Prevention better than cure: Making the case for screening colonoscopy

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Recently, I found out that a friend had died the previous night. I was truly shocked and saddened. He was a fit, active person. I was unaware that he had been ill, having been diagnosed with colon cancer three to four months earlier. On speaking with those to whom he had disclosed his illness, I learned that at the time of his colon cancer diagnosis there was already extensive spread to his liver and kidneys. He was sent home with a poor prognosis. He had never done a colonoscopy. I asked another mutual friend (who happens to be a physician) if she had done a colonoscopy. She had not. She said that she doesn’t want to know because what can she do if it is advanced? My own experience as a physician is that many patients choose not to do screening colonoscopy. Some of the reasons given include

• They don’t feel unwell. No symptoms, no problem
• The procedure will be uncomfortable
• If something is there they don’t want to know
• They cannot afford it

What is Colonoscopy?

It is a form of gastrointestinal (GI) endoscopy, that is, a procedure that uses a small camera to directly visualize and examine the lining of the gut. The upper GI endoscopy examines the oesophagus, stomach and upper small bowel, and lower GI endoscopy (often referred to as colonoscopy) examines the colon and rectum. This allows diagnosis of cancers and other conditions affecting the gut

What is the point of screening for colon cancer?

The aim of screening is to detect cancer when it is early and amenable to curative intervention. However, it is possible that at the procedure could find a cancer that is more advanced. From a practical standpoint one of four scenarios can occur:

1. The colonoscopy is normal. Most persons will not need another colonoscopy for 10 years
2. Early stage colon cancer is found. This provides an opportunity for surgical intervention to achieve a cure
3. Late stage colon cancer is detected. Follow up tests show no sign of spread outside of the colon. Surgical intervention has a place here. Adjunctive treatments such as chemotherapy and radiation therapy may also be recommended
4. Late stage colon cancer is present with widely disseminated spread. Any surgical intervention at this stage is only to relieve blockages created by the cancer to allow the patient as much time as is possible and to make them comfortable. It may seem like finding such a cancer is pointless. However in my view it allows time. Time to prepare your family emotionally and financially for what is to come. Time to make a will if it that had not been done. Time to have conversations that are important. Time to take the necessary steps to secure spiritual peace.

When should you start doing screening colonoscopy?

Most persons should start screening at 50 years. For those with high risk factors, especially any first degree relative (parent or siblings) with colon cancer it is recommended that screening start at age 45 years.

What is doing a colonoscopy like?

You will be asked to take certain things to clear out the bowel in the 24 hours prior to the procedure to allow clear visualization of the lining and a full assessment. You will need to be home as you will be using the toilet frequently. You will also be asked to drink a large amount of clear fluid. The instructions will be provided by the centre doing the procedure. Prior to the procedure a sedative is given, so you will not have any discomfort. Once the procedure is completed you will be allowed to recover from the sedative sufficiently to allow you to go home. You cannot drive yourself home after a colonoscopy as you will still be drowsy. I have had this procedure. There Is no reason to fear it.

Four reasons to get a colonoscopy if you are over 50

1. Peace of mind. A normal colonoscopy lets you know that you are unlikely to develop colon cancer for the next 10 years.
2. Puts the odds in your favour. Screening colonoscopy in an asymptomatic person will more likely detect early stage cancers and thereby increase likelihood that any abnormality found can be eliminated.
3. Planning. If the result is not normal the information allows the patient to work with their doctors to achieve the best treatment plan and to take control of what comes next.
4. Preparation. Even if the results indicate a poor prognosis it allows the individual time to get their house in order for family and business concerns, and allows decisions to be made and  important conversations to occur while there is still some time.

The other option is to do nothing and hope that no cancer develops. If symptoms are the trigger for colonoscopy the disease is more likely to be advanced and options limited. We all have that choice. I hope you choose to talk with your doctor about this.

Dr. Simone French is a consultant emergency physician, and the medical director at the Emergency Medicine Division of the UHWI. She is the physician owner of Imara Medical Centre where she practices general and urgent care medicine.