When your doctor first suggested a colonoscopy
to you, did you grimace? You’re not alone. Talking about bowel health makes many of us squeamish, but it's extremely important. According to the federal Centers for Disease Control (CDC), colorectal cancer
(cancer of the colon and rectum) is the second-most-deadly cancer in the United States, among cancers affecting both men and women. That's especially tragic because colon cancer is preventable.
Why You Need Routine Screening
Colon tumors arise from polyps
(small, sac-like growths within the intestine), and routine screening can spot these polyps before they become cancerous. Routine colonoscopies are performed by a gastroenterologist. The procedure might take place in a hospital clinic or a freestanding facility. You'll receive intravenous sedation, usually from a nurse but sometimes from an anesthesiologist, to help you feel more comfortable. The doctor will then look inside your large intestine using a colonoscope, which has a miniature camera attached to a long, thin tube and is inserted in the anus.
It is standard practice for your doctor to remove all polyps from your colon during the procedure and have them analyzed in a pathology lab. Dr. Sidney J. Winawer of Memorial Sloan-Kettering Cancer Center recently conducted a study that concluded that patients who'd had polyps removed during colonoscopies had a much lower likelihood of eventual death from colon cancer than those who had not.
The general guideline is to begin routine screenings at age 50 because 95% of colon cancer cases arise after 50, in large part because most polyps appear after that age. But some should start their screenings earlier. “Know your family history,” Winawer says. “For people with a family history of colon cancer or polyps, we recommend screening start younger – maybe in the 40s or even earlier if a person has a very strong family history of colon cancer."
If your doctor discovers few or no polyps in your colonoscopy, and no signs of cancer in the polyps that are removed, you need not be screened again for 10 years. If your procedure reveals a high number of polyps, but no cancer, your doctor may recommend you be re-screened in five years. If you have a very strong family history of colon cancer and your doctor finds multiple adenomatous polyps
(the type which can become cancerous) at your initial screening colonoscopy, you may need to be screened annually.
Your health insurance should pay for routine colonoscopies, but even if you’re uninsured or underinsured, you don’t have to put off screening. The CDC’s Colorectal Cancer Control Program (CCCP) funds free screening colonoscopies
for qualifying individuals age 50-64 in 25 states and four Native American tribes. The program is designed to increase screening rates for people over 50 in the targeted areas from 64% to 80% before its conclusion in 2014.
The Importance of Preparing for a Colonoscopy
Preparing for a colonoscopy generally involves drinking as much as a gallon of a liquid solution that helps to clean out the colon the day before the exam. “We’re trying to see the walls of the colon," says Dr. Reena Chokshi, a gastroenterology fellow at Washington University in St. Louis, "and in order to see them very well, you have to have a deluge of liquid material to clean those walls off.”
Many first-time colonoscopy patients are as wary of the preparation as they are of the test itself. But if you don’t complete your prep adequately, you may have to repeat the screening, and no one wants that. Besides, your fears may be exaggerated. “Many of my patients tell me the prep was no big deal,” Chokshi says. But doing it correctly is crucial. "Our recent research showed poor preparation can hinder our ability to see polyps during the exam," she says.
Different doctors use different prep solutions. Some are flavored, but the commonly prescribed Go-Lytely solution is not. Some people find its taste unpleasant, but "patients have told me chilling the solution helps," Chokshi says, adding that you can ask your gastroenterologist if you can “doctor” the drink. If so, she says, you may be able to "add something like Crystal Light to it as long as it’s not red or purple, which can tint the walls of the colon and make it difficult for us to see any blood during the exam."
Other Colon Cancer Screening Options
Colonoscopy remains the gold standard in colorectal cancer screening, but it’s not the only choice. If you have no family history of colon cancer, you might opt for the non-invasive Fecal Immunochemical Test (FIT), which uses antibodies to look for bleeding within the colon, specifically, and is a more reliable than older stool tests. You get a kit from the doctor’s office and perform the stool collection in the privacy of your home. If the test is positive, your doctor may recommend you follow up with a colonoscopy.
Colonoscopy and the FIT test offer a high degree of reliability and cost effectiveness. The same can’t necessarily be said for other screening measures. A virtual colonoscopy (performed by CT scan) is expensive and generally not reimbursed by insurance, since large-scale studies have yet to confirm their reliability in detecting polyps, and colonoscopy-in-a-pill technology continues to advance but is a long way from being ready. "There are lots of new technological developments coming in the future," Winawer says, "but for you the future is now."
Learn more about colonoscopies from our partners at Medline Plus.
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