Colorectal Cancer

Welcome and Crew Introductions

Stanton Shanedling: Hello, everybody! Welcome to Health Chatter. Today's show is going to be on early-onset colorectal cancer. We’ve got a wonderful guest, and we'll get to him in a minute.

Our crew is second to none; they help us with everything in order to make these shows successful and meaningful. Our research crew includes Maddy Levine-Wolf, Erin Collins, and Deondra Howard. In marketing, we have Sheridan Nygard, who also helps with research. Our production person is Matthew Campbell, who does our recording and also gets it out to you, the listening audience, with nice music attached. Great colleagues, Clarence Jones and Dr. Barry Baines, provide some useful insights from a public health perspective and medical perspective. Thank you to them; great friends and colleagues.

Hueman Partnership is our sponsor for all these shows. It's a great community health organization, and they do a lot of wonderful, creative things in order to promote health in the community. HueMan Partnership—you can check them out at huemanpartnershipalliance.org, and you can check us out at healthchatterpodcast.com. You can listen to the shows, and we also have transcriptions of the shows on there as well. So, thanks to everybody for making all our shows to this point wonderful and meaningful.

Clarence, I'm going to turn it over to you to introduce our wonderful guest today.

Introduction of Dr. Logan Spector

Clarence Jones: Thank you, Stan. You know, I'm pretty excited about introducing Dr. Logan. He and I have been working together for, I don't know, 3, 4, 5 years? I met him through a project which was around prostate cancer and barbecue, which is very, very important for Black men—the conversation of prostate cancer, but also barbecue. We did a study on that, so it's been exciting for me to work with him and to get to know him.

He's a pediatric cancer epidemiologist who specializes in the causes of childhood cancer. His work includes both traditional and genetic epidemiological approaches. He's been a PI or co-PI on 9 National Cancer Institute-funded studies of childhood cancer. He works in collaboration with colleagues and trainees locally, nationally, and internationally through the University of Minnesota. He's also the immediate past chair of the Children's Oncology Group. He's a very, very busy person, but also a very, very important person.

Currently, he is the chair of CLIC, which talks about epidemiological studies of pediatric cancer from across the world to better ascertain their causes. The ultimate goal of Dr. Spector's research is to enable the prediction, early detection, and eventual prevention of childhood cancer.

One of the reasons why I'm excited about him is that we had a conversation, not necessarily associated with this podcast, where we started talking about colon cancer hitting younger and younger people. I thought we should have Dr. Logan on here to talk a little bit about that, so that's kind of an introduction to him. I think he has a very sparkling personality, which will come forth. But I want to turn it back to you, Stan. Let's get going, let's begin to invite Dr. Logan into this conversation. So, Dr. Logan, welcome to our program.

The Barbecue Study and the History of Burnt Material

Logan G. Spector: Thank you for having me, Clarence. Let me just say that that project we had together was one of the most fun things that I've ever done in science, so it was just a pleasure to meet you. Part of the fun is that half the sample was collected at the State Fair. I'd just like to put a plug in for our research building at the State Fair—the Driven to Discover building. It's at 1367 Cosgrove, for those of you who live in Minnesota.

Stanton Shanedling: I can only imagine that some research where barbecue is involved, you know, what can be bad?

Logan G. Spector: You know, if you'll allow me to ramble a little bit, it's not the act of barbecuing itself—that's a fantastic art, and I love barbecue. But it's burning things. This goes all the way back to Mary Poppins. Did you ever see Mary Poppins?

Stanton Shanedling: Yeah, sure. Yep, great.

Logan G. Spector: Well, there was an epidemic of skin cancer in chimney sweeps because they didn't really bathe that much back then, and the soot gets everywhere. We're all guys on this call, so I'll just go there—they especially were not washing their scrotum. They had an epidemic of scrotal cancer, or really skin cancer of the scrotum. There's a guy named Percival Pott who first made the connection to this burned material and the cancer there.

Years later, when, believe it or not, it was controversial about whether cigarettes cause lung cancer, they kind of reached back and said, "Well, we connected burnt material to skin cancer in the chimney sweeps, and maybe inhaling burnt material could be unhealthy, right?" The same thing applies to burnt material when you eat it.

Stanton Shanedling: Yeah, I think I've read about the connection between it, for sure, and it's interesting.

The Rise of Early-Onset Colorectal Cancer

Stanton Shanedling: Well, we're going to talk about colorectal cancer. For those of us who are on the podcast, you know, we get our colonoscopies, and it really got into my psyche, frankly, when my physician said, "Stan, it's time for you to get a colonoscopy." Frankly, it was in the latter part of my 50s or 60s. But it never dawned on me that we might be asking patients or telling patients that they need to get colonoscopies earlier now, at a younger age. So let's start out with what's going on here. We're seeing this happening, but what's leading to it, and what's happening in general?

Logan G. Spector: Yeah, great questions. First, we should kind of start with the numbers. We track cancer incidence very well in this country; there's a central cancer registry in every state, but also internationally. Basically, everywhere in virtually every population, there's an increase in early-onset colorectal cancer. We define that as less than 50. They came up with the name "early-onset" because calling people in their 40s "young adults" seems a little funny. Young adult is up to 40—although I always say the young adult limit is always a year above my age, but I'm 52 now and definitely graying, so I probably shouldn't go on with that joke.

Anyway, it's been rising for years, and the rate has risen about 50% in early-onset since the '90s. There have been hints of this or attention paid to it, but the thing that really got people's attention was Chadwick Boseman, the Black Panther, who died in 2020 at the age of 43 of stage 3 colon cancer. There's a man who was ostensibly very fit; I mean, he was a superhero. And not only a superhero on screen, but I think he filmed the movie, or the second movie, while he was in treatment, which is incredible. But at 43, and obviously a very fit and talented man, it was just awful.

Then earlier this year, James Van Der Beek, who was in Dawson's Creek and Friday Night Lights—you know, he just died at maybe 48. Unfortunately, these celebrity deaths are kind of what brings public attention to it.

So the rate's going up. Like I said, I've got a paper in front of me looking at U.S. cancer statistics, and it really is in all groups. There's a slightly faster increase in non-Hispanic American Indians, but it's not much different. It really is everyone, everywhere. And that's extremely concerning. Before we get to the screening question, which is a great question, we should definitely talk about why.

The Role of the Microbiome and Colibactin Toxin

Logan G. Spector: I work with the International Agency for Research on Cancer, called IARC, in Lyon, France. It's actually a branch of the WHO that's just concerned with tracking cancer around the world, figuring out why people get cancer, and then making recommendations to reduce cancer incidence.

About 13 years ago, there was a guy in England—who has since been knighted for this—who realized that if you sequence a tumor, like looking at every DNA letter, and then compare it to the normal tissue, you can find what they called mutational signatures of what that tumor might have gone through. It's not exactly a fingerprint of the cause, but it is a fingerprint of its journey. We all have scars, whether they're physical or mental, so think of it as a scar on the tumor's DNA.

Last year, they published what they called a mutagraph study that was looking at what the tumor looks like. They collected them from a thousand colorectal cancers from different countries and at different ages. What they found in the young-onset colorectal cancer was a very high proportion—much higher than in the older cases—of a mutational signature of what's called colibactin toxin.

We all have bacteria in our guts, which we call the microbiome. Usually, when we say microbiome, people understand that to mean in the gut. E. coli, you've probably all heard of it because sometimes stuff gets into Bde Maka Ska, and they have to close it off to swimming so you don't catch anything. E. coli comes—we all have it in our gut—but some versions of it produce a toxin. Just the word toxin sounds bad, doesn't it? It directly mutates the DNA.

The fact that we find a high proportion of these mutations in early-onset colorectal cancer is a gigantic clue to the cause here. It really suggests that whatever people are eating—and we're pretty sure there's a role for obesity, because of course that's rising—the throughput and the reason that's happening is it's changing the microbiome and tipping it to a worse one. That's great to know, because now we have something to attack, manipulate, improve, or intervene with.

What Exactly is Colorectal Cancer?

Clarence Jones: So, Dr. Logan, I want to ask this question. We go around the term colon cancer; let's talk about what exactly that is for many of our listeners who need to know a more detailed explanation.

Logan G. Spector: Yeah, well, every cancer has got kind of a theme, if you will. It's cells that grow out of control. We talk about a car analogy: you have to have mutations in a cell that do two things. One, it puts the foot on the gas and makes them proliferate faster. Because the whole body has got to have control over how things grow, otherwise you'd be an undifferentiated blob. There are also genes that slow down the growth or make sure it goes in the right channel. If you put your foot on the gas to make the cells grow more, and there's also a foot off the brake, then the cells will grow out of control. They start to become selfish, taking the body's resources for themselves. They actually send out signals that cause blood vessels to grow into the tumor. It really is the body versus what's become a selfish mass.

Colorectal cancer is when that happens in the colon. It's not really a single disease; it's a bunch of different diseases in that it can occur in different places in the colon. We say colorectal, and it really does go all the way down to the end, although anal cancer is considered a different type.

But also, there are different ways we classify colorectal cancer based on where it is in the length. To me, it's very odd, but whether it's on the left side of the body or the right side of the body matters because, of course, the colon just snakes all throughout the body. I'm not even sure why that's so important, but when we get down to it, we look at some groups of people and it's mostly on the right side, and we look at other groups and it's on the left side.

Then you get down to the molecular genetics. I'm not going to bore you all with the particular genes, but I'll just say this: in cancer, we're getting down to the precise gene or genes that went wrong to make that cell go crazy. Now we think that the causes will differ depending on your subtype. But that's more of a matter of how much something causes it; diet, exercise, obesity, and the microbiome are going to be causes of all the subtypes.

Clarence Jones: You keep using the word diet. So is it our foods that we're eating that are causing this proliferation of diseases? Is it food?

Logan G. Spector: You know, when you try to nail down a scientist to just say it's one thing, they're never going to give you a straight answer. It's like all of it at once, and of course, diet is complex, too. I will say that the things we think are healthy to eat—at least until they changed the food pyramid in the last year—it's not really rocket science, right? You should eat a lot of fresh veggies in a variety of colors. Like we say, eat the rainbow. Dark leafy greens are great, and minimizing meat, not making it the star of the show. I enjoy meat, too, but it's not about saying no; it's about moderation. And Clarence, I actually don't know about early-onset colorectal cancer specifically, but barbecue—sorry, burnt foods—are associated with colorectal cancer, too.

Early Life Influences and Prevention

Stanton Shanedling: Let me ask you something. We oftentimes on our shows talk about prevention, detection, and then treatment. Let's start out on the prevention side of things. Obviously, you started that with a good diet. Let's talk about overall prevention. What's your perspective on that as it relates to early-onset colorectal cancer?

Logan G. Spector: Most of the people who are studying early-onset colorectal cancer came from adult cancer, which rises a lot after age 50, and they're maybe not thinking about the early life antecedents—the beginnings. For a lot of cancers that even occur in older people, there are hints that they start much earlier than that.

In fact, it surprises a lot of people, but there's an association between your birth weight and a woman's risk of breast cancer or a man's risk of prostate cancer. It's also true for colon cancer. You might say, "What does that mean?" We don't exactly know, but there's a couple of possibilities. One is to get to a bigger birth weight, you just need to have more cells. Cancer always starts in a cell or a group of cells that get that mutation, and they can go along without turning into cancer for decades. But if you have a mutation while you're in utero, while you're a fetus, you have a lot of growing to do. If that mutation happens early, it can expand, and then you have a large part of your colon, or your prostate, or whatever tissue, that's at risk for transforming. That moment when it tips into cancer is called "transformed."

So really, beginning from birth, a healthy life, healthy diet, and exercise are important. Now, I have kids, and my son, who's almost 6, I think he eats nothing but quesadillas and chicken nuggets. We've tried really hard for him to love broccoli, but I know how hard it is to get kids to eat healthy.

There's also a lot of change in the body during puberty. There is some evidence that the amount of physical activity that teenage girls have affects their later-life risk of breast cancer. But the real challenge is teenagers think that they're gonna live forever, right?

Stanton Shanedling: The illusion of immortality.

Logan G. Spector: Yeah, just getting them to understand that what you do now is gonna affect your health for the rest of your life—that is tough.

Stanton Shanedling: With kids, it's interesting. If you really ask them what's important to them, they'll say how they look on the exterior, not the interior.

Logan G. Spector: Some people have had success showing them pictures of what happens if you smoke for 30 years.

The Dilemma of Screening and False Positives

Stanton Shanedling: Right. So, as part of this, I want to talk about screening. For those of us who have had colonoscopies, there are actual colonoscopies, and then there are new techniques where you can do it at home, these types of testing. Let's talk about screening a little bit, and what it means for telling younger people that they have to get checked out.

Logan G. Spector: Screening, the optimal age of screening, and targeted screenings in high-risk populations—that is a matter of a lot of debate. Probably the public has seen how they've moved around the ideal age of mammograms for breast cancer. There is absolutely the recognition now that early-onset colorectal cancer is an epidemic. We say epidemic when, even if it's not an infectious disease, something has just risen everywhere all at once.

But it's a tough situation because when you screen a population, if the incidence is not that high, you get more false positives than true positives. Meaning, you're going to worry many more people than are gonna be saved. It's really a numbers game. Even though it's been rising by 50%, that's the relative rise. In absolute numbers, early-onset colorectal cancer is still pretty rare, at least compared to the over-50s.

So really, science has to do better with the method of screening. When a disease is rare, if your screening test isn't spot-on, then you will just worry a lot more people with so-called false positives, and that can have real consequences. You surely know about prostate cancer screening moving to the PSA test, the prostate-specific antigen. There was a lot of uptake because that's based on a blood test rather than the digital rectal exam. But it turns out that basically every man over 50 has an incipient prostate cancer, and it's not trivial to get treated for prostate cancer. You can have sexual dysfunction; no guy wants that. Why put anybody through that if they don't need it? So there's just a lot of effort into distinguishing between those prostate cancers that are gonna go bad and those that are just gonna sit tight. We need to develop that kind of knowledge for early-onset colorectal cancer; we need to get better tests that are less of a guess and more of a sure thing.

Another thing that was in the news a couple of weeks ago was Grail, the name of the company that had a multi-cancer early detection test. It was a spectacular flame-out. They claimed they had a test that would test what they call circulating tumor DNA. These tumors grow, and they end up throwing off their own mutated DNA, which you can find circulating in the blood. For the last 10 to 15 years, the entire field of cancer has hoped that this would be the Holy Grail—that's why they named the company that. You wouldn't be looking for blood in the stool, which can happen for a number of reasons, or shed cells. A lot of people also just don't want to collect stool samples, understandably. So if we could make it a blood test and detect the tumor DNA early, that would be fantastic. However, they had a trial of 100,000 people in the UK, and the goal was to shift the stage of diagnosis by one—so that hopefully people who were gonna be diagnosed with stage 4 moved back to stage 3, and stage 2 to stage 1. It flamed out, and Grail's stock took a giant nosedive. I'm not gonna say that it's gonna set the field back for a decade, but it certainly took the bloom off the rose.

Public Health vs. Individual Decisions

Stanton Shanedling: Hmm. So, Barry! Dr. Barry.

Barry Baines: Yeah, let me weigh in. I guess there are so many things to talk about here, certainly. I'd like to just touch on a few of them quickly and then have Logan chime in as well. We talked about a lot of aspects of things and the idea of what's causing this change to happen. It's multifactorial; we kind of touched on that. But that doesn't mean that there's a direct correlation between all of these things as opposed to saying, "This is the cause, and that's why, you know, what we have to do." But we suspect it's genetics, it's diet, it's activity, it's your weight, et cetera, et cetera.

The next step for that, when we talk about some of the screening pieces—not to get into the weeds—but the problem with a lot of tests is if it says it's negative, is it truly negative? And if it says it's positive, is it truly positive? Because even though a 50% increase is incredibly large, yet in terms of the total population, the number is small.

One of the issues when you look at public health decisions versus individual health decisions is that if you're a person that has early-onset cancer, you want to make sure that you don't get it and want to know what you can do about it. Whereas from a public health perspective, people generally don't appreciate that having a false-positive test means you go through the medical complex of lots of procedures and things. What rarely gets the spotlight is that there are complications from having all of these tests. If you wind up having to send hundreds of thousands of people through these tests, number one, can our medical system actually deliver that? I remember from a few years ago they said if everybody who's supposed to have a screening colonoscopy would have it, there wouldn't be enough physicians in the country to do that service. It gets to be a supply and demand kind of thing.

But one of the things I wanted to point out is with screening, what's been amazing is within a very short time span—maybe 10 to 20 years—the recommendations for colorectal cancer screening have plummeted by about 10 years. For anybody who's potentially high-risk, that's one thing.

The thing that's more concerning to me is that early-onset colorectal cancer, when it's discovered, is more aggressive in terms of being at a more advanced stage. For most of us kind of my age, now in my 70s, I'm starting to get close to where I don't have to have colonoscopies anymore, but they're not that bad, so that's okay. But colon cancer, when found at stage 1, oftentimes is almost 100% curable. The earlier you find it, you're, quote, "cured." But the more advanced the stage that you find a cancer at, the less likely you are to get a total cure. Then it becomes: how do you manage it moving forward so that, again, you achieve the longevity and quality of life that you want? It really presents a conundrum: how do you balance all of those things to come up with what makes the most sense for the populations that we deal with? It's so easy to want to focus on one thing, but you have to put it in the context of a much broader situation. But again, having the screening recommendations change relatively dramatically because of early-onset colorectal cancer is really astounding to me. It's certainly very, very important.

Part of it is that a lot of the earlier stages in colorectal cancer don't have obvious symptoms early on. Someone has hemorrhoids and thinks, "Oh yeah, I got a little blood on the toilet tissue, well, no, I just got hemorrhoids."

Symptoms, Smart Toilets, and Small Behavioral Changes

Logan G. Spector: Well, science is coming up with more public health messages. Clarence, the other week when I met you in person, we were talking about barbecue—like, don't burn your food. I'm not a marketer, so we could come up with something better.

But blood in the stool is concerning. If it's colorectal cancer, it's not bright red—that comes from the other end, the very end. It's like dark red. In fact, the Cologuard test, which is the home test, looks for fecal occult blood. It's not "occult" like they're doing black magic; it means the blood is not obvious, and that's a problem.

I'm a big believer that technology is a double-edged sword, but it could make our lives better. The Japanese are the world leaders in toilet technology. Why do we not have smart toilets that will just test your stool? It would also have to figure out who's on the pot, but in any case, these are all solvable problems by technology. When I used to watch Star Trek when I was a kid, they just waved the thing over you, told you what was happening, and fixed it at the same time. If you're healthy, you should be going to the bathroom quite a bit, so every time is an opportunity to find it. I think technology could come to our rescue.

Stanton Shanedling: But let me ask you. We're going to be doing a show down the pike here on longevity. We, as humans, have been able to extend our life expectancy. What kind of comes to my mind is: when life expectancy was 40, did people even think about colorectal cancer, or for that matter, many of the disease manifestations that we have now? But now, life expectancy is what, like 79? So now a lot of these diseases, per se, are coming to the forefront and we have to deal with them. By extending our life expectancy, we're also getting wake-up calls on things that can happen to us.

You also mentioned communication, and that's where I want to bring Clarence in on this. From a community perspective, these are things that can happen to you, but what should we be messaging, and how should we be messaging it to the community? I don't know, Clarence, if you've had any insights in dealing with that through Human, but it's important to address it.

Clarence Jones: Yeah, I think one of the things for me is that's why I was asking Logan about what colon cancer is. We hear these terms thrown around, we hear about people who have had colon cancer, but they don't necessarily explain to us what that is. From a community perspective, we need to make people more aware of it. Sometimes it just seems like these topics pop up every now and then. When people see it, they know what it is—or what little they know about it—but I don't think we have a real in-depth understanding about it, which is one of the reasons why we want to do these kinds of shows. People really need to understand more clearly what it is and why it's important.

The whole conversation about letting people know that it is something that you need to be addressing and looking at is vital. Right now, talking about being immortal and those kinds of things, people think they're gonna live to be 70 or 80 years old, but there's a lot of things preventing them from doing that. When we start talking about dying at 43, nobody expects you to die at 43, unless it's an accident. Or dying at 48—you're still a baby. Part of what we have to do in terms of communication is to really tell people how important it is for them to do this. The other thing, too, is that many times people think it's gonna be the other person, not them. You walk around with this whole idea about, "Well, it's not me, it's somebody else," and so they don't take the precautions that they need to. I believe that these kinds of conversations are important for people to enter into so that they can take care of themselves or help their loved ones talk to them about how important these things are.

Stanton Shanedling: I think there's potentially some confusion as well. Logan, you mentioned some of the key risk factors: diet, exercise, obesity. If you were to say that to virtually anybody, they'd say, "Well, those are the same types of risk factors for heart disease, and the same kind of risk factors for being diabetic." You just wonder, is this just another one that we add to the list here? Early-onset colorectal cancer is just another one?

Logan G. Spector: Again, even telling 40-year-olds that they might have heart disease when they're 80—I have a hard time envisioning myself at 80, although my dad's there, so I guess I'll be pretty much like him. And you also can't change the past. I've been myself for 52 years, but you can always change the present.

Behavior change is difficult; it's its own science, and I won't even pretend to know how to get people to change their behavior. But to me, it's about giving them the cognitive tools to make everyday decisions that improve their health. Americans tend to be all-or-nothing: "I'm going to completely change my diet and become a vegan for health." That's certainly something somebody can do, but it's not easy. I was a vegetarian. To me, it's about doing the small things, like New Year's resolutions.

We talk about exercise, but you do not have to go run marathons. Take the stairs if it's a floor up instead of taking the elevator. I think about just the small things that maybe have made life better as a whole but have reduced activity. My kids used to work at Target, and they have a machine that pushes all the carts. It used to be kids would push the carts and get exercise, and it's just small things like that that reduce the amount of physical activity. You do not have to go become an ultra-marathoner; you just have to move yourself more.

The Detective Work of Epidemiology and the Chain of Cause

Stanton Shanedling: You're an epidemiologist, which really gets into the idea of causes. I always call epidemiologists that I've worked with over the years the "Sherlock Holmes."

Logan G. Spector: Detectives, yeah.

Stanton Shanedling: Exactly. So, putting on your epidemiological hat for a second, have there been any "aha" moments that have come from your research or your discussions with colleagues that really help to drive the epidemiology side of looking at colorectal cancer?

Logan G. Spector: It was the paper I talked about earlier, the one that said it's the colobactin toxin. We talk about causes in different levels. Just to get technical, there's distal, meaning far away, and proximal. On the far-away side, we have policy. The government has been subsidizing sugar for decades, and we have more sugar in our diet than we should. That's not something an individual controls. Then we have individual behavior. But that seems to influence gut health. You have to intervene at multiple levels.

The fact that we see these mutations and it's due to the composition of the microbiome, that's something we can change. I am not recommending the so-called fecal transplant as a public health intervention, but that is a thing that people do now to replace the gut microbiome. It is possible that probiotics or something will help improve gut health. My wife's Korean, and there's a little probiotic drink that's very popular there called Yakult. What if everyone had one of those a day? A yogurt a day keeps the doctor away. So the "aha" moment for me was seeing that the last step in the chain seems to be the microbiome. If we can get people to have a healthier microbiome, maybe we can squash this.

Barry Baines: Actually, this is a microbiome question. I'm assuming that with the toxic E. coli, it's intrinsic to the gut, meaning once it's there, it's there. But has any of the research looked at transit time in the colon? One of the things way back was that people who have very high fiber in their diet and who defecate two, three, or four times a day have lower incidence. Do people have that ability? That's amazing.

Logan G. Spector: My dog had it a few nights ago, and that wasn't very fun because I was up every hour going outside!

Barry Baines: But the idea is, is E. coli sensitive in any way to colon transit time of food and waste through the colon? Can that mitigate it, at least a bit? Plus, obviously, it's not one factor, but multifactorial. I'm just wondering if you knew much about what else could impact the microbiome, and if colon transit time is one of the things, then diet and exercise are both things that increase colonic activity.

Logan G. Spector: We had a substitute teacher in high school who was the permanent substitute; he was there every day when somebody was out. Anyway, he was a runner, and he was kind of famous because he would have a toilet paper roll that he ran with in case he had to run into the woods. It just brought home to me that the reason exercise prevents colon cancer is just what you said, Barry. The more shaking you do, you're gonna shake things down. Fiber definitely helps.

But it isn't true that once it's in your gut, your microbiome is forever compromised. You have a whole ecology—a universe of bacteria in your gut—and they are constantly fighting a war for dominance. Really, what you have to do is be the puppet master here; you need to make the good guys win in your gut. So I wouldn't say that if you have the bad version, you're always gonna have it. You absolutely can change the composition of your microbiome, but it's not a one-and-done. Americans do love their one-and-dones, but it needs constant maintenance.

We haven't brought it up yet, but GLP-1 agonists, like Ozempic or Wegovy, are somewhat of a miracle drug, and that could be a one-and-done for prevention. I've never wanted to go on it, first of all, because I think I'm probably not quite there yet, and maybe I could take care of my extra risk with a little more willpower. But I worry a lot. Something that a lot of guys might worry about is: okay, this thing's decreasing my appetite for food, but it also decreases appetite for alcohol, gambling, and does it decrease libido? I don't want that either. So it's always a balance. I do think that the American habit of wanting a silver bullet is something we need to overcome. On the other hand, sometimes silver bullets are great, and the GLP-1 agonists are really looking like it.

Stanton Shanedling: I'll tell ya, we've had a discussion about this. Are we getting to the point as humans where we think, "Ugh, don't worry about it, there's a pill or there's a shot"? There is a balance that we all have to realize as we age. This has been incredible. Wow, it's an in-depth conversation, for sure. Barry, last thoughts that you might have on this?

Final Thoughts and Moving Forward

Barry Baines: This is a great conversation. This whole area is evolving as we speak, so we're getting in on the early end, no pun intended, of colorectal cancer. Probably down the pike, this is a topic that's gonna be very appropriate for revisiting again as technology plays more of a role in the detection of early-onset colorectal cancer. This is becoming a burgeoning public health issue, so I think it's going to be important for us and for our audience's sake to keep this on our radar screen and revisit this for updates as we move ahead. I don't want us to lose this. Logan, it was great to meet you today and to really hear some of your knowledge and wisdom in this area. Very much appreciated.

Logan G. Spector: My pleasure. If I could just say one thing that I wanted to touch on: there are a lot of changes at the top in the U.S. government as far as health recommendations. The screening recommendations that you talked about used to come from the U.S. Preventive Services Task Force. That, along with vaccination and everything, has been messed with by the people who claim that they're trying to improve America's health. I just want to say: do not listen to a body that has been messed with. Instead, private society, civil society, and medical societies are forming their own task forces, and you should listen to them while the government bodies that we used to trust are getting corrupted.

Stanton Shanedling: Yeah. Clarence!

Clarence Jones: Well, Dr. Logan, thank you. I appreciate this. In fact, as you were talking, I thought, "I better go get me some yogurt."

Logan G. Spector: Yep, just make sure it doesn't have added sugars.

Clarence Jones: Oh, okay, yeah, that was my primary thought, like, let me go get some yogurt. Anyway, thank you. Thank you for being a part of our show. I definitely learned a lot, and as they said, we will be talking back with you again.

Logan G. Spector: This was super fun, I'll be happy to come on again.

Stanton Shanedling: My thought is to echo everything here. Listen to your body, really listen. Given what's going on around us in the environment, listen carefully—and use soft toilet paper.

Logan G. Spector: Actually, get a Japanese bidet toilet; it'll change your life.

Stanton Shanedling: There you go. Thank you so much, Logan. This has been great. We reserve the right to get back to you, or for that matter, if some things really come up in your research that you would like to communicate out, feel free to contact us and we'll get you on another Health Chatter show.

Logan G. Spector: Thank you so much.

Stanton Shanedling: It's been great. And to everybody, we're going to be doing shortly a show on longevity, which also links with this topic that we did today, so stay tuned for that. Everybody, keep health chatting away.