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Why you needn’t fear the colonoscopy

August 8, 2016
No ifs, ands or buts about it — nobody wants to get a colonoscopy. Some people don’t understand what it is or why it is important, or their doctors simply don’t mention it, so they think it’s unnecessary. And then there are those who just put it off.

“People are usually worried it’s going to be painful, or think it’s embarrassing or dirty,” says Niraj Jani, M.D., chief of gastroenterology at Greater Baltimore Medical Center.

The truth is, colonoscopy, which involves sending a camera into the colon to examine its lining, is none of those things. What it actually is: A truly lifesaving test that’s now easier, safer and more effective than ever. It detects not only cancer but also precancerous growths called polyps, allowing doctors to remove them on the spot before they become dangerous. No other cancer-screening test can do that, Dr. Jani says.

The prognosis for colorectal cancer caught early is very good: The five-year survival rate is upward of 90 percent, according to the American Cancer Society (ACS). Found at later stages, however, survival rates drop.

Do you need a colonoscopy?

The current ACS recommendation says most people should have their first test at age 50. Those at higher risk for cancer, because of family history, for example, should be screened sooner. Some experts also advise African-American men to be tested at age 45 since statistics suggest that population is developing colon cancer sooner, Dr. Jani says. Other doctors might recommend earlier screenings no matter what.

“The incidence of colon and rectal cancer has been rising among people ages 25 to 45,” he says. “We’re not sure why — it could be linked to processed foods in our diet or obesity — but it’s a scary phenomenon.”

So, you think because you feel fine you don’t need a colonoscopy?

Consider this: “The Number One thing to realize is that rarely do you have symptoms with colon cancer until the cancer is very advanced,” Dr. Jani says. “That’s the whole point of doing colonoscopy — to find something early and remove it to eliminate the risk.”

It can take 10 to 15 years for colorectal cancer to develop from a precancerous polyp, according to the ACS, so chances are regular screenings will help keep you healthy. And in one study reported in the New England Journal of Medicine, the death rate from colorectal cancer dropped by 53 percent in patients whose doctors found and removed precancerous polyps.

But the odds aren’t with you if you put off the test. Colorectal cancer is the third most commonly diagnosed type of cancer and the third leading cause of cancer deaths, according to the ACS.

Relieving the fear and stigma

Advances in the procedure address many of the concerns keeping would-be patients away. “The biggest thing patients complain about is the prep,” Dr. Jani says, referring to the solution patients must drink to clean out the colon prior to the procedure. “You used to have to drink 4 gallons of the stuff, and it tasted terrible. Now we’ve evolved to preps that are much less in volume.” Think two doses of prep at only 16 ounces each — or about 6 percent of what you previously had to swallow.

In addition, technology has improved in the form of high-definition, magnifying scopes that can see greater detail, allowing doctors to detect smaller polyps. Complications such as bleeding or colon perforation are rare, and often doctors can manage and correct those things immediately.

“That’s a huge change,” Dr. Jani says. “In the past, you’d have to go to surgery, but now we can control most bleeding and repair perforations.”

As far as controlling patients’ fears or embarrassment, doctors do all they can for that, too. “We’re sensitive to their feelings, so we explain what to expect, why it’s important and that our staff is highly trained and does colonoscopies day in and day out, which allays a lot of fears,” he says. “We also reassure patients that there really is minimal discomfort during and after.”

Minimal discomfort is also thanks to another advancement: The use of carbon dioxide to gently inflate the colon (to make room for the scope) instead of oxygen, causing less pressure, gas and bloating, Dr. Jani says.

So, while you may be a bit groggy afterward (from sedation) — and need someone to drive you home — most people feel good, he says. “Many patients even go out for lunch afterward.”

Colonoscopy remains the gold standard screening for a reason: It can detect and correct potential problems early on. “It’s really the greatest screening tool available,” Dr. Jani says.

- Beth Janes for Greater Baltimore Medical Center
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