Here’s what you might think you know about a colonoscopy. One,
it requires a full day spent starving while chugging gallons of
vile tasting laxative and camping out in the bathroom. And two,
a camera … you know, there.
Now here are the things you should know about
colonoscopy. Though it is the No. 2 cause of cancer-related
deaths in the U.S., the colorectal cancer that the procedure
detects is also highly preventable. And — despite what your
neighbor, your brother or that overly dramatic coworker told you
— today’s lower volume prep regimens and twilight sedation make
the process safe, painless and far less inconvenient. Plus, many
insurance plans will cover the process in full as a screening
benefit, and a clean bill of colon health generally buys you a
full decade until your next test.
Still not convinced? You’re not alone.
“Despite the benefits of colon cancer screening,
only 60 percent of at-risk people undergo screening,” says Dr.
Aaron Baltz, board-certified physician in gastroenterology and
internal medicine at Ascension Wisconsin. Baltz says that
average-risk patients should begin screening at age 50, while
people with a family history of colon cancer or advanced polyps;
a personal history of colon cancer or polyps, abdominal
radiation, Crohn’s disease or ulcerative colitis; or symptoms
such rectal bleeding, abdominal pain, a change in bowel habits
and unexplained weight loss should seek the advice of their
physician about starting sooner.
“Many patients ask why we perform colonoscopies
when people do not have symptoms,” says Dr. Erica Samuel of GI
Associates. “We do this because small polyps do not cause
symptoms. Once the polyps are large, cancerous and symptomatic,
the cancer may be advanced, and cure is unlikely.”
Baltz says that choosing a quality endoscopist
helps ensure a higher polyp detection rate and a lower
complication rate. “While the risks are low, the more common
complications are bleeding [when a polyp is removed],
perforation or an issue with the sedation,” he says. “Studies on
the risk of perforation estimate the risk at less than 1 in
1,000 colonoscopies nationwide.”
And about that storied bowel prep regimen to
ensure the pristinely clean colon that affords optimal test
results? If you can get two large-sized fast-food drinks down
over the course of several hours, you’ll do just fine.
“Patients typically start the night before, after
returning home from their normal daily activities,” says Samuel.
“The prep drink is better tasting and a lower volume than ever
before — 64 ounces broken down into two 32-ounce drinks. In
fact, most patients can use the MiraLax prep, which is a
tasteless medicated powder mixed into a sports drink of their
choice.” You can add in Jell-O, popsicles and chicken broth to
ward off any hunger pangs, adds Baltz.
So what about those TV ads in which a cheery
little animated box encourages you to, er, go postal with your
cancer screening instead? As appealing an alternative as the
at-home, mail-in test might seem — well, other than packaging up
your own fecal matter and heading for the post office — both
Baltz and Samuel say that these testing products are
significantly limited in their ability to detect the
slow-growing polyps that can signal the onset of cancer. Polyps
that can be safely and easily removed during the colonoscopy
process, eliminating their ability to become cancerous.
“I tend to see a lot of dissatisfaction in my
patients who have done the Cologuard test,” Samuel says. “It is
a combination of two tests — a test for DNA found in cancer and
advanced polyps and a test for blood in the stool — and,
unfortunately, if the results come back positive, you are not
told which part of the test was positive. This leads to an
unreasonably high false-positive rate, which is understandably
stressful for patients who may be under the impression that a
positive test means they have colon cancer.”
Atop that, most insurance companies consider
Cologuard and other mail-in tests a screening procedure, so if a
patient tests positive, the traditional colonoscopy recommended
next will not be covered as a screening benefit.
“Insurance companies benefit in this situation,
as they provided coverage for the Cologuard test, which is only
a few hundred dollars,” Samuel explains. “If the patient had
opted for the traditional colonoscopy to begin with, the
insurance company would be responsible for the cost of the
colonoscopy, which is significantly higher. Insurance companies
are not always forthcoming about this.”
line: choosing a screening test for colon cancer is an
individual decision and should be discussed with your trusted
medical provider. But, both doctors agree, any screening test is
better than no test at all.