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Colonoscopy
Old 08-30-2009, 02:14 PM   #1
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Colonoscopy

As my mother had colon cancer (fully recovered), I have always been advised that I should be especially vigilant and make sure that I get a colonoscopy every 5 years, rather than every 10 years like most folks, because of my close relationship to her.

When I was scheduling the procedure recently, the Dr. asked how old Mom was when she had it. It recalled that she was about age 70 or so. The Doc says that since she was over age 65 when she had it that I have no more chance of colon cancer than the average person, so I should let them peek inside of my butt every 10 years, not every 5. Evidently new studies show that since folks over 65 tend to get colon cancer more than those of younger ages, relationship is no longer considered important if the original patient (Mom) was 65+.

Does this information square with all of you medical folks?

I'm still going to get it done soon, however I think my next one will be in 2019.
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Old 08-30-2009, 04:18 PM   #2
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That's the same info I got from my doctor, since my Dad had colon cancer in his 70's. I had my first colonoscopy last year, so I don't have to have another for 9 years. :woot:
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Old 08-30-2009, 04:35 PM   #3
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Mickey, that information is probably sound in terms of survival. Just as in coronary disease, a family history of premature disease is much more a risk factor than a family history of the diseases at the "usual" age.

However, bear in mind that even colonoscopy misses polyps a surprising amount of the time (the poor subjects of this study underwent colonoscopy, then another one an hour or two later by a second doctor, who found up to 20% of the patients had polyps the second go around -- mostly small and not requiring treatment, but still...).

My approach is to advise colonoscopy 5 years after the first one in the face of a 1st degree relative having colon cancer as an isolated event. If both are negative, the patient should be counselled and given the option of dropping back to every 10 years. Even a single normal colonoscopy puts you at much lower risk than the general unscreened population. Two normals 5 years apart is a good thing. Fecal occult blood testing at 5 years may be an acceptable, if unproven, compromise, with colonoscopy (and no fecal testing) every 10 years.

Caution: there are familial forms of colon cancer to which this does NOT apply, and some types of polyps which are more dangerous than others. As always let your doc advise you - only he or she knows all the factors to consider.

Hope that helps.
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Old 08-30-2009, 05:01 PM   #4
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My niece was found to have colon cancer at an early age, a Kaiser physician found it on a fluke. Her father, ~75, was found to have the same cancer earlier this year. Their health care professionals have hoisted a warning flag for all of my brother-in-law's descendants.
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Old 08-30-2009, 05:09 PM   #5
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Mickey, that information is probably sound in terms of survival. Just as in coronary disease, a family history of premature disease is much more a risk factor than a family history of the diseases at the "usual" age.
Rich, what's your take on virtual colonoscopies? I have a family history, so had a regular colonoscopy about age 55 (probably should have had one earlier than that). They removed a small polyp and told me to come back in 5 years. I went to a different hospital and they had advertising flyers out about virtual colonoscopies, which seemed less invasive, so I got one of those. Little did I know it entailed the same amount of prep, which was the only bad part of the colonoscopy.

They didn't find anything of significance on that one, but later I was talking with a medical person who thought that a regular colonoscopy is much better than a virtual one for someone with a family history. Do you have any thoughts about that?
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Old 08-30-2009, 06:23 PM   #6
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Rich, what's your take on virtual colonoscopies?
FR, recent technology has virtual colonoscopy approaching the sensitivity of real colonoscopy for detecting polyps. Unfortunately, as you point out, you still have to take the obnoxious prep; if something is detected (7-8% of the time) you now have to go back and have the real colonoscopy anyway, and you get a good slug of radiation (at least compared to routine x-rays) which is of uncertain risk but likely greater than zero.

I favor traditional colonoscopy for screening. There is also the possibility that if you have had 2 negative studies the most recent of which is over, say, age 60 or 65, you are at sufficiently low lifetime risk that no further scoping is beneficial (i.e. the risk of serious harm from the test exceeds the benefit of the rare early cancer detection in that population). This is speculation but it's plausible.
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Old 08-30-2009, 08:53 PM   #7
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Rich.....what's your take on flex sig + annual fecal occult blood test vs colonoscopy.
I have 3rd party knowledge of someone who got perforated during colonoscopy which
makes me nervous.
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Old 08-30-2009, 09:00 PM   #8
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Rich.....what's your take on flex sig + annual fecal occult blood test vs colonoscopy...I have 3rd party knowledge of someone who got perforated during colonoscopy which makes me nervous.
It's a secondary strategy, not as good as colonoscopy. People get perforated from flex sigs, too, and most of the colon is never examined. In good hands, it's rare for both procedures.

Annual occult blood testing when positive is mostly comprised of false positives, all of whom end up with colonoscopy. It's a marginal situation.

Better than nothing? Not so sure.
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Old 08-31-2009, 07:38 AM   #9
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I had a colonoscopy done this year, 1 flat polyp was found, removed, tested okay. Doc wants me back in 3 years for another colonoscopy. That surprised me a bit, I was expecting 5 years. I'm 48, no family history of colon cancer.

The reason I had the test done at 48 was I was pretty sure I'd be laid off sometime this year and I wanted to get all my checkups done while I had good health insurance. Given that, doc thought a colonoscopy would not be out of line.
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Old 08-31-2009, 04:18 PM   #10
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Rich,

Thanks for your comments. Very interesting.

As I understand it, the colonoscopy only peeks at the large intestine (LI). As the small intestine (SI) looks like it should have more cancer possibilities due to it's greater length, is there ever an occasion to scope out the SI as well as the LI? What % of colon cancer occurs in the SI?
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Old 08-31-2009, 04:38 PM   #11
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Originally Posted by mickeyd View Post
As I understand it, the colonoscopy only peeks at the large intestine (LI). As the small intestine (SI) looks like it should have more cancer possibilities due to it's greater length, is there ever an occasion to scope out the SI as well as the LI? What % of colon cancer occurs in the SI?
Cancers of the small intestine, despite its length, are quite rare and usually of an unusual cell type. They are not screened-for due to their rarity. It is visualized from above with something called enteroscopy (you swallow a camera, basically -- more like an endoscopy from the patient's viewpoint).

Colonoscopy sees the entire colon; flexible sigmoidoscopy only sees the lower "descending" colon.
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Old 08-31-2009, 06:10 PM   #12
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Got my 1st age related screen this year, no problems except for some minor diverticula. Doc told me to discontinue any food with shells or hulls (nuts, corn, seeds) and continue with Metamucil. Wants to see me in 5 years.
Family history is negative for colon cancer for maternal side, unknown records for paternal side. So as always, dealing with half a deck of info means I get more periodic screenings. No problem. Just turn up the juice.
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Old 08-31-2009, 07:09 PM   #13
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My wife's Dad, Uncle, and Aunt, had colon cancer, in their 70's.

My wifes' Dad had the "flat" polyp. The bad kind because they cannot "snip" off. My wife (late 50's) had the " flat " type also. My wife must have had 3 colonoscopiesin 3 years. The doctor was monitoring a "flat polyp" that did not look to good.

The doctor, finally recommend cutting out the "flat polyp", because it was growing and did not look good.

The surgeon cut out one third of my wife's colon, the top end, near the small intestine. This was about 3 years ago now. Wife is doing fine.

Here is where the story get's interesting. I told my wife to call all her cousins and tell them, get a colonoscopy, because it runs in the family.

Now three years later, one cousin got colon cancer and it spread to his liver. He's on chemo, and we'll see what happens. His brother then got a colonscopy, and they found cancer in his colon, in his case they cut a small piece of his colon out and it look good so far.

If my wife's cousin's had a colonscopy 3 years ago, they may have caught the cancer much sooner.

Also, the short version, sigmo, would not have caught my wife's cancer.

10 years seems long if it's in the family. Also, I noticed Kaiser, is very lax in giving colonscopies. Unless you pursue.
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Old 08-31-2009, 08:47 PM   #14
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I had colonoscopy last year. No polips, nothing.

The doctor added this in the report "Nice prep". I was a bit surprised, as I simply followed the given instructions to the letter. Obviously, some people don't.
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Old 08-31-2009, 10:41 PM   #15
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Don't dish Kaiser, they found my nieces colon cancer in her 30s with no overt indicators other than the fact that her grandfather died in late middle age of a stomach something. Her parents and brother were in seemingly good health. They did a colonoscopy as a result of her physician's hunch about her grandfather's cause of death. She is alive today only because the cancer was found early - and she was enrolled under a Medicaid program.

The practice of medicine is a combination of art and science (including probability). We would be on Kaiser if we were in their service area. No health care system is perfect but I have known several Kaiser physicians, they are consummate professionals concerned not only about their patients but about public health. There are some who feel that their system isn't touchy-feely. I disagree, you can have that relationship with a physician if you choose. I am in the Seattle area, served by Virginia Mason. Over the last 15 years my local clinic my primary care provider has changed 4 times because of physician re-locations.

My attitude may be in part effected by the fact that I am a mathematician by training, statistical approaches to medical care and treatment is OK for me. My childhood classmates include several notable physicians and surgeons. One comment I heard at our recent reunion, "Take care of your health" after one of our classmates - a retired professor at Syracuse - had a massive stroke the week before.

Getting old is only for the brave..
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