4 Screening Tests Women Fear

Colonoscopy

What It DoesThis procedure is the most effective way for your doctor to look for polyps and other precancerous growths in your colon; if she finds any, she can usually remove them painlessly on the spot through the scope itself. The procedure can last from 30 minutes to an hour.

The Fear FactorIt's not the thought of having a long, flexible tube with a tiny camera on the end (a scope) inserted in one's rectum that makes most people cringe (you'll be sedated)--it's the colon-clearing prep you have to do the day before. After being on a 24-hour clear liquid diet, you must drink either one-half or a full gallon of a salty prep liquid at least 7 hours before the exam. The drink will make you empty your bowels repeatedly until there's nothing but clear liquid coming out. This can sometimes cause abdominal pain, nausea, and vomiting.

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Geat a Head StartThe less you have in your gut before you start flushing out your colon, the easier the process will be. "I approach the prep as if it were a cleansing diet," says Dede Cummings, coauthor of Living with Crohn's & Colitis. "A few days beforehand, I start eating smaller, lighter meals, like skinless baked chicken, rice cakes, and applesauce."

Drink the Liquid in 1 DayIf you can, schedule your appointment for the afternoon, and then begin drinking your prep liquid that morning. Although the American College of Gastroenterology suggests drinking half the prep at night and half the next morning, a recent study at Thomas Jefferson University shows that patients who saved the entire prep for the morning of the procedure experienced less abdominal pain and had uninterrupted sleep because they weren't running to the bathroom all night.

Keep a Chaser On HandWash down the drink with water, Gatorade, or ginger ale, advises Sunanda Kane, MD, a professor of medicine and staff gastroenterologist at the Mayo Clinic in Rochester, MN. "You can't dilute the prep with another drink in the same cup, but you can drink them side by side," she says. Your colon must be completely clear to get an accurate reading, so follow prep guidelines exactly, says Harminder Singh, MD, an assistant professor of gastroenterology at the University of Manitoba Winnipeg. This is especially key for women: Dr. Singh and fellow researchers concluded that women are 31percent more likely to have their cancers missed than men, in part because cancerous lesions in women usually occur in the upper colon, where it's harder for the camera to reach.

Ask for Prep PillsIf you just can't tolerate the taste of the liquid, the prep is available as a pill. Think of this as a last resort: "You have to take thirty-two tablets in one and a half hours," says Carol Burke, MD, director of the Center for Colon Polyp and Cancer Prevention at the Cleveland Clinic, and the sodium phosphates in the pills have been associated with rare but potential kidney damage. But because the risk of kidney damage is smaller than the lifetime risk of colon cancer, in very few cases (less than 1percent), Dr. Burke offers the pills to prepresistant patients, with informed consent.

Are There Any Alternatives?

In a virtual colonoscopy, an MRI or CAT scan takes several cross-sectional x-rays of your colon. It's fast and noninvasive-- though you still have to do the full prep. But while some private insurance companies cover this alternative, it's not covered by Medicare unless there's a medical reason the patient can't undergo traditional colonoscopy (if there's excessive twisting or scarring of the colon, for example, or the patient can't tolerate anesthesia). Also, if the doctor spots a polyp, you'll need a regular colonoscopy to remove it anyway, says Dr. Burke. Upon FDA approval, which could happen as soon as 2012, those at low risk (no family history of colon cancer or personal history of polyps) may have a new screening option. The Cologuard test is an at-home kit that allows a patient to collect a small amount of stool and mail it to a lab for analysis. The test will look for DNA changes associated with precancerous and cancerous polyps. You'll need a traditional colonoscopy only if the test shows DNA change.

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Endoscopy

What It DoesUpper endoscopy is similar to colonoscopy, except that the scope is inserted down your esophagus while you're sedated to examine your esophagus, stomach, and beginning of your small intestine. Endoscopy is used to investigate the cause of specific symptoms, such as chronic reflux, swallowing difficulty, and upper abdominal pain. Just as with colonoscopy, your doctor can also remove any polyps on the spot. "It's important to look at patients over age sixty who have reflux or sudden pain swallowing, because the older esophagus is less sensitive--so by the time you feel pain, any disease that is present may be more severe," says Lawrence Brandt, MD, emeritus chief of gastroenterology at Montefiore Medical Center, in Bronx, NY. A diagnostic endoscopy should take about 5 to 7 minutes; if you have any polyps, it might take a few minutes longer.

The Fear FactorThere's little preparation; you just have to fast for 6 to 8 hours before the test. "Many patients are concerned that they'll gag or throw up when the scope is inserted," even though they'll be sedated, says Dr. Brandt. Those reactions rarely happen, but because the doctor inserts air while the scope is down, you might feel pressure. This usually goes away within a few hours; afterward, you might also have a slight sore throat.

Ace That Test!

Schedule it for First Thing in the AMYou naturally fast while you're sleeping, so Dr. Brandt suggests eating dinner as usual the night before and scheduling an early morning procedure.

Ask for an Anesthetic SprayIf you can't shake the fear of gagging, request an anesthetic spray before the procedure for peace of mind.

Treat Your Throat Gently AfterwardIf your throat feels sore from the scope, Dr. Brandt recommends eating soft foods for the rest of the day. Ease back in with yogurt, Jell- O, and ice pops, and skip anything irritating, like spicy or hard foods.

Are There Any Alternatives?

An old-fashioned upper GI series--in which you ingest a chalky barium drink and your esophagus, stomach, and first part of your small intestine are x-rayed-- is still an option, but there's also a newer development: With a capsule endoscopy, you swallow a large pill-size capsule that has a miniature camera inside. As the camera moves painlessly through your entire GI tract, it transmits images to a receiver you wear in a vest--no sedatives required. You can go home or to work while the camera travels through your system; it is eventually eliminated in your stool, and you can flush it away. The drawback? Because it allows only for diagnosis (not treatment) and has potential complications, capsule endoscopy is used and covered by insurance only when traditional colonoscopy and endoscopy have failed to locate the source of pain or bleeding.

MRI

What It DoesMRI (magnetic resonance imaging) uses a strong magnetic field and radio waves to create cross-sectional images of your body. Because it shows organs, soft tissue, and bones, doctors use MRI to help diagnose everything from torn ligaments to brain tumors and cancer. You'll be sent headfirst into an enclosed tube and must lie still while listening to the taps and thumps of the scanner (you'll be offered earplugs). It can take from 10 minutes to over an hour.

The Fear FactorAn MRI doesn't cause any physical pain, but the psychological challenge of lying still in a narrow tube may make a person feel claustrophobic.

Ace That Test!

Listen to a Favorite Book"Go to another place in your mind," says Jeanne van Gemert, a mind/body therapist at Duke Integrative Medicine. You can't take your iPod (or anything metal) into the MRI, but most centers have sound systems, so you can bring a CD of your favorite novel for them to play. Closing your eyes and visiting India or Italy can make the time go faster. Even a CD of your favorite music can keep you relaxed.

Imagine You're Going HomeNumerous studies link guided imagery to lower anxiety during medical treatments, including surgery, chemotherapy, and MRI. "I often advise patients to imagine the trip home from the hospital," says Donald Wood, a certified registered nurse anesthetist in Florida. "Picture every street you drive down and all the landmarks along the way, like the church on the corner. It can be a great distraction." Or fantasize about a vacation, family reunion, shopping spree--whatever makes you happy.

Take Antianxiety MedicationIf mental distractions won't ease your claustrophobia, ask your doctor to prescribe an antianxiety drug before the MRI.

Are There Any Alternatives?

At some "open MRI" centers, you can stand, sit, or even watch Glee on TV while you get scanned. But these tubeless machines aren't always ideal, says Jeffrey Weinreb, MD, a professor of radiology at the Yale University School of Medicine. "Open MRIs generally use low magnetic fields, which do not yield the same quality of images as the high magnetic fields in closed scanners," he explains. Low magnetic images may be adequate during a routine scan of the brain (for chronic headaches) or knee, Dr. Weinreb says, but for other exams, such as those looking to detect cancerous tumors, a high magnetic scan is recommended. The good news: Closed scanners are now being built with shorter, wider tubes and require only your head to be enclosed if you have a brain scan.

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Dr. Oz's Tips for a Pain-Free Colonoscopy

When Dr. Mehmet Oz went for his first colonoscopy last year, he wasn't anxious--until he was on the exam table. "I realized the unknown would be known," admits the star of The Dr. Oz Show. "But one of the best parts of colonoscopy is that they can usually remove and cure the problem at the same time." And, in fact, his doctor did find and remove a symptomless polyp that could have turned into cancer if left alone. Here's what Dr. Oz wants you to know about colonoscopy:

Listen to Your Doc: Eat Light!

"I made the mistake of eating beans for lunch the day before my colonoscopy," Dr. Oz recalls with a grimace. "Something light, like Jello, would have been easier to pass."

Deep Breathing Really Helps

Most people don't feel much, if anything, but "there were a few uncomfortable moments when they moved the scope around some corners," he recalls. "If you take slow, deep breaths and pretend you're elsewhere, it's much easier."

Getting Screened Can Make You a Hero

"Do it so you can be a role model for your loved ones. if you show them how simple it can be, then it becomes the norm for everyone else."

Ease the Stress of Any Test

Try Acupuncture

This ancient technique tamps down stress hormones while boosting feel-good endorphins, says Lixing Lao, PhD, a professor of family and community medicine in the Center for Integrative Medicine at the University of Maryland School of Medicine. "Several acupuncture points on the body work on general anxiety," including the ear, shoulder, and stomach, says Dr. Lao, who advises scheduling an appointment a few days before your exam. Your insurance may cover acupuncture; if not, a 1-hour session will cost $60 to $120, on average.

Calm Your Muscles

Begin progressive relaxation exercises in the waiting room, advises Jeanne van Gemert. Tense your shoulders for 5 seconds, then release; do your back next; repeat several times. "When you're stressed, you unconsciously tighten your muscles," she explains. "Clenching fully and then relaxing fully can be a big relief."

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