Division of Gastroenterology
My doctor wants me to have a colonoscopy even though I'm in my 40's and no one in my family has ever had colon cancer. Can I wait until I’m older to have the test?
You can wait, but you really shouldn’t.
If you knew you could save the life of a family member or someone you loved by giving up a few hours of your time, would you do it? You probably would and, essentially, that’s all that your physician is recommending. Except, in this case the life you are being asked to save is your own.
That may seem dramatic, but the facts tell a different story. By the time you finish reading this article, another person in this country will have died from colorectal cancer. More than 50,000 Americans will die and nearly 147,000 new cases of the disease will be diagnosed this year. It is the third most common form of cancer and the second leading cause of death from cancer in the United States. When colon cancer is caught early, 90 percent of patients live at least five more years. If not detected until the disease has spread, the survival rate can be fewer than one in 10. Despite that information, only about half of those who are at risk for the disease will take the time to be tested.
Who is considered “at risk”? Current guidelines, endorsed by the American Cancer Society, the National Cancer Institute, the American Gastroenterology Association and others recommend screening for everyone, who has reached the age of 50 – or 45 years if you are African American – and who is at “average” risk of colorectal cancer. “Average” risk means no symptoms of colorectal disease and no family members with a history of the disease. For those who have a personal history of Crohn’s disease, ulcerative colitis, or have a close family member diagnosed with colorectal cancer screening should begin at age 40.
Despite the evidence that shows colorectal cancer is a potentially preventable and highly curable disease, too many individuals postpone or avoid being tested, especially when that test is a colonoscopy, which remains the “gold standard” for detecting polyps or other abnormalities that could indicate colorectal cancer.
Patients often tell me that they’ve avoided the test, not because they fear the test itself, but because of the stories they’ve heard about the preparation for the test. Most of them later admit that their concerns were out of proportion to their experience. A colonoscopy is a painless procedure. The patient is given a sedative beforehand and will sleep through the entire test. The preparation for the test can cause some inconvenience, as it requires the use of laxatives to clear the bowel. Aside from causing frequent trips to the bathroom the day before the procedure, the test prep will cause only minimal and temporary discomfort. Another screening option is a “virtual colonoscopy” during which a CT scan is used to look for polyps in the colon. While this is less invasive than the traditional colonoscopy, the pre-test preparation and risk of complications is the same and, if polyps are found, the patient will still need to undergo a colonoscopy to remove those potentially cancerous growths.
Originally published in The University Doctor's MedicaLink- 10/09
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