In this episode of MedCast, Dr. Steven Rockower welcomes special guest Dr. Jennifer Christie. Dr. Christie is currently Division Director of Gastroenterology and Hepatology at the University of Colorado Anschutz Medical Campus. She is also the past President of the American Society for Gastrointestinal Endoscopy (ASGE). Dr. Christie talks about the Colorectal Cancer Screening Project that MedChi is championing in Maryland with ASGE, the importance of routine screenings, and more.
In this episode of MedCast, Dr. Steven Rockower welcomes special guest Dr. Jennifer Christie. Dr. Christie is currently Division Director of Gastroenterology and Hepatology at the University of Colorado Anschutz Medical Campus. She is also the past President of the American Society for Gastrointestinal Endoscopy (ASGE). Dr. Christie talks about the Colorectal Cancer Screening Project that MedChi is championing in Maryland with ASGE, the importance of routine screenings, and more.
Dr. Steven Rockower (00:00):
Welcome to MedCast, the podcast from Med Chi, the Maryland State Medical Society. Each episode we'll be doing a deep dive into medicine and taking an insider's look on issues facing Maryland's physicians, patients, and healthcare more broadly. I'm your host, Dr. Steven Rockower. Today my guest is Dr. Jennifer Christie, past President of the American Society for Gastrointestinal Endoscopy. She is presently at the University of Colorado. Welcome, Dr. Christie.
Dr. Jennifer Christie (00:28):
Thank you so much, Dr. Rockower. I am so excited to be here with you.
Dr. Steven Rockower (00:33):
Well, I'm happy to have you. I'm an orthopedist, so I know next to nothing about endoscopy or medicine in general, so you'll have to explain this all to me. Our audience is not only physicians, but the public and legislators. So we'll have to work on all kinds of levels in terms of explaining all this. So why don't we start by giving me a little bit of your background, where you went to medical school, where you trained, and how you became involved in the Society for Gastrointestinal Endoscopy.
Dr. Jennifer Christie (01:10):
Thank you so much. So as you mentioned, my name is Jennifer Christie. I'm originally from Washington, D.C.
Dr. Steven Rockower (01:16):
Ah, welcome.
Dr. Jennifer Christie (01:17):
Yeah, thank you. And I went to undergrad at the University of Michigan, and I received my medical degree from Howard University College of Medicine there in Washington, D.C. And then I went on to train in New York and New Jersey. I did my gastroenterology fellowship at the University Hospital in Newark. And then I was on faculty at Mount Sinai School of Medicine in New York City for six years, and then transitioned to Emory University in Atlanta where I was for 16 years until I joined the University of Colorado as the division director for gastroenterology and hepatology. And yeah, it's been a busy time. And my first year as the division director here at the University of Colorado, I was also president of the American Society for Gastrointestinal Endoscopy. And as president, one of my main initiatives has been this Colorectal Cancer Screening Project, which I'm really excited to talk more with you about today.
Dr. Steven Rockower (02:25):
Absolutely. Tell me more about the colorectal cancer screening and prevention.
Dr. Jennifer Christie (02:30):
Yeah, so colorectal cancer screening and the disparities around screening has been something that has really been of interest to me and a lot of people across the country, if not the world, and how to improve rates of screening in all individuals. And so as I was thinking about what I thought would have a huge impact for many populations, particularly the most vulnerable populations, as I moved into my presidency of the ASGE, I thought this was where we could make a large impact. And so the American Society of Gastrointestinal Endoscopy, we developed a proposal to work with Exact Sciences as well as some other industry partners, and then also with MedChi to get this project off the ground. And again, our goal is to try to make sure it increases the rates of colorectal cancer screening across the continuum. Specifically in those patients who are underserved.
Dr. Steven Rockower (03:35):
Is there a difference between screening and endoscopy?
Dr. Jennifer Christie (03:39):
Well, endoscopy is part of the screening process. So when we screen for colorectal cancer, there's a couple of ways in which to do it. We have the stool-based tests that looks for blood and looks for DNA changes that are seen in cancer or even in patients who have polyps, which are those types of neoplasms or masses that can lead to cancer. But they are sort of a pre-cancerous lesion. And so the stool test looks for that. And specifically the stool test that we're using for this project looks at both blood in the stool and for those DNA changes. And then patients can also undergo a colonoscopy for screening, which is still considered the gold standard. However, not everyone has access or even wants to do a colonoscopy. So the colonoscopy is part of that screening option.
Dr. Steven Rockower (04:38):
What age is the recommendation for the beginning of screening and or colonoscopy?
Dr. Jennifer Christie (04:47):
Yeah, great question. So that has changed. So currently the American Cancer Society and other professional organizations and the US task force for colorectal cancer screening suggests that we start screening all individuals at age 45 - average risk individuals. So those are people who don't necessarily have a family history of colorectal cancer or who don't have other medical conditions that could predispose or increase their risk for colorectal cancer, such as inflammatory bowel disease or colitis. So we recommend screening at 45, but of course, if you have a significant family history or other conditions that would increase your risk, we recommend that patients start to screen earlier than that.
Dr. Steven Rockower (05:40):
You mentioned certain populations that maybe are underserved and don't get screened as much. Who are those populations?
Dr. Jennifer Christie (05:50):
So what we know is that patients who tend to have lower incomes or who are uninsured tend to have lower screening rates. We also know people who have a lower educational attainment tend to have lower screening rates. People who have been marginalized in our society have lower screening rates. So these are racial and ethnic minorities. And really the important piece of that is that it really, a lot of this is around social economics and access to care and insurance. And so we're trying to level the playing field a bit and make sure people who don't have access have access, who may not even know about screening, know about screening and the different options.
Dr. Steven Rockower (06:47):
And that leads us into this, our Colon Cancer Awareness Project here in Maryland. How did that get started and where are we on that?
Dr. Jennifer Christie (06:57):
Yeah, so this project in Maryland, so actually the project that we're doing within ASGE, we're doing it in Maryland and in Georgia. So in Georgia, we are doing this in a rural community. And in Maryland it's both urban, more suburban community, but nonetheless patients that are underserved. Where we are now...So MedChi, we're working very closely with our partners at MedChi and the MedChi Network, in which we are working with a primary care group called Medi-Cal, where the primary care team there is recruiting patients who are eligible for just routine screening. So these are patients who don't necessarily have symptoms, and we could talk about too, that too. But people who are 45 years of age or older who have not been screened within the recommended time period to undergo the stool-based test. And Exact Sciences is working with those patients to educate them on how to do the test appropriately and accurately. They have patient navigators that help them through that process and how to process the stool test. And if that test is positive, and this is where it becomes really critical, then we want to make sure that this test gets followed up by a colonoscopy. That is the critical piece that oftentimes gets dropped in overall patients, but certainly in patients who are underserved. So if you have a positive stool-based test and you don't have a follow-up colonoscopy, you have not completed screening, and we are here to make sure that happens.
Dr. Steven Rockower (08:44):
Yeah, that's actually very, very important that a positive stool test absolutely needs to be followed up with a colonoscopy. Even I as an orthopedic surgeon understand that. The problem as I see it, one is, as you say, socioeconomic and people who don't like having things. But also I think, at least as I understand it, males tend not to want to do this either because they don't like their prep, they don't like having anything inserted in various orifices, and that's always a problem to get people on board with this.
Dr. Jennifer Christie (09:24):
Yeah, I think the prep piece that you mentioned is important because for the colonoscopy, I mean, each of these tests have pros and cons. So the stool-based tests, people don't necessarily want to manipulate their stool. And I say this all the time, even if you don't want to do it, it is around education, getting people doing it, comfortable around this, around it has to be done depend on you and who want you to be around and many years to come to share and all the things that life has to offer. So manipulating the stool and going through that process. And then if you need a colonoscopy or you decide you want to start with a colonoscopy, then this is the prep. But there's so many different options now with the prep, Dr. Rockower, that it's not as bad as people as it used to be, or people anticipate it is. And again, education around that will mitigate some of the challenges that people have with taking the prep. And the beauty of it is that during the procedure, we typically give you a really good nap. You don't feel anything. You don't remember anything. So whatever concerns you have about the actual procedure, you're typically not aware of it during it. So that is the part that I like to tell patients and to have a good experience.
Dr. Steven Rockower (10:47):
Sure, I've been there, done that. I understand. But the important thing is the education of the population in general to get them to come in for the screening and how are you planning on doing all this?
Dr. Jennifer Christie (11:04):
So having them to learn more about screening and why it's important. And then obviously that relationship that they have with their primary care doctor and with the primary care teams is really, really critical for patients to follow through with this. So we are providing additional educational material for the healthcare team so that they can communicate really well with the patients. And then I mentioned to you patient navigation, which is a program that exec sciences has really helped to enhance and improve patient compliance with the stool-based test. But addition to that, if a patient has a positive stool-based test, we are partnering with the MedChi network services to navigate patients to that completion colonoscopy. So helping to schedule, helping to educate, discussing the prep, discussing the sedation during the prep, follow up after the prep. Those things are really critical in everybody, but certainly in populations that may not have the same support and resources that other groups have.
Dr. Steven Rockower (12:17):
Let's take a break. We're speaking with Dr. Jennifer Christie, a gastroenterologist discussing gastrointestinal colorectal cancer screening Funding for this podcast has been made possible by iPrescribe, toss your prescription pad now. There's a safe and easy way to prescribe any drug from your smartphone while you are away from the office. The app includes access to your patient's medical history, state PMPs, clinical alerts, and more. Visit iPrescribe.com to learn more. Welcome back to MedCast, the podcast from MedChi, the Maryland State Medical Society. We're continuing our discussion with Dr. Jennifer Christie as she discusses colorectal cancer screening here in Maryland. Are there legislative ways of getting the resources to the people who need it?
Dr. Jennifer Christie (13:18):
And I'm glad you brought that up, Dr. Rockower. This is a very important component of what we're doing. So with MedChi, we're partnering with state legislators both in Maryland, and then I mentioned to you that we're doing this project in Georgia as well
(13:32):
To really try to create policy around navigation and helping to complete this screening process. In fact, we are, ASGE is again, working with MedChi to encourage lawmakers in Maryland to support the cancer prevention funding and the state's cigarette restitution fund for fiscal year 26. And some of this funding will help support a grant to facilitate some of those support services that I mentioned to you to ensure that patients get screened and they complete screening. And then if we find something on the colonoscopy that then these patients have access to resources to get the care that they need. If we were to find a cancer or an advanced polyp on their colonoscopy,
Dr. Steven Rockower (14:24):
What are the survival rates of people who get diagnosed with cancer early as opposed to waiting until they get symptoms?
Dr. Jennifer Christie (14:36):
And that right there is the crux of this, right? So well, if we do a colonoscopy, well, if the stool test signals something to us that something may be there, we do a colonoscopy and we find a polyp, oftentimes we can take that polyp out before it grows and turns into a cancer. So that's one. And then if we were to find an early stage cancer, the five-year survival rate is over 90%. So most of these patients do well with surgery. Maybe they need some additional therapies, but they do really well. So that early detection is key. Once these cancers become larger or they spread to different parts of the body, those survival rates drop significantly. So again, it is important to get these patients in early and then treat what we find early.
Dr. Steven Rockower (15:28):
And often, as you say, if you can get it early, even before there are symptoms, then the survival rates go way up. Because if you wait till you have symptoms, then it's much, much too late.
Dr. Jennifer Christie (15:43):
Absolutely. And actually, the most common symptom of colorectal cancer, at least early colorectal cancer, is no symptom. Okay. So that is why screening is so important. This is preventable too. As I mentioned to you, we can take out polyps and then certainly it is treatable if we find it early.
Dr. Steven Rockower (16:03):
And even some of the surgical techniques over recent years, I know you're not a surgeon, but they're now doing this with endoscopy through laparoscopic ways so that a lot of this can be taken out through minimal incisions. So people are in the hospital for a day or two at most.
Dr. Jennifer Christie (16:25):
Absolutely. And actually, our endoscopic techniques have evolved as well. There's a lot of innovation around this where we could do what's called submucosal dissection, meaning that we can excise it if it's reasonably small and hasn't spread deep into the layers. But oftentimes our specially trained gastroenterologists can get some of these out endoscopically as well.
Dr. Steven Rockower (16:51):
That's terrific. So what can legislators or primary care docs or the public in general do to help increase the rates of screening?
Dr. Jennifer Christie (17:01):
So I would say to you to answer that question, the importance of this project, and I think this reflects much of what we all do, is the partnership and that collaboration. So for this particular project, we have a council of wonderful healthcare providers and legislative professionals to help move this project forward. And then with that, we're partnering with MedChi and with the legislators in Georgia and with the primary care docs and with the pet patient navigation programs to make sure and with industry, our industry partners who are supporting this program to make sure that we can get this pilot off the ground. And then we're creating a playbook so that we can be a model for other parts of the country to do something very similar. And a lot of people are doing this work, but what our goal is to really continue to partner with those policymakers such that we can prove that not only does early detection and prevention save lives, but it is cost effective.
(18:13):
This funding really helps to decrease some of that economic burden down the road for patients who require care because they never got screened, but they have extensive colorectal cancer and they need care. And so our goal is to try to make sure that this helps patients and also that it is cost effective. So it is that partnering with the local policy makers to create policy around this and get it passed. But we are now in the process of showing that this works and that it is the best for our community members and for the country as a whole.
Dr. Steven Rockower (18:55):
Is there a way of measuring numbers of people being screened and how much of the population we're getting to, and I guess following it down the line, how many fewer colorectal cancers are being treated late? Is there a way of doing any of that?
Dr. Jennifer Christie (19:17):
And each state has their own data where they're following this. What we hope to do with this program is to, yes, capture how many patients we have screened, and our goal is to make sure that we get a substantial number in each state, and then we make sure that those patients get followed up if they have a positive stool-based test. And then why is it positive? So if they have an advanced polyp that it gets treated, if they have cancer, they get treatment. And so we're going to be following that within this program. But then also the state can measure it as a whole to see what the trend is for their overall rates. And we could extrapolate and see how a program like this could impact their rates of early detection and treatment and the decrease in the burden of colorectal cancer in any given population.
Dr. Steven Rockower (20:13):
How long is this program going to be going for?
Dr. Jennifer Christie (20:15):
So we are currently in the third year where we're of the program, and this is a critical time. This is a time in the program in which we're actually screening patients. So we will probably screen, we started screening in Maryland about three months ago, and so we will continue through this. Our goal is to get at least 300 patients in Maryland screened, and that may take another, I don't know, six months, nine months. And then we will kind of see where we are as far as how many patients we screen, what the results were, and then the outcomes that the patients had if they have colon cancer. And then we're just starting the process of creating this playbook that I mentioned to you, and we're working with local policymakers to try to create some policy around this to try to get it into the budgets for either fiscal year 26 or 27.
Dr. Steven Rockower (21:17):
The budget is always a problem, I guess, in every state, but we're having our difficulties right now. What outreach efforts are being made to get to the public about all this? I know you're going through the primary care docs and I guess the gastroenterologists, but is something going on to television, radio, social media, to try to get people going?
Dr. Jennifer Christie (21:41):
Yeah. Well, so there's a lot happening at the local level. So the patients that are coming through to, like I said, Medi-Cal, who are deemed eligible are being asked to undergo screening. So that's one way. But also the staff and the members of MedChi, they're also reaching out to local community groups to educate them about the project. We have made several press releases, both in Georgia and in Maryland to continue to remind people about the project. We have also, and Governor Moore I know just made a proclamation recently that March is Colorectal Cancer Awareness Month. So those,
Dr. Steven Rockower (22:32):
I was going to bring that up.
Dr. Jennifer Christie (22:34):
So those types of announcements and discussion are key to bringing people in to our project, but just bringing people into the screening framework, and even if they don't get it with us, just get screened. So all of these outlets are really important in terms of getting that message out and continuing the conversation.
Dr. Steven Rockower (22:53):
And where can people get any more information on the screening project through the ASGE,
Dr. Jennifer Christie (22:59):
So both patients as well as providers and other community members or policymakers can go to as ge.org/crc. And we have a webpage that discusses the project and where we are and the folks that are participating to make this project happen.
Dr. Steven Rockower (23:26):
Let me repeat that. A S g.org/crc?
Dr. Jennifer Christie (23:31):
Yes.
Dr. Steven Rockower (23:32):
That's wonderful. Is there anything more that you want to tell us about?
Dr. Jennifer Christie (23:36):
No, I think this has been a great discussion. I appreciate the time and the collaboration with MedChi, with Medi-Cal and all of the community groups that are partnering with us, and I just want to say, and primary care providers where it starts getting that message out. If there are any questions, you can reach out to anyone in the program or to me and happy to discuss further and happy to get people involved. As I mentioned, that partnership is critical.
Dr. Steven Rockower (24:11):
Okay. Well, let's switch gears a little bit and go to a couple of other kinds of topics. What would you be doing if you were not a physician?
Dr. Jennifer Christie (24:21):
I didn't expect that question, Dr. Rockower. What would I be doing when people ask me that, you know what? I used to play the guitar as a young girl, and I tried to start playing again as an adult, but I just got life started to happen, got busy. So I think I would probably be either am a solo band or have a band and just go around the country with my band and sing.
Dr. Steven Rockower (24:48):
Okay. That's cool. What's the best advice you've ever received?
Dr. Jennifer Christie (24:53):
The best advice I've ever received. I've received so much advice. That's a hard question. I
Dr. Steven Rockower (24:59):
Know. These are the gotcha questions.
Dr. Jennifer Christie (25:04):
Okay. The best advice I've ever received is,
Dr. Steven Rockower (25:10):
Or alternatively, what advice would you give to your younger self?
Dr. Jennifer Christie (25:13):
Yeah. I would say just continue to be the most authentic and best you that you could be. And don't worry about what other people think or what they're going to say because they're going to say it anyway. But just continue to be the best you and all of the other things will follow, and you will inspire and influence people just by being authentically you.
Dr. Steven Rockower (25:42):
Okay. Well, thank you so much to Dr. Jennifer Christie, who has been our guest on MedCast, the podcast from MedChi, the Maryland State Medical Society. Tune in next time as we continue our conversations with the leaders of medicine in Maryland and around the country to discuss issues facing physicians and our patients. For all of us here at MedChi, I'm Dr. Steven Rockower. Thank you, and goodbye.