Just thinking about it – the prep, the procedure itself – could be enough to send a shiver down your spine. It isn’t necessarily pleasant, but in the end, colonoscopies can save your life.
According to the National Cancer Institute, studies suggest that colonoscopies have reduced deaths from colorectal cancer by about 60 to 70 percent.
Colorectal cancer, which includes cancer of the colon or the rectum, is the third most common cancer in the United States, not counting skin cancers. The lifetime risk of developing colorectal cancer is about 1 in 21, or 4.7 percent, for men and 1 in 23, or 4.4 percent, for women, the American Cancer Society states on their website, adding that it is expected that there will be 50,260 deaths from colorectal cancer in 2017. The American Cancer Society estimates there will be 95,520 new cases of colon cancer and 39,910 new cases of rectal cancer this year.
“The price to pay to have a colonoscopy is a very small price, when compared to having a diagnosis of colorectal cancer,” said Edmundo Justino, MD, a gastroenterologist with Trinity Health.
Justino said that it is heartbreaking to diagnose someone with colorectal cancer – especially because it is very preventable.
A colonoscopy, which involves an arduous preparation, is an examination of the colon in which a colonoscope is used, via entry from the anus, to inspect the colon and look for polyps or other abnormal signs. The patient is usually sedated during the procedure.
If polyps are found, they may be removed by passing a wire loop through the colonoscope to cut the polyp from the wall of the colon using an electric current.
Prior to the colonoscopy, the patient would drink 16 ounces of solution – a mixture of six ounces of cleanser and ten ounces of water – the night before the colonoscopy, as well as the day of.
“Drinking this is the only way to clean the colon,” Justino said. This is done with a “clear, liquid diet” the day before the procedure.
A 2016 report from the American Cancer Society states that the number of colonoscopies for people over the age of 50 has increased from 19 percent in 2000 to 55 percent in 2013.
However, in North Dakota, Justino says, the numbers of adults over the age of 50 – the recommended age one should get a colonoscopy – is still low.
“In North Dakota, we still rank poorly when compared to other states,” Justino said. When looking at statistics from other stations across the nation, “most states are able to reach close to 50 percent of the population. North Dakota, and a few other states, are in the forties.”
Ideally, Justino adds, “we would like to screen every eligible person – 100 percent.”
Those who are adverse to getting a colonoscopy have recently become acquainted with Cologuard, an alternative testing modality which is considerably less invasive. It involves the study of a stool sample.
“You go to the doctor, obtain a kit, take it home, collect a sample, and send it back,” Justino said.
The test can show abnormalities, but it cannot identify exactly what the abnormality is – is it colon cancer or just a polyp? Occasionally, it means the patient would need a colonoscopy in order to investigate what the abnormality is.
A caveat to this is that the Cologuard test can only apply to those who are low risk, meaning that if a patient has any family history of colorectal cancer or polyps, they are ineligible for the Cologuard test, Justino said. “High risk patients should not be doing Cologuard; they need a colonoscopy.”
Other modalities of screening
Outside of colonoscopies and Cologuard, there are other screening modalities that can be used for colorectal cancer.
High-sensitivity fecal occult blood test – This test checks the stool for blood, which may be a sign of polyps or cancer. Patients can provide stool samples at home, after they receive a kit from their healthcare provider. Those with a positive test will be referred for a colonoscopy. The US Preventive Services Task Force (USPSTF) recommends these tests be done annually, starting at age 50.
Sigmoidoscopy – A sigmoidoscope, a thin tube with a light on the end, uses a tiny video camera to transmit images of the rectum and lower colon (called the sigmoid colon) to help detect polyps or cancer. Physicians can insert special instruments into the scope to biopsy and remove polyps. Typically, if polyps are found, the patient will require a colonoscopy for a more thorough analysis of the entire colon. The procedure, recommended every five years for individuals between 50 and 75, doesn’t typically require sedation. Patients need to give themselves an enema before the procedure to cleanse the lower colon.
Colonoscopies are recommended starting at the age of 50. After the first colonoscopy, someone with an average risk – that is, a person with no family history of cancer or polyps – should get a colonoscopy every 10 years; if there is a family history, it is recommended that they get a colonoscopy every five years.
If there is a family history of colon cancer or polyps, Justino recommends that you not wait until age 50 to get your first colonoscopy. The Cologuard test should be performed every year as an alternative to colonoscopies. Regardless of the modality, screening for colorectal cancer is important – especially as colon cancer is a disease that is very preventable, Justino noted.
Colonoscopies are the only test that studies have shown to decrease mortality, Justino said. “It decreases the number of people who die of colon cancer. There is no reason why people shouldn’t get a colonoscopy in this day in age.”
A referral is needed for a colonoscopy, with an order from your primary care physician. If you need a colonoscopy, please speak to your primary care physician.
Trinity Health’s team in gastroenterology include Rukshana Cader, MD, Edmundo Justino, MD, and Bonnie Ler, FNP-C. Their offices are located at Health Center – Medical Arts, 400 Burdick Expressway East, Minot. They can be reached at 857-7389.