I’ll admit it up front: I don’t like procedures. I’m fine doing them to other people. Having one done to me is different. For 10 years I treated my colonoscopy the way some people treat a check-engine light. I knew it was there, I knew what it meant, and I kept driving.
Every birthday there was a reason to wait. I was too busy, I had no symptoms, I’d get to it next year. I’m 55 now, which means I spent a full decade telling patients to do what I wouldn’t.
Two groups finally wore me down. The first was my wife, who is persistent and usually right, a combination I find exhausting. The second was my colleagues, who brought it up in the lounge more often than you’d think. Once a doctor’s wife and his co-workers are on the same side, the argument is over.
Seeking counsel
Before any big decision, I call my senior partner. He’s been my mentor for years, and he has the sharpest wit of anyone I know. He’s also, as I learned that day, almost no help at all.
I told him I’d finally decided to schedule the colonoscopy. He paused, and then said: “It’s a good thing you called. Now I’ll know why you’re walking funny the next day.”
I hung up, wondering why I keep calling him. I also quietly saved the whole speech, word for word, so that I can pass the same useless advice to the younger doctors in our group. Some traditions deserve to continue.
Why we do this at all
Colorectal cancer is the third most common cancer worldwide, accounting for approximately 10% of all cancer cases and the second leading cause of cancer-related deaths globally. . In India, it accounts for about 65,000 new cases a year and is rising, especially in cities, and with no national screening programme, too many cases are found late. Nearly 38,000 Indians die of it every year. It is also one of the few cancers we can actually prevent, not just catch early.
Most colon cancers start as polyps, small growths on the lining of the colon. Over roughly 10 years, some become malignant. That long, quiet stretch is the opportunity. If you find a polyp and remove it, the cancer never gets a chanc’e to start. A colonoscopy is one of the few screening tests that also serves as treatment.
A brief history
Colonoscopy is younger than you might guess. In the late 1960s and early 1970s, William Wolff and Hiromi Shinya in New York used new flexible fiberoptic scopes to examine the whole colon. Dr. Shinya also developed the wire-loop snare to remove polyps through the scope, so they no longer had to be removed through open abdominal surgery. That was a revolutionary change.
The landmark evidence came from the National Polyp Study. In 1993, Sidney Winawer and colleagues reported in the New England Journal of Medicine that removing adenomatous polyps sharply cut the rate of colorectal cancer compared with what would otherwise be expected. In 2012, a long-term follow-up in the same journal showed that removing polyps reduced colorectal cancer deaths by about half. Our whole screening approach rests on those two papers.
The recommended starting age in the United States has also come down. Rising rates in younger adults led guidelines to lower it from 50 to 45. That leaves people like me with no excuse.
The alternative
Think about what skipping it looks like. A polyp grows unnoticed for years, and colon cancer often gives no warning until it’s advanced. Then the symptoms come: bleeding, a change in bowel habits, weight loss, fatigue, anaemia. By that point the conversation is about surgery, chemotherapy, and staging scans.
For some patients it means a colostomy, where the bowel is brought out through the abdominal wall and stool goes into a bag, sometimes permanently. For too many, it means dying of a disease that a simple screening test could have prevented.
Put that way, a day of inconvenience looks like a bargain.
The prep and the procedure
Every patient will tell you the procedure is easy and the prep is the hard part. They’re right.
I’ll spare you the details. You either already know, or you’ll find out soon enough. The good news is that the prep has come a long way. The dreaded jug is no longer your only choice, and tablet preps have made the whole thing far more bearable. If your doctor offers them, take them.
The next morning was close to anticlimactic. I checked in at the outpatient centre, changed into a gown that and got an IV. A nurse went through the usual checklist, and we chatted about nothing.
Then came propofol.
If you’ve never had it, here’s what it’s like. A warm flush rises up your arm, a brief awareness that something is about to happen, and then nothing. No dreams and no sense of time passing. One moment you’re listening to the anaesthesiologist, and the next you’re in recovery with a cup of juice, asking whether they’ve started yet.
The verdict
My gastroenterologist is also a friend, and he was completely professional from start to finish. He was calm and thorough, and he put me at ease. He came by recovery to tell me he’d found one polyp and removed it. It will go to pathology, and I’ll come back for surveillance on whatever schedule the results call for.
That polyp had probably been growing for years while I made excuses. Now it’s gone. That’s the point of screening: find it before it becomes cancer.
The bottom line
It really isn’t that bad. The prep is unpleasant for a single night, and easier than it used to be. The procedure takes less time than your commute, and the sedation is the best nap you’ll take all year. It may keep you from getting cancer. That’s a pretty good trade.
If you’re 45 or older and you’ve been putting it off as I did, talk to your doctor about getting screened. Colonoscopy isn’t the only option. You can do stool tests at home, and your doctor can walk you through other options. The best test is the one you’ll actually do. Doing nothing is the only wrong answer.
(Dr. Dinesh Arab is Director, Interventional and Structural Cardiology, AdventHealth Daytona Beach and Clinical Assistant Professor of Medicine, Florida State University dinarab@yahoo.com)