Importance of Colonoscopies
From the Show: Stoughton Hospital Health Talk
Summary:
Air Date: 9/25/19
Duration: 10 Minutes
Dr. Derek Hubbard discusses the importance of colonoscopies, at what age you should start, and why early prevention is crucial for colon cancer.
Transcription:
Melanie Cole (Host): If you’re someone who has been hesitant to get your colonoscopy and you are of a certain age; we are here today to tell you all about them so that you don’t have to be hesitant because they are an important, really important screening tool. My guest is Dr. Derek Hubbard. He’s a Family Practice physician at Stoughton Hospital. Dr. Hubbard, as I said in my intro, this is such an important screening tool. Tell us a little bit about colon cancer and the importance of colonoscopies as one of the best screening tools we have out there for cancer.
Derek R. Hubbard, MD (Guest): Colon cancer is the third leading cause of cancer deaths and the third most common cancer amongst men and women. As far as colonoscopy, it started to become increased in the primary detection tool approximately in 2001 when Medicare guidelines changed from flexible sigmoidoscopy which only checked half the colon to the full colonoscopy. And incidence has decreased since that has become the primary screening tool. And essentially, there have been other methods around the years, but this has been the one that’s been the primary screening method for the last 15 years.
Host: One of the things I find most interesting Dr. Hubbard is that they say colonoscopy can prevent colon cancer, which is pretty huge thing to be able to say. How does that work?
Dr. Hubbard: Correct. I think the primary thing to understand about colonoscopy is that it’s polyp detection and polyps are precancerous growths and if we detect those early, we can remove them very easily and prevent the development of cancer that may take five or ten years to grow. Other methods that detect blood or even the blood and DNA tests are more likely just detecting cancer when it’s already happened. So, I think that it is a unique screening tool where it’s curative of the prevention of cancer and also detecting before it happens.
Host: Well as somebody who has had quite a few of them in my days; I can tell the listeners how easy they are. So, why don’t you start by speaking about the current screening guidelines. When are you supposed to get your first one and based on the results of those; how often afterward?
Dr. Hubbard: The age of 50 for men and women currently. There is one governing body, the American Cancer Society that has put out a recommendation at age 45 that has not been accepted yet by every organization. The US Preventative Service Task Force is probably the largest one that we will look at to see if they end up changing that or not. For family history, the biggest thing would be if people have a primary relative, first degree under age 60, they should start even as young as 40 or two second degree relatives. And generally, at least ten years younger than any large polyp or cancer so the next generation does not succumb to this same type of cancer that their relatives had.
Host: Well then let’s talk about the procedure itself. I mean people are afraid of it but mostly they are afraid of the prep. What’s going on with that and tell us kind of from start to finish, what it looks like.
Dr. Hubbard: The main thing is people will need to go clear liquid diet the day prior, avoiding some hard to digest foods even a few days before, but there are different types of preps but in general, it involves some type of liquid that does not absorb because we need the colon to be cleansed in order to see. So, there’s combinations. Most commonly though, they will involve about a half a gallon of liquid and that is drank usually it is half of the preparation the night before and then half several hours before the next morning. That’s been shown to give us the best visualization of the colon to see all polyps.
Host: So, the prep really is what people are mostly afraid of and then, the colonoscopy, I imagine you hear Dr. Hubbard, when you start people say when are you going to start and you tell them, you are already finished. It’s a pretty simple procedure, yes?
Dr. Hubbard: Typically, twenty to thirty minutes, most people think it was just a few minutes. And because of the medications that are sedative and mild narcotics typically or a nurse administered propofol medicine; all of which make a person be surprised that they are finished. And they are very safe because we monitor them every second while they are in the procedure room.
Host: So, then let’s talk about polyps. If you find some in there, what do they mean? Because are some polyps cancerous or precancerous? Are some just totally benign and there’s no problem with them? But you take them out anyway. Tell us about polyps.
Dr. Hubbard: Yes, so we take out all polyps we see. There are certainly several that are minor. I think of them like skin tags that are not precancerous, and they may still be removed and do not change your risk. You still can repeat a colonoscopy in ten years. Other polyps called tubular adenomas and serrated adenomas are the next most common. We actually see those in 30% of patients. And we do remove them and depending upon the number and size that people have; we would follow up in most commonly a three to five year interval pending the patient’s exact risk.
Host: Are there any certain things you’d like patients that have polyps removed to know about that day of, going back to work or lifting heavy things? Are there any specific requirements?
Dr. Hubbard: Most often there is not a risk. Certainly the day they get the medication, they are not working at the procedure. It would be rare maybe 1% of patients who have large polyps that may have risk for bleeding or required some type of clip procedure in order to have them avoid heavy lifting for a day or two. But most people can go on walks later in the day and do minor things at home.
Host: Dr. Hubbard, besides the fear of the prep and what they might find out; some people are hesitant because they are not sure if insurance covers this. As of right now, colonoscopies are covered under many insurances at 100%, yes as a part of a well-visit or a preventative type procedure?
Dr. Hubbard: Certainly insurance is complicated, and it can depend upon whether it’s considered a screening or a diagnostic. And that is actually one of the complicated parts about colonoscopy versus a blood test that’s offered, or the stool test that is offered that detects blood called Cologuard. That one actually turns an insurance test from a screening to a diagnostic and then actually it is not completely covered. So, there’s complexities where people may not understand which method they are getting. But colonoscopy has been covered for 18 years amongst all primary insurances for preventative tests short of what patients’ copays may be.
Host: What a great point and thank you for pointing out that if someone does the blood test and then there’s a red flag that then that screening colonoscopy would then be considered diagnostic. That’s a really important point for listeners to know. As we wrap up, what would you like listeners to know about colonoscopy, the importance of getting their loved ones in if it’s time, as someone who shoved my husband in to get his; and they pulled out a pretty big polyp; I know how important it is to make sure to get these when they are required.
Dr. Hubbard: Do not have a fear of a common procedure that is safe and is less than one in 2000 risk as far as problems of injury or bleeding. I have done 9500 in my career and have had no major problems, certainly minor problems but it is something that the amount of cancers we’ve seen and prevented are greatly outweigh those risks. Stoughton Hospital is doing 500 cases a year and also patients are very happy afterwards. They get food and a loaf of bread as part of their postoperative recovery. So, it is a very pleasant place to get your colonoscopy at and feel comfortable that you are getting a quality exam, getting polyps removed.
Host: How wonderful. I love the loaf of bread. That’s awesome. Thank you so much Dr. Hubbard and listeners really, go get your colonoscopies. It’s so important, it could save your life or someone that you love. And that wraps up this episode of Stoughton Hospital Health Talk. You can head on over to our website at www.stoughtonhospital.com for more information and to get connected with one of our providers. If you found this podcast as interesting as I did; please share with your friends and family. Share on social media, share with those you love because this is a preventive procedure that can also prevent cancer. It’s that important. And be sure not to miss all the other fascinating podcasts in the Stoughton Hospital library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): If you’re someone who has been hesitant to get your colonoscopy and you are of a certain age; we are here today to tell you all about them so that you don’t have to be hesitant because they are an important, really important screening tool. My guest is Dr. Derek Hubbard. He’s a Family Practice physician at Stoughton Hospital. Dr. Hubbard, as I said in my intro, this is such an important screening tool. Tell us a little bit about colon cancer and the importance of colonoscopies as one of the best screening tools we have out there for cancer.
Derek R. Hubbard, MD (Guest): Colon cancer is the third leading cause of cancer deaths and the third most common cancer amongst men and women. As far as colonoscopy, it started to become increased in the primary detection tool approximately in 2001 when Medicare guidelines changed from flexible sigmoidoscopy which only checked half the colon to the full colonoscopy. And incidence has decreased since that has become the primary screening tool. And essentially, there have been other methods around the years, but this has been the one that’s been the primary screening method for the last 15 years.
Host: One of the things I find most interesting Dr. Hubbard is that they say colonoscopy can prevent colon cancer, which is pretty huge thing to be able to say. How does that work?
Dr. Hubbard: Correct. I think the primary thing to understand about colonoscopy is that it’s polyp detection and polyps are precancerous growths and if we detect those early, we can remove them very easily and prevent the development of cancer that may take five or ten years to grow. Other methods that detect blood or even the blood and DNA tests are more likely just detecting cancer when it’s already happened. So, I think that it is a unique screening tool where it’s curative of the prevention of cancer and also detecting before it happens.
Host: Well as somebody who has had quite a few of them in my days; I can tell the listeners how easy they are. So, why don’t you start by speaking about the current screening guidelines. When are you supposed to get your first one and based on the results of those; how often afterward?
Dr. Hubbard: The age of 50 for men and women currently. There is one governing body, the American Cancer Society that has put out a recommendation at age 45 that has not been accepted yet by every organization. The US Preventative Service Task Force is probably the largest one that we will look at to see if they end up changing that or not. For family history, the biggest thing would be if people have a primary relative, first degree under age 60, they should start even as young as 40 or two second degree relatives. And generally, at least ten years younger than any large polyp or cancer so the next generation does not succumb to this same type of cancer that their relatives had.
Host: Well then let’s talk about the procedure itself. I mean people are afraid of it but mostly they are afraid of the prep. What’s going on with that and tell us kind of from start to finish, what it looks like.
Dr. Hubbard: The main thing is people will need to go clear liquid diet the day prior, avoiding some hard to digest foods even a few days before, but there are different types of preps but in general, it involves some type of liquid that does not absorb because we need the colon to be cleansed in order to see. So, there’s combinations. Most commonly though, they will involve about a half a gallon of liquid and that is drank usually it is half of the preparation the night before and then half several hours before the next morning. That’s been shown to give us the best visualization of the colon to see all polyps.
Host: So, the prep really is what people are mostly afraid of and then, the colonoscopy, I imagine you hear Dr. Hubbard, when you start people say when are you going to start and you tell them, you are already finished. It’s a pretty simple procedure, yes?
Dr. Hubbard: Typically, twenty to thirty minutes, most people think it was just a few minutes. And because of the medications that are sedative and mild narcotics typically or a nurse administered propofol medicine; all of which make a person be surprised that they are finished. And they are very safe because we monitor them every second while they are in the procedure room.
Host: So, then let’s talk about polyps. If you find some in there, what do they mean? Because are some polyps cancerous or precancerous? Are some just totally benign and there’s no problem with them? But you take them out anyway. Tell us about polyps.
Dr. Hubbard: Yes, so we take out all polyps we see. There are certainly several that are minor. I think of them like skin tags that are not precancerous, and they may still be removed and do not change your risk. You still can repeat a colonoscopy in ten years. Other polyps called tubular adenomas and serrated adenomas are the next most common. We actually see those in 30% of patients. And we do remove them and depending upon the number and size that people have; we would follow up in most commonly a three to five year interval pending the patient’s exact risk.
Host: Are there any certain things you’d like patients that have polyps removed to know about that day of, going back to work or lifting heavy things? Are there any specific requirements?
Dr. Hubbard: Most often there is not a risk. Certainly the day they get the medication, they are not working at the procedure. It would be rare maybe 1% of patients who have large polyps that may have risk for bleeding or required some type of clip procedure in order to have them avoid heavy lifting for a day or two. But most people can go on walks later in the day and do minor things at home.
Host: Dr. Hubbard, besides the fear of the prep and what they might find out; some people are hesitant because they are not sure if insurance covers this. As of right now, colonoscopies are covered under many insurances at 100%, yes as a part of a well-visit or a preventative type procedure?
Dr. Hubbard: Certainly insurance is complicated, and it can depend upon whether it’s considered a screening or a diagnostic. And that is actually one of the complicated parts about colonoscopy versus a blood test that’s offered, or the stool test that is offered that detects blood called Cologuard. That one actually turns an insurance test from a screening to a diagnostic and then actually it is not completely covered. So, there’s complexities where people may not understand which method they are getting. But colonoscopy has been covered for 18 years amongst all primary insurances for preventative tests short of what patients’ copays may be.
Host: What a great point and thank you for pointing out that if someone does the blood test and then there’s a red flag that then that screening colonoscopy would then be considered diagnostic. That’s a really important point for listeners to know. As we wrap up, what would you like listeners to know about colonoscopy, the importance of getting their loved ones in if it’s time, as someone who shoved my husband in to get his; and they pulled out a pretty big polyp; I know how important it is to make sure to get these when they are required.
Dr. Hubbard: Do not have a fear of a common procedure that is safe and is less than one in 2000 risk as far as problems of injury or bleeding. I have done 9500 in my career and have had no major problems, certainly minor problems but it is something that the amount of cancers we’ve seen and prevented are greatly outweigh those risks. Stoughton Hospital is doing 500 cases a year and also patients are very happy afterwards. They get food and a loaf of bread as part of their postoperative recovery. So, it is a very pleasant place to get your colonoscopy at and feel comfortable that you are getting a quality exam, getting polyps removed.
Host: How wonderful. I love the loaf of bread. That’s awesome. Thank you so much Dr. Hubbard and listeners really, go get your colonoscopies. It’s so important, it could save your life or someone that you love. And that wraps up this episode of Stoughton Hospital Health Talk. You can head on over to our website at www.stoughtonhospital.com for more information and to get connected with one of our providers. If you found this podcast as interesting as I did; please share with your friends and family. Share on social media, share with those you love because this is a preventive procedure that can also prevent cancer. It’s that important. And be sure not to miss all the other fascinating podcasts in the Stoughton Hospital library. Until next time, I’m Melanie Cole.
