Screening for colon cancer (or colorectal cancer, bowel cancer)

[Aerides]

I heard so many folks complain about getting a colonoscopy…the prep, the fasting, the this, the that. I’ve had two now. Clean on both. They are not that big of a deal.

I had my first one last year and I agree. I dreaded it... but the suprep was easy to drink (I mixed w/sprite, downed in two big chugs).

Then it was just water and...emptying, which was done pretty quickly. Then more water in the AM. Then in and out, and home and a nap and that was that!

Not a big deal at all. I had pizza that night and any dreams of losing 2-3 lbs from the experience quickly disappeared.

 

[Gotadimple]

Not a big deal! Of course it's a big deal. It's 2 days out of your life for a 10% chance at cancer, and a 90% chance of an intestinal blockage in 20 years or so. https://www.healthline.com/health/tubular-adenoma

I have issues with the insistence that small (less than 1cm) polyps need to be extracted every 5 years, and the income from that 7 minute operation is $1500 -$5,000, and it turns out to be just fine 9 times out of 10.

I'm on the fence about scheduling my 3rd (and final) colonoscopy in my 70's when the first two found fewer than 3 polyps each less than 4mm in size over a 20 year period. Yes there are anecdotal stories, and for those who lost a family member, I am sorry for your loss. But somewhere in here there has to be a point of 'finesse' in the art of medicine with all that is known about colonoscopies and polyp removal.

 

[Helen]

Not a big deal! Of course it's a big deal. It's 2 days out of your life for a 10% chance at cancer, and a 90% chance of an intestinal blockage in 20 years or so. https://www.healthline.com/health/tubular-adenoma

It's really less than 24 hours. I start my liquid diet in the morning, but I will still be up and active. The prep starts at 5pm and the procedure is at 10am the next morning. I will gladly go through that to minimize a 10% chance of colon cancer.

The one nice thing to say about colon cancer is that it isn't contagious so everyone's decision is truly their own.

 

[RonBoyd]

It's really less than 24 hours. I start my liquid diet in the morning, but I will still be up and active. The prep starts at 5pm and the procedure is at 10am the next morning. I will gladly go through that to minimize a 10% chance of colon cancer.

The one nice thing to say about colon cancer is that it isn't contagious so everyone's decision is truly their own.

I, too, find it a not very disruptive event. I had a colonoscopy every year for ten years than skipped ~3 because of the pandemic. They have found 10-15 polyps each time. I had a grandfather and an uncle succumb to colon cancer -- both died in great (excruciating) pain. I had my DNA tested and (apparently) I have no greater risk than the average person.

In any event, to me the few hours of inconvenience is worth the peace of mind. BTW, I am way past 70 years old.

 

[harllee]

Colon cancer is one of the cancers that is almost 100% preventable--the way to prevent it is to have a colonoscopy. I don't understand why anyone would not do that. I just wish that some other cancers--like pancreatic cancer-- were preventable like colon cancer is.

 

[RonBoyd]

Colon cancer is one of the cancers that is almost 100% preventable--the way to prevent it is to have a colonoscopy. I don't understand why anyone would not do that. I just wish that some other cancers--like pancreatic cancer-- were preventable like colon cancer is.

Kinda like, Covid vaccine is 100% guarantee you will survive and not vaccine is 100% guarantee of dying. Why even concern yourself with the unknowable?

 

[jpeter1093]

Colorectal cancer is one of the most lethal cancers and also the most easily detected at an early stage and curable. The other cancer with similar characteristics is cervical cancer which is now largely preventable with the HPV vaccine.

As someone who is quite healthy and at low-risk for most things, I was very happy to get screened as soon as possible. Cologuard and colonoscopy both have pros and cons but eventually DNA based tests like Cologuard will probably become the standard for initial screening for low-risk individuals.

Out of curiosity, were you screened as part of an annual physical? I'm trying to understand why you're against them?

 

[Helen]

I had my covid test today and am now quarantining in prep for my Monday colonoscopy. I have one every three years. The first one was when I was 51 and they found 13 polyps. The last one they found a polyp on my appendix so I opted to have the appendix removed.

The colonoscopy prep that I am to drink cost over $200 without my insurance and $93 with insurance. It's mostly magnesium. Next time I will opt for Miralax or Suprep.

The colonoscopy is over - yay! They found 8 polyps!!! I had my last colonoscopy 3 years ago, my colon just likes to grow polyps.

I feel very fortunate we have the technology and I have the insurance to do these tests.

 

[6miths]

Out of curiosity, were you screened as part of an annual physical? I'm trying to understand why you're against them?

Some of it may be semantics and misunderstanding. I am 'against' the traditional 'annual physical' (from the other ongoing thread) because evidence does not support them and most professional bodies do not recommend them. This is to say that people who feel well and look well and have no medical conditions requiring indicated visits do not benefit from the traditional 'annual physical' and the visit that goes with it. This is from a risk-benefit and a cost-effectiveness point of view. This is the review from the Cochrane Database.

Screening for colorectal cancer is one of several manoeuvres that have been shown to be effective in reducing morbidity and mortality in the group to which I belong and as a 'healthy' person with many quality life years ahead of me (statistically), colorectal cancer would be relatively high on the list of 'preventable or fixable' things that could take me out.

Consumer Reports often has reasonable critical medical articles - this one is for men. Most of these things, like colorectal cancer screening, are not needed annually and many, such as doing a BP, do not require a doctor's visit even. It is a political statement but medicine is a business in the US and one business model is the 'maintenance plan' approach. I can understand people finding it reassuring to sit down with their doctor once in a while for a chat but the idea that the 'routine annual physical' or getting serum rhubarbs done every 6 months or getting a total body MRI are going to have a net benefit on the health of an otherwise well individual is not founded in fact.

 

[JoeWras]

Colonoscopy saved my life. Period.

My doctor is not into a bunch of tests. He's not a fan of heart stress tests in healthy people who exercise, for example. Full body stuff? Nope.

But he is pretty insistent on the age 50 colonoscopy. Thanks Doc!

 

[harllee]

Colonoscopy saved my life. Period.

My doctor is not into a bunch of tests. He's not a fan of heart stress tests in healthy people who exercise, for example. Full body stuff? Nope.

But he is pretty insistent on the age 50 colonoscopy. Thanks Doc!

When I turned 50 I was going to a doctor who had a rule--all of her patients who turned 50 had to have a colonoscopy or she fired them as patients. So I got my first colonoscopy at 50 ( and one at 60 and one at 70).

 

[HawkeyeNFO]

My doc said they just changed to recommendation for the 1st butt-scope from 50y/o to 45y/o. I'm in between there, and my aunt just died from colon cancer, so I'm on the doctor's sked for next month.

 

[MRG]

My doc said they just changed to recommendation for the 1st butt-scope from 50y/o to 45y/o. I'm in between there, and my aunt just died from colon cancer, so I'm on the doctor's sked for next month.

Good for you!
One of my former co-workers was recently diagnosed stage 4 in his early 50s. He wasn't worried about it. My sister put it off till 74 when she had 6" of her colon removed. I'm on a three year schedule due to history and eosinophils.

 

[RonBoyd]

My doc said they just changed to recommendation for the 1st butt-scope from 50y/o to 45y/o. I'm in between there, and my aunt just died from colon cancer, so I'm on the doctor's sked for next month.

Again, there is a DNA test that gives your odds of developing Colon Cancer. I have forgotten what it is called but your doctor should know. I don't know how accurate it is but it does give me some comfort after having a grandfather and uncle die -- both on the same side of the family. There was, also, a very lengthy interview process that came before determination if the test was given.

I took the test some fifteen years ago and, although, I have a Polyp farm, they have all been benign.

 

[athena53]

Again, there is a DNA test that gives your odds of developing Colon Cancer. I have forgotten what it is called but your doctor should know.

I don't know what it is, either but a first cousin who developed breast cancer in her 40s got genetic testing and the mutation they identified was not only a marker for increased BC risk (and her sister was also found to have it) but for colon cancer risk. Her maternal grandfather had died of colon cancer and it came from that side. So- their 3 brothers are also on the alert.

 

[6miths]

There are several hereditary familial cancer genotypes - the best known are BRAC1 and BRAC2 which increase the risk of breast, ovarian, colorectal, pancreatic, and prostate cancer and malignant melanoma. There are many more mutations that can be inherited and lead to familial cancer clusters but most cancers are caused by new mutations in these and other genes as we are exposed to agents that damage our DNA. Thus most cases of cancer are caused by mutations that are acquired as opposed to inherited.

 

[chassis]

There are several hereditary familial cancer genotypes - the best known are BRAC1 and BRAC2 which increase the risk of breast, ovarian, colorectal, pancreatic, and prostate cancer and malignant melanoma. There are many more mutations that can be inherited and lead to familial cancer clusters but most cancers are caused by new mutations in these and other genes as we are exposed to agents that damage our DNA. Thus most cases of cancer are caused by mutations that are acquired as opposed to inherited.

Thanks @6smiths. That is genuinely the most interesting thing I have read about cancer. Would you mind sharing whether you are involved in cancer research or medicine?

 

[RetMD21]

Some of it may be semantics and misunderstanding. I am 'against' the traditional 'annual physical' (from the other ongoing thread) because evidence does not support them and most professional bodies do not recommend them. nths or getting a total body MRI are going to have a net benefit on the health of an otherwise well individual ....

I like the consumer's report link. Guidelines for US and Canadian primary care providers recommend asking a lot of questions (diet, exercise, smoking) and some targeted testing. Patients in the US devalue the talking part and demand nonspecific blood tests, the more the better. Some docs know better but comply. I don't know if Canadian consumers are less demanding.

 

[Teacher Terry]

The recommendation is to continue screening through 75 and consider it from 75-85 in consultation with your doctor (USPSTF)

Interesting the recommendation I read said they are routinely recommended to age 70. My skin is pretty thin on my arms which means it’s probably thin in other places and I am concerned about a puncture during the procedure which usually ends in death. They found my mom’s stage one colon cancer at age 84 and suffice it to say she would have been better off if it hadn’t been detected. It’s a long, unpleasant story. I never blindly follow medical recommendations. The only person living with the consequences is the patient.

 

[RetMD21]

Interesting the recommendation I read said they are routinely recommended to age 70. My skin is pretty thin on my arms which means it’s probably thin in other places and I am concerned about a puncture during the procedure which usually ends in death. They found my mom’s stage one colon cancer at age 84 and suffice it to say she would have been better off if it hadn’t been detected. It’s a long, unpleasant story. I never blindly follow medical recommendations. The only person living with the consequences is the patient.

Sorry to hear about that. At some point the cost/benefit changes. Although not as good as colonoscopy you could consider FIT testing with colonoscopy only if abnormal.

 

[6miths]

I like the consumer's report link. Guidelines for US and Canadian primary care providers recommend asking a lot of questions (diet, exercise, smoking) and some targeted testing. Patients in the US devalue the talking part and demand nonspecific blood tests, the more the better. Some docs know better but comply. I don't know if Canadian consumers are less demanding.

I live just around the corner from the house that Sir William Osler grew up in and one of the town's main streets is named after him. 'Listen to the patient. They are telling you the diagnosis.' I'm sure that the students tire of my stressing that the best start to most answers is, 'I would do a complete history and physical'. I think that there are many reasons that Canadian patients are less 'demanding', most of them good and perhaps the primary likely being that they don't see themselves as 'consumers' or being involved in a business relationship with the healthcare system.

 

[athena53]

I like the consumer's report link. Guidelines for US and Canadian primary care providers recommend asking a lot of questions (diet, exercise, smoking) and some targeted testing. Patients in the US devalue the talking part and demand nonspecific blood tests, the more the better. Some docs know better but comply. I don't know if Canadian consumers are less demanding.

Sadly, I think most Americans KNOW they have unhealthy habits and they don't want to hear what they need to do (lose weight, stop smoking, restrict salt, sugar and fat). They want pills.

 

[aja8888]

After my last colonoscopy a year or so ago, my doc said don't come back as I am clean and 76 years old. They really were not a big deal to have done.

 

[rodi]

There are several hereditary familial cancer genotypes - the best known are BRAC1 and BRAC2 which increase the risk of breast, ovarian, colorectal, pancreatic, and prostate cancer and malignant melanoma. There are many more mutations that can be inherited and lead to familial cancer clusters but most cancers are caused by new mutations in these and other genes as we are exposed to agents that damage our DNA. Thus most cases of cancer are caused by mutations that are acquired as opposed to inherited.

My mom died of ovarian cancer, my brother had melanoma then died of neuroendocrine carcinoma (even rarer than the carcinoid form). Dad had prostate cancer, then died of multiple myeloma. A first cousin has had both prostrate cancer and testicular cancer. Gramps had leukemia, Gramma had breast cancer, and the other grampa died of lung cancer. Grammy had cancer - but she made it to 91... and they were just managing her pain. I only have 3 cousins because mom was an only child and dad only had one sibling. So yeah - my family is a cancer cluster. My brother's oncologist suggested I get genetic testing when he was in the hospital for his super aggressive neuroendocrine carcinoma. Nothing - no mutations on any of the cancer markers. Some families just tend towards cancer, others tend towards heart disease or stroke.

 

[RetMD21]

Sadly, I think most Americans KNOW they have unhealthy habits and they don't want to hear what they need to do (lose weight, stop smoking, restrict salt, sugar and fat). They want pills.

True. And maximal intervention. Folks here who care seem to strongly favor colonoscopy for screening. The Canadian approach for standard risk individuals is FIT testing. Although it is a good, cost-effective approach I don't think that it would be so well accepted here.