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Colonoscopy Still Saves Lives

You may have read about the new study showing that colonoscopy might not be as good as everyone thought at detecting cancerous or precancerous polyps.

But that's no excuse to skip this time-tested form of cancer screening. (You're not getting off the hook that easily!)

The study, conducted in Canada and published Tuesday in the Annals of Internal Medicine, found that colonoscopies don't detect lesions in some parts of the colon as well as in others. Instead of reducing colon-cancer mortality rates by 90 percent, the astounding figure commonly attributed to colonoscopy, the study puts that number at 60 percent or 70 percent. (Which is still really good for a cancer-screening tool, as an editorial accompanying the study remarks.)

But Robert Smith, director of cancer screening for the American Cancer Society, says those findings may be skewed by the fact that most of the colonoscopies in the study were performed by general practitioners and other nonspecialists. That's typical in Canada. In the U.S., he says, most such procedures are done by gastroenterologists, who specialize in the workings of the digestive tract.

Even among GIs, though, Smith says skill levels vary. The keys to a thorough colonoscopy are reaching the cecum at the end of the bowel and a slow, careful withdrawal of the scope once it has reached that end point. (The bulk of the examination takes place on the way out, he explains.) If a colonoscopy doesn't catch potentially cancerous lesions, it's more likely a failure of the practitioner than of the procedure itself, Smith says.

Unfortunately, there's no way to know for sure how skilled your practitioner is ahead of time, though choosing a GI who has done lots of colonoscopies is a good start. But you can up your odds of getting the job well done by doing your part beforehand. "Follow preparation instructions to a T," Smith advises, "no matter how tedious or tiring the preparation becomes."

For the uninitiated: Colonoscopy prep involves consuming only clear liquids the day before the procedure and then, the night before, drinking, and, er, expelling, a whole bunch of a solution that clears your bowels out. (The FDA recently ordered stern warnings be placed on labels for certain bowel cleansers because they can cause kidney damage. You can read about it in this Checkup entry last week.)

The preparation "is regarded by most people as the worst part of the exam," Smith says. "People stop in the middle of it, or they don't do the clear diet the day before." But if the colon's not completely clear, the scope's view of your innards will be impeded, making it more likely to miss lesions.

The new study reminds us not to be complacent after a colonoscopy -- or any other cancer screening, for that matter. Cancer has a way of showing up when you least expect it. But while you may not be guaranteed a clean bill of health, Smith stresses that it's extremely rare for colon cancer to be detected soon after a normal colonoscopy.

Are you due for a colonoscopy? Check the American Cancer Society's cancer screening guidelines here. If you have had one recently, tell us about it. Was it an ordeal?

By Jennifer LaRue Huget  |  December 17, 2008; 7:00 AM ET
Categories:  Cancer , Medical Technology , Prevention  
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I have had 2 colonoscopies, 1 in 2000 and the most recent in 2007. They were done for routine screening purposes as a person my age (65) should have from time to time. In both cases, the procedure was conducted by a GI specialist with lots of experience. No lesions were found either time.
The procedure itself, on both occasions, was something of an ordeal. My colon, so I am told, is unusually long and twisting and sedation, even though increased as the procedure progressed, was insufficient to curb the sensations from the scope. After the second experience, the MD told me I should have general anesthesia on subsequent colonoscopies.
I regret writing this out of concern that some who should have the procedure will think twice about going ahead with it. What I experienced was not awful and I shall have colonscopies in the future as I should. But what concerned me more than the discomfort itself was the lack of concern by the staff in attendance during the most recent time. I told them of my experience with discomfort on the prior occasion and they did not take my concern - even talking down to me. The doctor was very subdued when he visited with me after I became alert enough to give me his report. If you are to have your first colonoscopy, I suggest you meet beforehand with your physician and go over the specifics of what he / she will be prepared to do if the initial dose of sedation is not sufficiently effective.

Posted by: CloggedCleats | December 17, 2008 6:03 PM | Report abuse

I just had my second colonoscopy. I'm on the five year plan, because of a family history of colon cancer and polyps. The first time, I thought that it would be cool to watch as it proceeded. Big mistake. I couldn't laugh for two weeks afterwards (too painful). This time I was fully compliant (sedated), and had no problems. The cleansing process has improved over the past five years (tablets instead of gallons of salty liquid) and was much easier. I recommend using Gatorade as the liquid of choice (to maintain your electrolyte balance). I've had pre-cancerous polyps found both times, so I view this as a lifesaver. Don't put it off..just do it.

Posted by: Beagle1 | December 18, 2008 10:51 PM | Report abuse

Do NOT postpone or refuse to get a colonoscopy because of this study. I had one this year (mainly because my mother insisted based on years of complaints), and I almost cancelled the appointment at the last minute, thinking I was being whiny and I should just suck it up. Well, turns out I have diverticulosis, and since I've taken steps to avoid flareups, I feel better than I have in years.

Posted by: smc0047 | December 22, 2008 2:15 PM | Report abuse

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