going to ask you that, doctor.

We don't know.

Um, I' I'd say most likely not.

Um, you know, I think there there are a lot of theories about how fasting impacts metabolism in our body and how that then might impact cancer growth, cancer death, chemotherapy benefits or not benefits, um, treatment effects.

And there's just a lot of information out there.

And and to be honest, I'm not sure anything is proven enough one way or the other, whether it's helpful or harmful that that I would advocate that either way.

Okay.

So, okay, I'd ask you guys to chime in, but I want to get to at least one more of these.

If I want to learn more about living a healthy lifestyle to avoid getting cancer, what are some movies, shows, books I should read?

You guys have any great recommendations?

Mediterranean uh cookbook.

That's good.

Well, yeah, the Mediterranean diet has been shown in a number of studies and and there's a number of books written about the the health benefits of a Mediterranean diet.

Um, I was trying to think of the fork above um fork knife fork over.

So that is a that is a book that talks a little bit more about plant-based diet but also including some proteins that come from more from animal flesh or not excluded but thinking about how you balance out as Americans we we don't tend to eat as much green food you know and there's a point some of the things that we would like to eat take more expense to get to us so they are more costly but it's a good thing to garden too when you have the opportunity and I think we're lucky um actually Duth's not a bad place to grow things especially the you have to kind of be in the right part of town where there's a little bit of black dirt instead of clay.

But uh yeah, thinking about that even to small extent is growing some of your own lettuce.

Any other recommendations?

Yeah, I think in there if you go online there are like thousands of uh recommendations but the problem is everything could be like contradictory to one another.

uh primarily like like Michael Poland he's one of the journalist he had like a good documentary eat food not too much mostly plants so that's what I follow at least like to follow good advice I'll stick with that all right I want to thank our panelists Dr.

Brett Friday Dr.

Krishna Colandaval and Dr.

Sandy Stove and our medical student volunteers Justin Acasta Ian D Roof and Carolyn Lee please join Dr.

Ryan Harden next week for a program on arthritis and joint pain when his panelists will be Dr.

Jay Allen, Dr.

Anna Fernandez, and Dr.

Dylan Wyatt.

Thank you for watching and good night.