Colonoscopy Still Saves Lives
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?
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