SIMPLY HEALTH: Squeamish about a Colonoscopy?

posted 09/08/2008
So you turned 50 recently and have been told "It's time". Or you've been putting off your first screening colonoscopy for a while, dreading even the thought of it. This procedure has been the butt of many jokes and ripe material for many a stand-up comedian. But it is no laughing matter and a little minor embarrassment may save your life.

Last month I had my annual women's check-up and owned up to procrastinating on my colonoscopy. That same evening, I got a call from a close friend who is three years younger. She confided that colon cancer, at a very early stage, had just been found on colonoscopy, her second screening in 3 years Her father and aunt had died from colon cancer.

I called the next morning, scheduled my colonoscopy and had the procedure last week. Like breast and cervical cancer, regular screening saves lives. However, screening rates for colon cancer lag far behind those for breast and cervical cancer. Less than 40% of colon cancers are found early and 60% of deaths from colon cancer could be prevented by screening everyone over the age of fifty. The good news is that more people are getting screened- and "getting" the fact that it is not a test to be feared or put off.

Even though it's nobody's idea of a good time, a colonoscopy is not to be dreaded. (The old sigmoid exam, which evaluated only the first one third of the colon, was another story.) The prep to clean the bowel has been vastly improved. Besides, they give you this great drug (Versed-the "I don't care" drug) that allows you to be conscious but have little or no recollection of the procedure. After completing his colonoscopy last year, even my husband admitted the anticipation was far worse than the actual experience.

So what's holding us back?

The Scoop on Colon Cancer

3rd leading cause of cancer deaths.
Lifetime risk for most people is 5%.
Because of poor screening rates, less than 40% of cancers are found early.
60% of deaths could be prevented if everyone over age 50 were screened.
30% of cases are associated with familial clustering.

Fear- this is pretty much a painless procedure. The prep is no big deal and yes, you may feel nervous or embarrassed. Crack a few of those colonoscopy jokes you've heard to help you relax. Access-most general surgeons and all gastroenterologists (stomach doctors) do colonoscopies. Risks-may include mild pain and bleeding, seldom infection, and rarely bowel perforation. With any procedure, the more experienced the person doing it, the greater the safety and accuracy. Cost-the procedure runs about $1500 or so. It would pay to buy insurance just to get the discounted rate. With insurance, you may have to pay very little. Medicare covers colonoscopy.

"Virtual colonoscopy" is done with CT (xray) imaging and has been promoted for those squeamish about colonoscopy, but it has several limitations. It is quite costly and your insurance may not cover it. There is also all that x-ray exposure and you still have to do the prep. If any abnormalities are found though, the next step is an actual colonoscopy so biopsy can be done.

Most but not all colorectal (colon and rectal) cancers develop from polyps-grape-like growths that arise from the mucous membranes that line the intestines. Most polyps are benign but those that are adenomatous types can degrade over time into a cancer. The lifetime risk for colon cancer for most of us is 5%. If the first screening is normal, then you don't need to be screened for another ten years. Those with adenomatous polyps have a 10 to 15% risk of developing colon cancer and are screened more frequently at three to five year intervals.

Common familial colon cancer accounts for about 30% of all cases. Risk for this type of cancer exists if there is either colon cancer or adenomatous polyp in any first degree relative. One affected family member increases risk by 10-15% and two affected relatives increases the risk to 20%. If even one relative was diagnosed with colon cancer before age 50, risk for developing colon cancer rises to 20% for other family members.

Risk Factors for Colon Cancer

Over age 50.
Family history of colon cancer or polyps.
Personal history of polyps.
History of ulcerative colitis or Crohn's disease.
Smoking, obesity and sedentary lifestyle can increase risk.

Early detection saves lives-not original, but oh so true. Don't be squeamish or foolish. See your health care provider and get scheduled for your screening colonoscopy today. You'll be relieved that you have it behind you.

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