Episode 10, Colon Cancer Screening
Statistics show that colon and rectal cancers are the second biggest cancer killer, yet unlike most cancers, this disease is preventable with proper screening. On this episode of “To Your Health with Dr. Jim Morrow,” Dr. Morrow welcomes gastroenterologist Dr. Simon Cofranceso to the show to get the lowdown on colon cancer screening. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.
Dr. Simon Confrancesco, GI North
Dr. Simon Cofrancesco is a board certified gastroenterologist with over 25 years of experience. Dr. Cofrancesco is originally from Massachusetts. He completed his medical training at Baystate Medical Center of the Tufts University School of Medicine, followed by a Fellowship in Gastroenterology at Long Island College Hospital in Brooklyn.
Dr. Cofrancesco began his career in an underserved area of Mississippi as part of his school loan repayment. He worked at Southwest Mississippi Regional Medical Center in McComb, Mississippi, for over sixteen years and was named Chief of Staff in 2007. While in Mississippi, he met his wife Roxanna Redden, and they started their family of 5 children, ages 10-19.
Dr. Cofrancesco then moved to Georgia and founded GI North in 2011, followed by GI North Endoscopy in 2018. GI North has steadily grown and currently has 3 additional providers including two additional gastroenterologists and a GI nurse practitioner. GI North is physician owned and operated, and because of their commitment to patient centered care has been awarded “Best of Forsyth” in 2017 and 2018. For further information on GI North you can go to their website at gi-north.com, or call 404-446-0600.
About Morrow Family Medicine and Dr. Jim Morrow
Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be. At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!” Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.
Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce. He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.
Intro: [00:00:06] Broadcasting live from the North Fulton Business RadioX Studio. It’s time for To Your Help with Dr. Jim Morrow. To Your Health is brought to you by Morrow Family Medicine, an award-winning primary care practice, which brings the care back to health care.
Jim Morrow: [00:00:23] Good afternoon. This is To Your Health with Dr. Jim Morrow, and that’s me. I’m Jim Morrow. I’m with Morrow Family Medicine. We have an office in Milton, Georgia and in Cumming, Georgia, where we like to say we are bringing care back to health care. And we are here every second and fourth Wednesday on North Fulton Business Radio. We’re very excited to be here today. We’re doing something new and different for our show today. Today, for the first time, I have a guest with me who I’m going to be talking with about colon cancer and colon cancer screening. So, I’d like you to welcome Dr. Simon Cofrancesco from GI North in Cumming, Georgia. Hey, Simon.
Simon Cofrancesco: [00:01:01] Thanks, Jim.
Jim Morrow: [00:01:03] Good to have you.
Simon Cofrancesco: [00:01:03] Thank you very much. Glad to be here.
Jim Morrow: [00:01:05] Yeah. So, tell me a little bit about your practice and you before we get started, if you would.
Simon Cofrancesco: [00:01:09] GI North started in 2011 when I got to town, and we’ve steadily grown since then. We started out with just myself. And then, we’ve added three additional providers – two gastroenterologists and one nurse practitioner. And we’ve opened up an endoscopy center that’s just starting to get going. In addition to our clinic, it’s actually just across the hallway in a building, probably a half a mile from where you are.
Jim Morrow: [00:01:41] Well, that’s wonderful. I know you’re glad to have that up and running.
Simon Cofrancesco: [00:01:44] Absolutely.
Jim Morrow: [00:01:45] That’s got to be a good thing. So, I want to talk to you about colon cancer screening and colon cancer itself a little bit. And I know the whole thing of colon cancer screening has changed so much since you and I were in training. We went from what looked like this stand this microphone is on to what’s thankfully a lot more flexible now. But if you would, give us an overview of what a colonoscopy is all about.
Simon Cofrancesco: [00:02:14] Most people today, especially around here, know about it. It’s unusual, like you said, 20 or 30 years ago to run into somebody who’s not familiar with what it is. But it is just a long, flexible tube, very small, about like a finger in diameter, and it has a light on the end. And we just look carefully in the colon for little growths called polyps and remove those because that’s how you develop colon cancer. A slow process of a little growth called a polyp that over years gets bigger, and eventually turns into cancer.
Jim Morrow: [00:02:50] Okay. Now, speaking of colon cancer, can you talk a little bit about how many people get colon cancer and how common it is? Is it something everybody needs to be worried about and so forth?
Simon Cofrancesco: [00:02:59] Well, it really is either the second or third most common cancer in this country. And I think the number has hovered around 5%. That’s a big number, 5% of people in this country are going to get colon cancer. But the good news is, is that you can prevent that. Not catch it early but prevent that by getting a colonoscopy and removing polyps to prevent cancer.
Simon Cofrancesco: [00:03:26] So, it’s really a very different concept than most other cancers. It’s not like a mammogram where you detect breast cancer early. We prevent it. And the numbers are showing that. So, the newest numbers out show that colon cancer in people older than 50 is going down in this country over decades because people are getting screened for it. Unfortunately, the other new news is people under 50, it’s going up. So, the good news, though, is you can prevent it and they’re starting to change some of the age ranges, and it’s very prevalent, and it’s the number two cancer killer in this country.
Jim Morrow: [00:04:10] Wow. Well, that’s a wonder. I know I preach to people about going to get colonoscopies to the point, sometimes, of berating, I suppose you could say, but I certainly browbeat them if nothing else if they’re 56 or 58 and they haven’t been.
Jim Morrow: [00:04:25] So, you had one the other day, 63 years old, never been for colonoscopy. I’ve broken the bad news to him. I said, “You need two colonoscopies. You need one for when you were 50 and one for when you were 60. Lucky for you, you can make that all up in one. You don’t have to worry about it.” Now, people worry about colon cancer, but what are the signs and symptoms of colon cancer?
Simon Cofrancesco: [00:04:45] The bad news is, is that we go based on age because symptoms are not a reliable way to detect it. So, everybody thinks they’re in touch with their body. And I constantly hear, which I’m sure you hear too, “I know my body. I feel fine. There’s nothing wrong.” And it’s hard to explain to people, when you do find cancer, and it’s really a surprise that it’s probably been there for — it’s been cooking or evolving for 5 to 10 years. So, probably, one of the most common symptoms of colon cancer is that there isn’t any symptoms.
Jim Morrow: [00:05:22] Wow.
Simon Cofrancesco: [00:05:22] And that’s the scary part. But when people do get more advanced disease, some things that do show up to the patient are pain, or change in bowels, or blood in the stool. If they’re lucky enough to have those symptoms because of where the cancer is, then they may get detected at a time where they can be treated successfully. But, again, probably the cancers that we’re seeing more and more lately start in the beginning of the colon. And so, those symptoms I just mentioned are not usually as prevalent or common.
Jim Morrow: [00:05:59] Okay, good. Now, I know the thing that patients talk about the most about a colonoscopy, at least, to me, is the prep. They dread the prep because they know that they’ve got to drink, or they think they’ve got to drink this gallon of salt water, and it’s horrible. Last time I had one, I think you told me to put a packet of Crystal Light in my gallon of GoLytely. And, now, I can’t drink Crystal Light because I can’t get that taste out of my mouth, the GoLytely. But talk about the options for a prep for a colonoscopy.
Simon Cofrancesco: [00:06:30] Well, there’s been some improvement. We have smaller preps now that are about half of a soda, six ounces or so. So, it’s improved. It’s not a major improvement, but it’s an improvement. And it does make it a little easier on patients, to be honest with you, because more people can tolerate low volumes even though the taste isn’t that good. So, it’s a lot easier as far as the prep goes. It’s still the part that people don’t like.
Jim Morrow: [00:07:03] Well, if it’s only a few ounces, it must be liquid dynamite. Is that what they call it?
Simon Cofrancesco: [00:07:06] Well, it works. It works for 99% of people.
Jim Morrow: [00:07:10] I bet. I bet it does. I can just imagine. So, if we’re going through the colon, and we’re looking for things, and we found a polyp, what do you do at that point?
Simon Cofrancesco: [00:07:21] The majority of the time, we just take it out. It’s usually not big. And we have devices that can remove them. People don’t feel anything. The risk of injury to the colon is very very small. Especially today, we use devices where we don’t have to use any electricity. And that really has almost completely removed significant risks from performing a colonoscopy, but it’s just a small bump. Now, there are times where it’s big unexpectedly, and we can’t safely remove it endoscopically. And sometimes, people do have to have surgery, but that’s a real vast minority of people.
Jim Morrow: [00:08:02] And am I right in remembering that if you do that, you’ll put a tattoo on the inside of the colon?
Simon Cofrancesco: [00:08:07] Very correct. That is correct. If there’s something that we have to monitor closely or we have to alert the surgeons to, then we do put a tattoo on that. That’s correct.
Jim Morrow: [00:08:17] That’s amazing.
Simon Cofrancesco: [00:08:18] Yeah.
Jim Morrow: [00:08:18] That’s amazing. So, you mentioned a potential problem. And the other thing people talk about is I’ll say, “Well, you need a colonoscopy,” and I’ll hear, “Well, I don’t want a colonoscopy because I knew somebody that had a colonoscopy, and they had a perforation.” And, usually, at that point, I’ll say, “Well, how do you get to the office?” And they’ll say, “Well, what do you mean? I drove.” And I’ll say, “You drove an automobile? Have you not known anyone that got killed in a car wreck? Oh my God. And you drove here.” So, talk about the numbers for perforations.
Simon Cofrancesco: [00:08:51] Well, they’re changing, and they should be changing because, as I mentioned, in the last 5 to 10 years, we’re using devices that make it almost impossible to perforate somebody. Now, if something’s big, and we have to use what’s called electrocautery or electricity, that does increase the risk, but it’s still somewhere in the range of 1 in 2000. And I like your approach with the automobile. What I tell people though is the other side of the coin is that there is a rare risk of perforation, but what is your risk of colon cancer? And it’s going to be, at least, 5%. So 1 in 2000 versus, at least, 5%, which one’s less risky?
Jim Morrow: [00:09:36] I have to get the calculator, Apple, my phone, open to answer that, but I’ll do that later, I promise. So, you’re going through the colon, and you’re looking at polyps, and you pull them out, and you take them off and do a polypectomy. You send them to the lab. This is a little bit more detail than some people will want, but I think we’ve got a fairly intellectual listening audience. So, I want to give them some details about that. Can you talk a little bit about the types of polyps they might find?
Simon Cofrancesco: [00:10:01] Probably the easiest thing for me to say, and this is a big point of confusion, is that there’s two types of polyps. Not really, but I’m going to simplify it. So, there’s the kind of polyp that you have to remove because it has potential in time to turn into cancer. And then, there’s some small percentage of polyps that don’t have any potential to turn into cancer. And we see those in certain locations of the colon.
Simon Cofrancesco: [00:10:29] So, I first divided into that kind of approach. Then. you get into a lot more detail that’s probably, as you’ve mentioned, a little bit above the routine dialogue you’ll have with the patient, but there is two kinds of polyps. And there’s some that we can simply ignore because they’ll never be a problem.
Jim Morrow: [00:10:51] So, I know, until recently, it was fairly clean cut, very simple. If you had a hyperplastic polyp that doesn’t turn to cancer, you can repeat the test in five years. If you had an adenoma, the type that can turn to cancer, you’re going to repeat it in one to three years, depending on size. But you told me not long ago that that has changed. So, what should people expect in that now?
Simon Cofrancesco: [00:11:14] Yeah. The most common thing is that if people are going to have polyps, or there’s a family history of polyps or cancer, they should get a colonoscopy roughly every three to five years. It’s usually five years but depending on what we find, it can vary a little bit.
Simon Cofrancesco: [00:11:30] In people who are average risk, where they don’t have polyps, and/or nobody in their family has polyps or cancer, they can go 10 years. That shows you how slow a process colon cancer is. If we check someone today whose average risk, it would, generally speaking, take 10 years for them to start to develop colon cancer. So, it’s such a slow process, but it’s usually that 5 or 10 years.
Simon Cofrancesco: [00:11:57] And then, we do kind of bring it down under certain circumstances. There’s variables that we look at that can make us do it more frequently – the size of the polyp, how we have to remove the polyp, the specific pathology of the polyp, the number of polyps, how well they were cleaned out, avariety of different things.
Jim Morrow: [00:12:19] And the low-volume prep, as they usually call it, does a good enough job, so you don’t have to go back because you didn’t get cleaned out well in most cases.
Simon Cofrancesco: [00:12:26] The preps work but not all the time. And that’s true. Unfortunately, we disappoint about 1 out of 10 people. They have to come back because the standard prep, for whatever reason, didn’t work. Studies show that. I see that in my experience. So, there are a small group of people that will do what they’re supposed to, and it doesn’t matter whether it’s a large volume prep, Jim, or the new smaller ones.
Simon Cofrancesco: [00:12:52] The change we have in the preps today are split dose. And nobody likes this, but it does allow us to get a better examination where you take half of the prep the day before like usual, and the other half, three hours before your colonoscopy. And what that does is it keeps the colon clean on that beginning part of the colon where the bacteria start to repopulate very quickly from drinking the prep the day before. So, we don’t see as well when they do it all in one day versus plating it up. So, that’s a quality measure that us, GI doctors, are supposed to be doing to get a more thorough examination.
Jim Morrow: [00:13:34] Super. You mentioned the family history. If they do have a family history, what age do you recommend they start it?
Simon Cofrancesco: [00:13:40] A family history is either at 40 years of age, from 50 to 40, or if the person in the family, like a 45-year-old comes in, and I find a polyp on them, it would be 10 years younger than that, whichever is the youngest. So, I’m seeing polyps now, and people in their 30s and 40s, their children have to get checked 10 years before they were diagnosed with a polyp. So, we’re starting to reach downwards with colonoscopy.
Jim Morrow: [00:14:11] Well, as I tell patients too, I think very few people ever died and went to the pearly gates and said to St. Peter, “I wish I had so many colonoscopies.” But I can promise you that the opposite have been said to St. Peter.
Simon Cofrancesco: [00:14:23] Yeah.
Jim Morrow: [00:14:24] So, occasionally, patients will tell me that it was very uncomfortable when they had their colonoscopy or there were unable to finish the colonoscopy because of what’s called a torturous colon, a twisted sort of colon, curvy colon. Can you tell me a little bit about what you do in that situation and what all that means?
Simon Cofrancesco: [00:14:41] Well, first off is that if you have an experienced gastroenterologist, the chances of not completing a colonoscopy should be literally 1%, 2%, or 3%.. I mean it should be exceptional.
Jim Morrow: [00:14:55] Good.
Simon Cofrancesco: [00:14:55] So, first of all, that’s not really something that’s very common. But on occasion, it can happen. And then, if that does, by chance, happen, the testing you would have to do as an alternative would be probably some form of an x-ray or some of those tests that people who don’t want to have colonoscopy get like hemoccult testing, which is testing for microscopic blood in the stool, or there’s that relatively new DNA test cologuard. Those aren’t perfect ways. Those have limitations, but those are some of the things that you can do. It should be exceptional that a colonoscopy cannot be completed, just so you know.
Jim Morrow: [00:15:34] So, you mentioned cologuard. I was going to get to that because I get asked that daily, it seems like. What do you tell patients about why the colonoscopy is a preferred test to cologuard?
Simon Cofrancesco: [00:15:46] Cologuard has a lot of limitations. It’s not meant to pick up polyps, first of all. It picks up cancer. So, you’re already moving away from something that can prevent cancer, and you’re moving into something that diagnoses cancer. Big difference there, right? Number one.
Simon Cofrancesco: [00:16:07] Number two. Although the studies say that it’s supposed to be accurate or specific 85% of the time, I think not, just myself but everybody I’ve spoken to will say that it’s not the case. Probably the last 20 people I’ve scoped with a positive cologuard have not had colon cancer. So, it’s been wrong.
Simon Cofrancesco: [00:16:32] And then, finally, the biggest thing about cologuard is that patients and doctors don’t know what it’s indicated for. It’s very narrow indication. It’s not for everybody. It’s for average-risk individuals. So, if they have had polyps, or cancer, and/or if somebody else in their family has had polyps or cancer – in other words, a high-risk individual – it’s not intended for them because those people have a high rate of polyps, and the cologuard test will not tell you if they have polyps.
Simon Cofrancesco: [00:17:07] So, it’s very narrow, but, in reality, I know that people get it, and I don’t blame you for what you do or anybody else, is that they’re just not going to have a colonoscopy. And this is probably the best you can do. So, that’s real world. People ask me, who’s the cologuard for? I tell them it’s for chickens because it’s just for people who don’t want to have the best test because they’re scared, or frightened, or things like that.
Jim Morrow: [00:17:31] They’ve been reading on the internet about colonoscopies.
Simon Cofrancesco: [00:17:34] Yeah. And like you say, it’s very anecdotal. They’ll hear about — you do hear about that one person who had a tragic complication, but they don’t hear about the thousands of people that they don’t mention it because it was no big deal.
Jim Morrow: [00:17:49] Yeah. And after a colonoscopy, what should patients expect post-op, if you will? I know it’s not an operation. But after the colonoscopy, what’s the rest of their day likely to be like?
Simon Cofrancesco: [00:17:59] I have to say it should be normal. I mean, the biggest thing when they wake up is going to be just the sedation wearing off, and what they’ve just been through the day before by not eating, and maybe some electrolyte disturbances. They may feel tired a little. They’ve been getting up very early to finish the second half of their prep. So, the biggest thing is this, people are going to probably be a little bit fatigued or tired after sedation, and not eating regularly, and maybe some mild electrolyte abnormalities.
Simon Cofrancesco: [00:18:30] But here’s a nice thing, I’ll put a little plug in for our practice. We have scopes now where we are that we don’t use air to put into the colon. We use CO2. So, that bloating, and distention, and air feeling that some people got, or cramping, they won’t have that at our place because we have CO2, for instance, which was probably the most common complaint – feeling bloated, or distended, or cramping. So, barring a rare complication, most people are just pretty normal after the procedure. They can eat normal. They can’t drive but everything else is pretty much the same.
Jim Morrow: [00:19:10] And they can’t drive because they’ve been sedated. In these days, you’re using Propofol. Is that right?
Simon Cofrancesco: [00:19:15] Which is ultra quick, and it wears off quick. And people feel great. They really feel like they can drive, but, still, their motor skills probably aren’t up to snuff, and that’s even though they feel like they are.
Jim Morrow: [00:19:28] Right. And by that, Propofol was what Michael Jackson used to go to sleep at night for years, and years, and years, which is a little bit of a problem, which is why his doctor is in jail right now.
Simon Cofrancesco: [00:19:39] Yeah. And that came up a lot. When that first happened with Michael Jackson, a lot of patients were very scared. And all I can convince people and tell people about is I’ve been using Propofol for my patients for probably 20 to 25 years right before we were using Versed and so forth. And it’s a perfect drug for endoscopy. In fact, when I have my colonoscopy, that’s what I have, Propofol.
Jim Morrow: [00:20:04] Which is incredibly safe, and people just don’t realize the one-off that they’re doing is nothing compared to anything else. So, I think it’s a great choice. I’m glad you’re using it now. I know when I had mine done, it was a nothing event.
Simon Cofrancesco: [00:20:17] Exactly, exactly.
Jim Morrow: [00:20:18] [Crosstalk] is just a nothing event. So, with the colonoscopy, you’re going through there, you’re looking for polyps, but I know there are other things that you might find. It doesn’t relate directly to colon cancer screening, but talk about some of the other things you might find – the inflammation, and bleeding, and so forth, and so on.
Simon Cofrancesco: [00:20:37] Yeah, the most common thing we see is polyps or actually second most common thing because everybody’s got diverticulosis. I’ll mention that. It’s very unusual in this country that I do a colonoscopy on someone 50 or older and don’t see diverticulosis. So, fortunately though, most people won’t be bothered by that. Only a small percentage will get an infection called diverticulitis.
Simon Cofrancesco: [00:20:59] So, that is the most common abnormal finding, and we don’t really do anything about it except, excuse me, encourage people to eat more fiber, and to take a fiber supplement every day. Actually, I encourage everybody to take a fiber supplement every day. It’s an important part of our diet that we are missing in this country. We just don’t get enough fiber. So, with or without diverticulosis, I think it’s a good idea, but especially with diverticulosis.
Simon Cofrancesco: [00:21:26] And then, probably, the next most common thing that we see is inflammatory conditions, which you’ve already kind of alluded to. And they can be infections, or, very commonly, it can be autoimmune conditions like Crohn’s disease or ulcerative colitis. We see a lot of autoimmune conditions. It’s very common. It’s not diminishing. In fact, I think it’s probably becoming more common in my practice to see somebody with Crohn’s or ulcerative colitis. And then, there’s a smattering of less common diseases that cause inflammation.
Jim Morrow: [00:22:00] And with insurance coverage today, most insurance companies that I know of these days cover a screening colonoscopy. Is that right?
Simon Cofrancesco: [00:22:08] Yes, they do. And the problem is it’s very complicated, but you’re correct. If someone has no history of colon cancer, colon polyps, they get screening, but it’s funny how the insurance companies play games. And if your family history was positive, or you have irritable bowel syndrome or symptoms, or you’ve had a polyp in the past, they try to change things, or if I remove something during a screening colonoscopy, it changes. So, my perspective on that is it’s become a very tricky thing. It’s become a game, and you know how insurance companies do that.
Jim Morrow: [00:22:50] True.
Simon Cofrancesco: [00:22:50] And we were constantly struggling to placate the insurance companies on this and help our patients. It’s kind of a little conflictual.
Jim Morrow: [00:23:01] Okay. Yeah. So, while you’ve got patients, so there are a lot of times when the patients will come to me, and they’ll be taking Prilosec or the generic version and take it every single night. If they don’t take it for two days, they have horrible heartburn. So, while we’re staying in the endoscopy suite, sort of, you can look for ulcers by doing an upper endoscopy, not just a colonoscopy. So, how is that procedure done?
Simon Cofrancesco: [00:23:30] Upper endoscopy is a much quicker test. You don’t have to prepare for it. It takes about 10 minutes. All you do is skip your breakfast, put in an IV, and then people take a nap for 5 or 10 minutes. They won’t know anything was done. Just like a colonoscopy, they’ll wake up speaking to the nurse like when are they going to start. So, like you said about your experience, there is no experience.
Simon Cofrancesco: [00:23:51] And we look carefully at the esophagus, stomach, and do a DME, which is basically the upper GI tract. Commonly, we see diseases of the esophagus. It’s very common, probably more so now than stomach disorders, believe it or not. Ulcer disease was the king when I was starting out in the early ’90s. And it’s funny how it’s shifted esophageal diseases have become much more common. Maybe it’s because of the medications we have over the counter. Maybe it’s because of H.pylori being treated so much. But esophageal diseases make up a big part of what gastroenterologists take care of in the upper part.
Jim Morrow: [00:24:29] I think every time I mentioned to a patient that they can do the two tests at the same time, their biggest question is, will they use a different scope? And I assure them that they will. And if they don’t, ask them to do the upper first. That way, it doesn’t really matter.
Simon Cofrancesco: [00:24:44] Yeah. I joke around, and I tell them it depends on their insurance.
Jim Morrow: [00:24:50] I’ll have to remember that. I love that. So, John’s over here acting like he has some question for us. We’re here in the studio at Renasant Bank on Windward Parkway. And we’ve got John Ray here in North Fulton Business Radio. John’s got some questions from listeners.
John Ray: [00:25:05] That’s right.
Jim Morrow: [00:25:05] What you got, John? How are you doing?
John Ray: [00:25:07] I’m good. How are you?
Jim Morrow: [00:25:08] Good. This is my first guest.
John Ray: [00:25:10] I know. You did a great job.
Jim Morrow: [00:25:11] I’m nervous as a cat.
John Ray: [00:25:13] Why?
Jim Morrow: [00:25:13] I don’t know, but I am.
John Ray: [00:25:15] Well, he’s the one that had to have all the answers today. Usually, it’s you.
Jim Morrow: [00:25:20] I count on him too.
John Ray: [00:25:22] Okay. Well, here’s a couple of questions that we’ve got that have come in. So, this question is about blood in the stool. Does that automatically mean I have colorectal cancer?
Simon Cofrancesco: [00:25:37] Absolutely not. If I looked at all comers with that problem, fortunately, it’s a minority, but it’s important for us to make sure that it isn’t colon cancer. But in many instances, it’s something very insignificant or small that we can easily take care of, hemorrhoids, et cetera.
Jim Morrow: [00:25:59] So, along those lines — let me jump in there, John.
John Ray: [00:26:01] Sure.
Jim Morrow: [00:26:02] If someone comes to me, their family doctor, and says ” I have some blood in my stool,” do I send them straight to you?”
Simon Cofrancesco: [00:26:11] I guess, if it’s been a few years since they’ve had a colonoscopy, and if they’re not young like 20 or 25, it does kind of get into that mode where there might be a concern about liability because today, it’s hard to ignore an adult who has blood in the stool, who hasn’t had a recent colonoscopy. I’d say it’s almost a no-brainer, but there are some circumstances where you could probably just say, “Let’s try to treat you for hemorrhoids first because you had a colonoscopy a year or two ago,” or something like that.
Jim Morrow: [00:26:47] Well, it’s good to know I’m doing that, right? Because I do know that one of the worst things I hear is when you hear about a patient, 36 years old, that actually died from colon cancer because it does happen, and you talked about that earlier. And if anybody gets anything from this, I hope they’ll get it, they need to go for colonoscopy. What else you got, John?
Simon Cofrancesco: [00:27:07] So, I want to say something about that because I, actually, last year, had a young man with no family history who came to me with what sounded like hemorrhoidal bleeding, and I wiped the sweat off my brow after I scoped him because he had colon cancer. So, your experience with a 30-year-old, and I’ll just tell you why you got to pay attention, and I didn’t mean to say you don’t pay attention when they’re younger because I’ve clearly had people — fortunately, this young man survived and has done very well, but I see all age groups. And so, it gets tricky, but it’s a no-brainer when they’re mid 40s and 50s, and they have blood, and you just got to get checked.
Jim Morrow: [00:27:49] Right, right.
Simon Cofrancesco: [00:27:49] Yeah.
John Ray: [00:27:50] So, you’re hitting something on that this next question gets at right now, which is you mentioned the earlier incidents of colorectal cancer. So, is every 10 years enough?
Simon Cofrancesco: [00:28:07] I can just tell you about my experiences is that it works well the vast majority of times. The screening procedures are set up not to be perfect. They’re not perfect. And I hate to have to explain common sense to people. We don’t have perfect tests, and we don’t have unlimited resources, so they draw a line somewhere that gets almost everybody. But yeah, 10 years is a long time. And when that first was incorporated, a lot of us were very uncomfortable. As it’s panned out over the years, I don’t see a lot of people getting burned, but it’s not perfect. Some people will.
John Ray: [00:28:51] Now, one other age-related question. This comes from a listener talking about her mom. At what point does a patient’s age make a colonoscopy more of a problem than it’s worth?
Jim Morrow: [00:29:03] Good question.
Simon Cofrancesco: [00:29:03] Yeah, that’s an excellent question, and there’s no simple answer to that. I go through that every day. Everybody’s very focused on the number. The first thing I’d say is the number starts the conversation. So, to give you an example, I have an 85-year-old gentleman, and this is not an isolated situation. I have lots of people like this in their mid-80s, highly functioning. They just finished mowing their lawn, they drove themselves in, and I diagnosed them with colon cancer six years ago, and they want their colonoscopy. So, they’re a high-risk individual, and they’re highly functioning. That person has already broken the curve on the age thing.
Jim Morrow: [00:29:39] Right.
Simon Cofrancesco: [00:29:40] So, I do a colonoscopy. And I have lots of those people, and they do great. And then, I have somebody who comes in who’s 75, who’s not doing well. They’re just not healthy. And they have a limited life expectancy. Maybe three, four, or five more years left. They haven’t had polyps, or there’s no high risk. That person clearly doesn’t need a colonoscopy. The risk of the colonoscopy might be greater because their risk of cancer is low.
Simon Cofrancesco: [00:30:08] So, I mean, age is, to me, something that you start a dialogue with. And then you have to look at both sides. What’s the risk for the patient of the procedure, and what are their risks possibly of having colon cancer? And then, I get with the patient. And then, we come together on a decision because, many times, sometimes, I do a procedure because the patient wants me to because they’re concerned because their dad had colon cancer, and they don’t want to get colon cancer. And that may make us favor doing a colonoscopy. So, it’s not an easy answer, and it’s a case-by-case basis.
John Ray: [00:30:43] Peace of mind is an incredible commodity. I tell people you should get all you can get.
Simon Cofrancesco: [00:30:49] It can be therapeutic for some people. Jim and I see people everyday that suffer from anxiety. I mean, it’s real, especially as people get older. They get more fragile. And you can give them peace of mind. And if you’re smart, and you’ve done this, we’re not hurting older people, but there’s definitely people that are older that safely can have colonoscopy.
John Ray: [00:31:13] Great.
Jim Morrow: [00:31:13] That’s it?
John Ray: [00:31:14] That’s it.
Simon Cofrancesco: [00:31:15] That’s it.
Jim Morrow: [00:31:16] Well, good. Well, this is Dr. Jim Morrow. And, again, I want you to know that I’m with Morrow Family Medicine. At Morrow Family Medicine, we use technology and old-fashioned attitudes to do our very best to make you feel better every day. We’re located in Milton and Cumming, Georgia. Our website for the show is toyourhealth.md. If you want to send us a question or a show topic you might want us to try, the email is email@example.com, or you can tweet us @toyourhealthmd. And Dr. Simon Cofrancesco, if you would tell us a little bit about how patients can get in touch with you, and come see you, or one of your partners.
Simon Cofrancesco: [00:31:55] Absolutely. Thanks, Jim. GI North. And the phone number is 404-446-0600. They can also look at our website, ginorth.com. And I believe our web site is GI-north — I’m blanking out right there. Help me out here.
Jim Morrow: [00:32:19] His marketing director is right behind him.
Simon Cofrancesco: [00:32:21] Unfortunately, my marketing director doesn’t remember our website. So I apologize.
Jim Morrow: [00:32:27] We’ll have it in the show notes. This is great. I love it. Well, I do appreciate everybody listening. And if you are enjoying the show and the podcast, wherever you’re listening, hit the subscribe button, so you can be sure and be notified when there’s another episode. I really want to thank Dr. Simon Cofrancesco for being my first guest on the show and for coming on with us. It’s great.
Jim Morrow: [00:32:49] In two weeks, we’re going to have a very interesting show, a little bit different also. This is going to be an interview with Derek Bailey from the Right Move. They specialize in helping your seniors find a good location and a good solution to whatever their residential situation might be. So, we’re going to talk with Derek in two weeks. And until then, that is To Your Health.