Colonoscopy Concerns? Take a Friend With You

Oct. 20, 2008 — -- Hardly a week goes by that I don't hear about someone losing the battle to colon cancer. And each and every time I ask how this could happen, when today we have the ability to diagnose colon cancer years before it will spread -- and often in a precancerous polyp stage.

Why weren't they screened for colon cancer? Didn't they know the statistics? Except for lung cancer, which is usually caused by smoking and diagnosed in late stages because there are no reliable early screening tests, colon cancer is the leading cause of cancer death in men and second only to breast cancer as a cause of cancer death in women.

While it's tempting to simply avoid getting checked for colon cancer -- and surveys show that less than half of us are getting checked because of what many patients refer to as the big "hassle factor" -- the feeling of relief after being tested and the assurance you have done all you can to prevent this disease is tremendous after the exam.

I am proud to say that I have had my colonoscopy so I can speak directly from experience. The hassle of being checked is well worth the peace of mind.

Screening Recommendations

Last week the U.S. Preventive Services Task Force updated its 2002 recommendations on colorectal cancer screening. The group is emphatic that standard colonoscopies should be performed every 10 years, beginning at age 50 and continuing until age 75. Additionally, the group recommends a stool sample test for hidden or microscopic blood be performed each year starting at age 50.

The task force recommends against routine screening for adults 76 to 85 years old, unless doctors feel that the patient's personal history warrants it. They make this recommendation for our oldest seniors because current research shows that, in this age group, finding an early polyp or precancerous or even cancerous problem is unlikely to change the ultimate outcome.

It is thought that many older seniors will die sooner from heart disease or another problem long before any colon problem will be evident. However, if you are a healthy 80-year-old with no serious health problems, talk to your doctor about getting screened.

After age 85, the task force recommends that no screening for colon cancer (or other cancers for that matter) should be done, because research suggests that the risks outweigh the benefits in our very oldest seniors.

Virtual Colonoscopies

The U.S. Preventive Services Task Force, unlike the American Cancer Society, does not recommend virtual colonoscopies over the traditional approach. The group emphasizes that despite recent studies showing some possible benefit, more research is needed.

Yet many people are now talking about getting this newer X-ray test in hopes of: 1) avoiding the bowel preparation they have heard so much about (even though a completely empty bowel is still needed so the preparation/liquid drink can't be avoided); and 2) avoiding the anesthesia required for the colonoscopy. (You do avoid the anesthesia, but the installation of air to keep the bowel wall open during the exam can be uncomfortable.)

And to complicate things further, if your doctor finds a small polyp or abnormality on the virtual X-ray test, you will need to take the bowel preparation all over again and return for the standard colonoscopy. Only during the standard colonoscopy can your doctor take a biopsy of a suspicious area or remove a polyp.

So far, most experts say they believe there is nothing better than the full, standard colonoscopy done by a doctor with lots of experience. And the good news is that most GI doctors now have tons of experience doing colonoscopies, so not finding the right doctor is rarely a good excuse.

Far fewer doctors and facilities today have the experience it may take to get the best results with virtual colonoscopy. So stay tuned for more doctor research and experience!

Getting Screened

So what do I recommend for all adults?

Starting at age 40 everyone should have a regular rectal exam, which is a preliminary test for colon cancer. It's simple. You roll over on your side and your doctor inserts a gloved finger in your anus. Or you can have the test done during your pelvic exam. It should be routinely performed as part of the bimanual exam; while the patient is in stirrups, the doctor inserts a finger in the rectum to check for masses and to get stool to check for hidden blood.

Starting at age 50 everyone should talk to their doctor about the following:

Colonoscopy: This an examination of the colon with a flexible, lighted tube. It should be performed every 10 years to help screen for colon cancer. If a polyp is found, the test will be repeated more often.

Stool Occult Blood Test: This test is designed to find hidden (occult) blood in the stool. You do it yourself at home using stool cards that you return to your doctor. Your doctor will give you the cards with instructions. The presence of blood can signal precancerous or cancerous polyps in the colon or intestinal bleeding from such causes as a stomach ulcer, internal hemorrhoids or severe colitis. All men and women ages 50 or older should do this test every year.

If you have a family history of polyps, colon cancer or severe colitis, you should talk to your doctor about colon cancer screening earlier and more often. For some, your doctor may suggest you begin with an annual stool check and periodic colonoscopy at age 40, or five years earlier than the age of disease onset for any family member.

Finally, consider asking a friend or family member to get a screening colonoscopy with you. I call it a form of "paying it forward." By encouraging a friend or family member to be tested along with you, one more person will be assured they have done their part to prevent colon cancer.

I encouraged my best friend to have her colonoscopy along with me -- and we laughed and empathized with each other as we drank the necessary liquid to prepare us for the procedure. My friend had a family history of colon cancer, yet she was afraid to be tested. She had tremendous peace of mind when she learned her exam was normal.

With today's technologies, there is no reason anyone should be diagnosed with colon cancer.

Have you been tested for colon cancer? Consider encouraging your partner or friend to be tested, too.

Wishing you good health.

Dr. Marie Savard is an ABC News medical contributor. To learn more about Savard's health management system, download free forms and a sample letter to your doctor, visit http://www.drsavard.com and click on "Learn how to take charge of your health."