Posted by: Chris Maloney | August 11, 2012

Should I Get A Colonoscopy?

Stomach colon rectum diagram.

Stomach colon rectum diagram. (Photo credit: Wikipedia)

Short answer:  if you have symptoms, yes.

Longer answer:  The current guidelines in the U.S. recommend that every adult over fifty gets a colonoscopy.  Whether or not this is necessary is still a matter of some discussion.  The most recent meta-analysis (a look by experts at all the studies) found that “CRC mortality was reduced 13 to 21 percent after 8 to 13 years of screening in two trials, although another two trials did not show mortality benefit until after 15 to18 years of screening.”  (http://www.ncbi.nlm.nih.gov/pubmed/20722162)

In other words, two studies found that the screening reduced the risk of dying of colon cancer by as much as 21%, but two other studies didn’t find any benefit.  So how would a healthy adult with no increased risk from family history decide whether or not to have the test?

One camp declares that there is no harm, so why not?  But if a polyp is found, there is harm.  Even though it may not be cancerous, the “formerly healthy” patient now must wait for a pathology report and return a future date to get tested again.  Depending on the doctors involved, patients may be asked to return as soon as six months.  These are not months spent blithely living life.  Too often I see patients who have restructured their lives and diets around the possibility of colon cancer without a shred of evidence that they have anything.

The other camp (and these are the tiny minority) refuses testing, just as they refuse all other testing.  But if there are any symptoms, colonoscopy is a very reasonable test to do.  Chances of dying from a perforation of the bowel from a botched colonoscopy are about 0.012%, very good odds.  By my calculation, chances of a healthy person dying of colon cancer are somewhere in the range of 0.008%, so if you are a statistically minded person, have fun with those numbers.

What we should be doing a lot more of is fecal occult stool testing.  Blood in the stool can be from eating meat, but can also be a good indication of internal bleeding.  According to the meta-analysis:  “refinements in current CRC screening                    recommendations to add some fecal tests appear warranted.”  So let’s do a few more swabs and a few less scopes.  It will bring costs down and give patients some indication of their health between colonoscopy checks.

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