For Cancer Screening, There’s No Substitute for Colonoscopy

Thu, 13 Oct. 2011 - 12:56 a.m. MT
Credit: ARA Staff - American Running Association

Colorectal cancer is the second leading cause of cancer death (the first is lung cancer). Early detection could reduce mortality by as much as 60%. Colonoscopy, however, remains far from routine: a study in The Archives of Internal Medicine found screening rates of only 18% among 500,000 Medicare recipients for the year 2002-2003.
 
Contrary to popular conception, colonoscopy need not be painful or uncomfortable. The procedure is now usually performed at your doctor’s office under sedation, and is typically painless. While the procedure requires a 24-hour fast with oral laxative to cleanse the bowels, it no longer requires drinking the vast amounts of foul-tasting liquid it once did. A single serving of laxative is usually all that is required, and even the impossibly frequent trips to the bathroom and painful bloating that patients once experienced are largely a thing of the past. 
 
The test takes roughly 30 minutes, and involves the insertion of a camera-tipped tube into the anus to inspect the interior walls of the entire colon. Colonoscopy allows doctors to see potential lesions or polyps and remove them for biopsy on the spot, making it unsurpassed in colon cancer screening efficacy.
 
If you’ve tested normal in a fecal occult blood test (FOBT), which checks for trace amounts of blood in the stool (a sign of many possible conditions, including cancer), you should not assume you don’t need a colonoscopy; precancerous and even cancerous polyps do not always cause bleeding. Another concern is that by the time bleeding is detected, the cancer may have become considerably more dangerous. The Gastroenterology Division at the Johns Hopkins Bayview Center recommends a colonoscopy every five years for people age 50 and up. (Annual FOBTs are still a good idea.)
 
“Flexible sigmoidoscopy” was used frequently in the past but not much anymore. Using only two feet of tube reaching to the sigmoid, or end portion of the descending colon, this test is less accurate, and cannot immediately perform biopsies on any detected polyps.
 
One promising development is virtual colonoscopy, which scans the abdomen while an inserted tube pumps air through the rectum and colon. This is known as a CT colonoscopy, and it produces 2D and 3D images more detailed than the standard x-ray machine. While less invasive, some people report mild discomfort during the procedure. Furthermore, a 24-hour bowel preparation is still necessary. In one study comparing CT to standard colonoscopy, CT found 39% of lesions greater than or equal to 6mm (considered dangerous) and 55% of 10 mm or larger. Colonoscopy detected 99% and 100%, respectively. Like sigmoidoscopy, CT colonoscopy cannot perform immediate biopsy. If a polyp is detected, a colonoscopy still becomes necessary.
 
(Health After 50, 2007, Vol. 19, No. 5, pp. 6-7)

(RUNNING & FITNEWS® September / October 2007 • Volume 25, Number 5)


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