Seems like it’s human nature for most of us to be reactive rather than active. We procrastinate ’til the last minute and delay anything that seems like it might be unpleasant or uncomfortable. When it comes to medical tests, that rule certainly applies. Cancer screening tests can be unpleasant. A blood draw for a prostate specific antigen (PSA) test may be mildly unpleasant. A mammogram can be uncomfortable. No woman looks forward to her annual Pap test. However, among the major cancer screening tests, perhaps the least popular is the colonoscopy.
As discussed in When Cancer Hits Home, Colorectal cancer (CRC) is one of “the big four” cancers, with the others being breast, lung, and prostate (visit http://thecancermd.com/ for more info). Together, these “big four” are diagnosed in roughly 750,000 patients per year in the U.S. About 150,000 people are diagnosed with CRC and 50,000 patients die of the disease annually. Clearly, colorectal cancer remains a major cause of cancer death in America. Yes, there have been some exciting advances in treatment, including the much discussed blockbuster drug, Avastin (generic is bevacizumab). Hoewever, an ounce of prevention….
Acceptable CRC screening options for the average 50+ year old adult without a family history or other major risk factor include: fecal occult blood (FOB) testing once per year, flexible sigmoidoscopy once every 5 years, or colonoscopy once every 10 years. In my mind, the best evaluation is the full colonoscopy, since the GI specialist is ideally able to see the entire lining of the colon. Nevertheless, currently not everyone may have the resources to have a colonoscopy, so the FOB test is an inexpensive, alternative proven method of CRC screening. In my opinion, flexible sigmoidoscopy, which evaluates only a portion of the colon, is a middle ground for CRC screening that should be used by a limited few. Other tests that can be effective but are used less frequently include double contrast barium enema and virtual colonoscopy using CT scan. Check out: http://www.cancer.org/Cancer/ColonandRectumCancer/MoreInformation/ColonandRectumCancerEarlyDetection/colorectal-cancer-early-detection-screening-tests-used for a full discussion.
A recent analysis shows that one third of people age 50-75 years old still aren’t up to date with their screening for colorectal cancer: http://www.npr.org/blogs/health/2011/07/05/137633255/colorectal-cancer-deaths-declining-but-millions-still-arent-getting-screened?ft=1&f=1001 Most people who’ve had a colonoscopy say that the preparation isn’t too pleasant (having to clean out the bowel so that the doctor can see the lining of the colon clearly), but the actual procedure isn’t too bad. In most cases, the doctors give people medicines to make them relax and they don’t remember the procedure. Some people even enjoy the sound sleep that they may get at home after the procedure. If all looks well, then a repeat procedure isn’t needed until a full decade later.
The bottom line is that if you’re 50 or older and haven’t yet had a colonoscopy, please speak with your primary doctor about it. In addition to not smoking and making good lifestyle choices about nutrition and activity, choosing to have a colonoscopy is important to reducing your risk of dying of colorectal cancer.
- Patrick Maguire, MD