Frequently Asked Questions (FAQ)
Because 90% of colon cancers develop from polyps. These polyps take an average of 12 years to develop into cancer. If you have a screening colonoscopy during that time, the doctor will remove the polyp and prevent the cancer.
Dr. Lloyd believes the patient has a right to make their own decision about such an important health screening test. It has been determined that doctors with a quality measure (ADR) below the national standard give patients only one-tenth the protection of the doctors performing above the ADR of 25. This is why it is so important to know the ADR of the doctor scheduled to perform your screening BEFORE you schedule a colonoscopy. Never get referred to a group, you will be assigned a doctor with below the standard ADR half the time. Only go to a doctor with a documented ADR above 25.
In the over 50,000 patients already screened in the Tandem Colonoscopy program, 67% or 2 out of 3 have had at least one polyp. The older you are, the more likely to find polyps.
No. There are two types of polyps: Adenomatous and hyperplastic. Only the adenomatous have the danger of becoming cancer. Unfortunately, 2 out of 3 polyps are the dangerous type.
The purpose of a mammogram is to find the breast cancer early, before it has had a chance to spread. With regular screening mammograms, a woman can reduce her risk of dying of breast cancer by 25%. Colonoscopy is superior because it has the added benefit of actually preventing the development of the cancer by removing the pre-cancerous polyps before they turn into full-blown cancer. Similarly for prostate cancer, the PSA helps identify men with prostate cancer that hopefully has not spread, but it does NOT prevent the development of prostate cancer. Colon cancer is “the preventable cancer” because of the long time period from the appearance of a polyp to the time it becomes cancerous.
Unfortunately, 75% of colon cancer patients present AFTER they experience a symptom. Most of them will die. The proper time to be tested is BEFORE ANY SYMPTOMS develop, when the cure rate is 95%. In America, only 40% of people over 50 have been screened with colonoscopy.
There are four main reasons:
- Facts: too few know the facts on the preventability of colon cancer. Too few know how deadly colon cancer is when c
- Fear: Many think the test is painful. This is not true. You are “put to sleep” for the test. 90% do not remember anything about the test.
- Finance: For those without insurance, the test at a hospital would cost approximately $4,000. Although a colonoscopy is 50 times more likely to save a life than a mammogram, it can also be fifty times as expensive. More insurance companies are covering colonoscopy as a routine screening test. The Affordable Care Act (Obamacare) require all insurers to over colonoscopy with zero out of pocket expense. We strive to minimize financial barriers. Let us check your insurance to see if you are entitled to a “free” colonoscopy, of the highest quality, too.
- Family Doctor: Patients who get regular check-ups and get a firm recommendation are three times as likely to proceed to colonoscopy.
Colon cancer is slightly MORE common in men, but only a little. Women get colon polyps and therefore, cancers later than men. Due to the fact that they live longer, women experience nearly the same number of total deaths each year.
Colon cancer is far more deadly in the African American patient. More African Americans die of colon cancer, often due to the stage at which it is discovered. African Americans get polyps earlier and they evolve into cancer quicker than in their white counterparts. Less African Americans are screened, so the disease is often more advanced (and therefore, deadly) when diagnosed, so more will die. African American men die twice as frequently when diagnosed with advanced stage colon cancer. The American College of Gastroenterology (along with many other public health organizations) recommends the African American patient initiate screening.
Remember: You should be screened BEFORE any symptoms develop - when the cure rate is 95%. If you wait until any symptoms develop the cure rate drops to 15%! But, since you asked, here are the symptoms:
- Passing blood with bowel movements.
- Change in the bowel habits: Either constipation OR diarrhea.
- Change in the thickness of the stool.
- Unexplained weight loss.
- Abdominal pain.
- Anemia (low blood).
For individuals with a family history, screening should start earlier, usually at age 40. If the polyps or colon cancer was discovered at an early age, screenings should begin 10 years younger than the age of the relative with the polyps or cancer.
No. Not that we are aware of.
Definitely YES! A FIT stool test is only positive when the polyp (or cancer) is bleeding. This occurs only when the polyp has advanced into dangerous stages. Half of the polyps and cancers will not give you a positive result until it is too late. It has been said that performing a FIT or other stool based tests is like asking a woman to have a mammogram, but only on one breast! You’re only looking for a cancer and it may already have spread by the time the abnormal tissue is leaking blood.
The only way to eliminate the 50,000 unnecessary deaths is to screen everyone of age. It is your body. You know if you need to be screened. A referral is not required. You are encouraged to discuss colon cancer screening with your doctor. The important thing is to be screened.
There are four groups of physicians who perform most of the colonoscopies: Gastroenterologists, surgeons, colo-rectal surgeons, and primary care physicians.
There are four measures of quality in colonoscopy:
- How often is the doctor able to get to the end to examine the entire colon? Sometimes the twists and turns prevent a complete test. In the Tandem Colonoscopy program, 99% have had a complete examination. The national average is 95%.
- How often does the doctor find polyps? The most frequently used quality measure is a doctor’s adenoma detection rate (ADR). According to the American College of Gastroenterology, the ADR should be above 25. This means the doctor finds an adenoma (pre-cancerous polyp) in at least 25% of patients screened. The more careful the exam, the less polyps that are missed. In the Tandem Colonoscopy program, 63% have had polyps. The national average is 32%.
- How much pain does the patient feel? A good doctor should prevent any memorable pain.
- How often are there problems? Complications can occur. In several studies, complications occur in 3 per 1,000 cases. The most serious complication is for a hole to occur (a “perforation”). In the 65,000 patients in the Tandem Colonoscopy model there have been 12 perforations.
Check with the doctor who will perform your test and ask for specific statistics on the four quality measures, especially the ADR. The more experience, in general, the better. Dr. Lloyd has performed or supervised over 65,000 colonoscopies. He has taught over 50 physicians in the art of Colonoscopy.
GET SCREENED! That is our goal. We can find a mutually convenient time for almost everyone. We even have Saturday hours on occasion to help those who cannot get off work.
The quality of the test is dependant on the quality of the bowel cleansing. The better the prep, the better the test. For many years, we used a gallon of “Golytely.” Now we use Ducolax tablets (Bisacodyl) and 2 10-oz.bottles of magnesium citrate. Although it tastes extremely tart, it can be mixed with juice to hide the flavor. We find our prep to be far better tolerated and to give us an excellent view of the colon surfaces nearly every case. If you suffer from frequent bowel movements or diarrhea, you may need to adjust the preparation accordingly. Also, if you suffer from chronic constipation, it is very important to begin your cleansing preparation earlier and to add any laxatives that work well for you. A clean colon is crucial to an accurate test.
If you have no risk factors and had a completely normal test, you don’t have to have another test for TEN YEARS. If you have ever had polyps or a family history of polyps or cancer, the interval should not exceed FIVE YEARS. If you had a polyp during your last test, the timing for the next test depends on the lab report - usually five years, but occasionally sooner if the polyp was determined to be growing more rapidly or larger than most or near cancer.
We will send a report and pictures to your primary care physician, at your request.
Our goal is to have everyone who should have a test get THE TEST. We hope you will help us get the word out. Tell your family members, co-workers, friends how easy it is to be screened. No referral is necessary.
If you are over 50, most South Carolinians qualify for a special “healthy Connections Check-up” program administered by the Medicaid office. The local DSS office can help you fill out the forms. This is not a typical Medicaid program that requires you to be poor to qualify. For a family of four, an annual income below $40,000 will meet the eligibility. For those that do not qualify, we have an internal indigent care program called the “parking lot” that may allow you to have a colonoscopy at no cost.
There are some medications you can continue and some you should hold off on.
HYPERTENSION: For patients with high blood pressure (Hypertension), we ask that you bring your pills with you. Often the prep lowers the blood pressure, and you don’t need you pills until the next day. We will monitor your blood pressure and EKG throughout the test and give whatever medications are needed.
DIABETES: When you are not eating, your need for blood sugar medication is much lower. For patients taking insulin, we usually recommend one-half of the regular doses on the day of the test. For those on pills, you can continue them. We will check your blood sugar before your test and make appropriate adjustments. Call the Center if you have any questions.
HEART PATIENTS and/or BLOOD THINNER patients:
ASPIRIN: We no longer routinely stop aspirin before the test. If it is a medication you take on your own (not recommended by your physician) you may hold the aspirin for a week, but this is not essential.
IF you are on Coumadin, Pradaxa, Eliquis, or Xarelto there is an increased risk of bleeding when polyps are removed. We often recommend stopping your coumadin three days before your test, but only with permission from the doctor who prescribes it. We like to have a current reading on the blood level. Please call and speak with one of our nurses or the doctor to determine the best approach for you. Blood thinners are very powerful medications and should not be discontinued without a doctor’s supervision. We do not stop blood thinners routinely.
Mechanical Heart Valve Replacement Patients: We will administer preventive antibiotics before your test.
PREDNISONE: If you are on prednisone for any reason, the risks of complications are higher. We would like to discuss the best approach for you. We must know about the history and obtain medical records BEFORE you test.
In general, it is best to ask questions several days before your test to ensure your safety.