By Alisse M. Ryan, MD
As a primary care physician, I help ensure adults of all ages receive the general care they need throughout their lives. This includes screenings when warranted. Every time I see a patient who is 50 or older and hasn’t had a colonoscopy, I encourage them to get one scheduled since the simple screening could save them from one of the most preventable malignancies – colon cancer.
According to the National Institutes of Health’s National Cancer Institute, 2015 saw an estimated 132,700 new diagnoses of colorectal cancer, which comprised 8 percent of all new cancer cases in the United States. An estimated 49,700 people died from the disease last year.
Though the median age of diagnosis is 68, it’s important to begin getting colonoscopies every 10 years starting at age 50, unless you are at higher risk due to a family history of colon cancer.
There are factors, like age and where you live, that you don’t have much control over, but there are contributing risk factors for the disease that you can control. Alcohol, tobacco, being inactive, obesity, diabetes – things you can manage to help reduce your chances of developing the disease.
Colon cancer often begins as a growth called a polyp, which can grow on the inner wall of the colon or rectum and not exhibit any symptoms. Over time, some polyps may become cancerous. Colonoscopies search for and remove these polyps.
Overcoming any concerns
It is common for people who have not had a colonoscopy before to not be thrilled with the idea of getting screened.
If I sense a patient is hesitant to be screened, I try to figure out what their barriers are, eliminate misconceptions and encourage them as much as I can. For instance, I often tell my patients that colonoscopy is a test that had to be rigorously studied until it was proved that the benefits outweigh the risks. If the risks were too high, it would never have been approved by the U.S. Food and Drug Administration (FDA). I also tell them the risk of complications is very, very low and the rewards – peace of mind and, possibly, a life saved – are huge.
People might be unnecessarily embarrassed or fearful of colonoscopy, but once they go through it for the first time, they quickly realize it was easier than expected and pretty quick. The prep work is almost always the hardest part and even that is pretty simple, certainly much easier and more appealing than dealing with a colon cancer diagnosis.
The screening process
Once a patient has spoken with their health care provider about getting checked for colon cancer and learned about the various tests – in addition to the risks and benefits of each type – it will be decided if they are healthy enough to be screened. If so, a team member will educate the patient about what to expect from the procedure. The day prior to their colonoscopy, patients need to stick to as close to a clear liquid diet as possible, take any prescription medications they are on and drink a specially formulated beverage to clear their bowels.
The day of the exam, patients will be “consciously sedated” using an intravenous drug called propofol to induce a drowsy, relaxed feeling. In 2014, Virginia Mason became the first site in the United States to begin performing colonoscopies using a new, FDA-approved, computer-assisted sedation system called SEDASYS. It monitors medication impact in real time – before, during and after the procedure – and allows 99 percent of healthy patients having a colonoscopy to recover from sedation within 10 minutes.
Once ready on the exam table, the patient will lie on their left side and a gastroenterologist will insert a colonoscope – a flexible, tubular instrument, about a half-inch in diameter that transmits an image of the colon – into the rectum and move it forward to look for polyps. The scope bends as it is moved around the curve in the patient’s colon and blows puffs of air to help expand the colon for a clearer view. Patients sometimes experience mild cramping, but otherwise the medications do their job to minimize any discomfort.
If any polyps are found, they will be removed during the colonoscopy and tested in a lab to determine if any are precancerous.
The procedure itself usually takes about 30 minutes and patients are in and out within a couple of hours. Once the screening is finished, you will need someone to drive you home.
The facility matters
As with most medical procedures, the more a provider performs a procedure, the better and more proficient they become, which most often equates to safer care and better outcomes. Colonoscopies are no different.
Gastroenterologists at Virginia Mason performed 9,800 colonoscopies in 2015. The national target rate for detecting polyps is 20 percent. At Virginia Mason, the polyp detection rate is 54.4 percent.
“Completion” refers to whether a gastroenterologist can see the entire large intestine during a colonoscopy. Things that prevent colonoscopy completion include poor bowel prep, obstruction of your intestine from colonic disease or lack of physician expertise. Virginia Mason gastroenterologists have a 99 percent colonoscopy completion rate, compared to the national target of 90 percent.
Screening saves lives
It is estimated that early screening would prevent 90 percent of colon cancer cases, which is the third most common form of cancer in the United States. Men and women face the same risk and often do not feel any symptoms.
I can’t emphasize enough how important it is for everyone – regardless of outward physical health – to have a colonoscopy every 10 years starting at age 50. You could be healthy, athletic, and never smoked or drank a day in your life. You could be doing everything you’re supposed to be doing. But I have met people like that who have gotten colon cancer at a younger age, too.
It is important to get it done so you don’t have to think about it and can be around for your family members.
Remember, screening saves lives!
Alisse M. Ryan, MD, is board certified in Internal Medicine. She practices Primary Care at Virginia Mason Hospital and Seattle Medical Center (1100 Ninth Ave., Seattle, WA 98101; (206) 223-6600) and lives in Issaquah.
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By Alisse M. Ryan, MD