Bottoms up, push for your tush, get your butt seen, and get behind your behind: Colon cancer organizations have tried every cheeky trick in the book with their campaigns aimed at convincing Canadians to submit to colonoscopy screening -- considered the gold standard for the detection of colon cancer. There were 23,900 new cases of this cancer in Canada in 2013, and as March is colon cancer awareness month, Dr. Sapna Makhija of the GI Health Centre in Burlington, Ontario, has a special message for women: Just do it.
"Until recently women have been hesitant to seek medical attention. Historically, women had to be clean and proper. We don't like to discuss our bowels or look at our stools to see if there is anything different," says Dr. Makhija, a gastroenterologist who with two other female GI specialists has launched a clinic specializing in GI disorders. "But colon cancer is the third most common cancer for women; over a lifetime, one in 15 women will be diagnosed with it and one in 31 will die."
"It's not a procedure that people look forward to," Dr. Makhija says, referring to the universally dreaded colonoscopy. And though the procedure is pretty common today, myths continue to plague it. For example, some people still think they don't need to be checked until they're over 50. "But for patients with a family history of colon cancer, polyps, uterine or ovarian cancer, colonoscopies should be started earlier," she stresses. "Say your mother was diagnosed with colon cancer at the age of 46, then her daughter or son would need to be checked at age 36. Yet most 36 year-olds would not think of getting screened for colon cancer." On the other hand, only ten to 20 percent of people who have this cancer have a family history, so don't be complacent.
There's still a lot of misinformation around symptoms, she says, and some people dismiss the idea of screening because they say they have no symptoms. But colon cancer can have few symptoms until advanced; you want to catch it soonest. Rectal bleeding, dark stools, or a change in bowel habits lasting more than a few days are some worrisome signs. If you're over the age of 50, have a family history of cancer, or have any of these symptoms, make an appointment with your family doctor now. There are several tests that could be considered, including a fecal occult blood test, fecal imuno-chemical test (FIT), a flexible sigmoidoscopy, a double-contrast barium enema or a colonoscopy.
Fear and anxiety stops some people from making that colonoscopy appointment. And the fact that in Canada colonoscopy wait times, especially for outpatient hospital procedures, can be several months doesn't help; public not-for-profit clinics which are on the increase have less wait times -- sometimes just a few weeks.
Dr. Makhija adds that pain should not be a worry or a colonoscopy deal breaker because comfortable sedation is widely available. Anyone who has had a colonoscopy will tell you that the preparation, the day before it spent taking laxatives and running to the bathroom, is worse than the actual procedure. (To learn what to expect from this procedure, check out www.colonversation.ca.) "There's still a social stigma to having a colonoscopy," she says. "It's still considered a taboo subject."
Taboo it may be, but one recent U.S. report attributes the decrease in the incidence of colon cancer in older adults by 30 percent in the past decade to the tripling of the colonoscopy rate. "Much of the credit for the lower incidence of colorectal cancer goes to improved uptake of colonoscopy among people ages 50 to 75," reported Charles Bankhead. The results came from data analyzed from the National Cancer Institute Surveillance, Epidemiology, and End Results program, the North American Association of Central Cancer Registries, and the National Center for Heatlh Statistics.
Despite this, and the knowledge that colonoscopies can detect and successfully treat polyps which are precursors to bowel cancer -- in effect curing the potential cancer during the screening process -- millions of North Americans are still bottom shy and have avoided screening.
That may change, however. A recent report in www.medical newstoday.com noted that American colorectal cancer organizations have pledged to have 80 percent of Americans over the age of 50 screened by 2018. A worthy goal for Canada, too!
5 Colonoscopy Myths: Busted
Myth #1: The "Prep" Will Be Horrible(01 of05)
Open Image ModalYes, you have to empty your colon, but no, it shouldn't be a horrible experience. The most common patient complaint isn't about time in the bathroom or the actual colonoscopy; it's about how much they had to drink. If you have difficulty drinking a large volume of liquid, ask about using one of the newer low-volume options. They are equally effective and easier on people who can't drink a lot of liquid at one time. Follow all instructions, including eating a liquid diet (broth, jello, juice) the day before your colonoscopy. Remember: the cleaner your colon, the better the physician can detect polyps, which is, after all, why you're there. (credit:Alamy)
Myth #2: It Will Hurt(02 of05)
Open Image ModalActually, it shouldn't. Prior to the procedure, patients are given a combination of a narcotic and sedative called "conscious sedation." About 95 percent of patients sleep through the entire procedure and wake up with no memory of the experience. About five percent of people experience cramping, and state that it felt similar to the urge to have a bowel movement. If you are worried about discomfort, or have any fear related to the procedure, please tell your nurse or physician. They can help alleviate your fear and discuss options with you. Additionally, if you are uncomfortable being sedated, or have side effects related to sedation, your physician can perform the procedure without sedation. However, it is less stressful and more comfortable for the vast majority of patients to utilize conscious sedation for a colonoscopy. If fear is keeping you from scheduling your colonoscopy, consider a virtual colonoscopy. The prep procedure is the same, but a virtual colonoscopy is done in an external CT scanner instead of with an internal scope, and is done without sedation. (credit:Alamy)
Myth #3: I'm Too Embarrassed(03 of05)
Open Image ModalPhysicians realize that a colonoscopy is one of the most invasive tests most people will ever experience. They do everything possible to ensure the most private, respectful and modest experience for every patient. Some people are more comfortable choosing a male (or female) physician to perform their colonoscopy. It is also helpful to remember that our physicians perform thousands of colonoscopies a year, and consider the colon the same way they consider any other organ. These experts chose this field due to its good mix of medicine and their ability to perform technically challenging procedures. It is also one of the fields in medicine where physicians have the ability to immediately impact a person's life by eliminating or vastly reducing the possibility of cancer. This is important work, and our team wants to make you comfortable. (credit:Alamy)
Myth #4: There Could be Complications(04 of05)
Open Image ModalThere is a very low risk of complications during a colonoscopy. Fewer than one in one thousand (less than .1 percent) of UW Health patients experience any type of complication. In fact, your chance of getting colon cancer is much higher. One in 20 people will get colon cancer in their lifetime, and one-third of people diagnosed with colon cancer will die from the disease. Colon cancer is the third most common cancer in both men and women. It is important to schedule your colonoscopy with a physician who is certified to perform the procedure. The American Society for Gastrointestinal Endoscopy (ASGE), a leading gastrointestinal medical society, has recognized the UW Hospital and Clinics Ambulatory Procedure Center and the Madison Surgery Center as part of its program specifically dedicated to promoting quality in endoscopy. The ASGE Endoscopy Unit Recognition Program honors endoscopy units that follow the ASGE guidelines on privileging, quality assurance, endoscope reprocessing and CDC infection control guidelines; and have completed specialized training on principles in quality and safety in endoscopy. Additionally, every one of our physician's adenomatous polyp detection rate (the rate at which suspicious polyps are found and removed) exceeds the national standard. (credit:Shutterstock)
Myth #5: You Don't Need a Colonoscopy Until You Have Symptoms(05 of05)
Open Image ModalPlease don't wait to schedule your colonoscopy. The vast majority of colon cancers are found in patients who did not have any pain or other symptoms. Following the national recommendations for scheduling a colonoscopy helps physicians find polyps early, before they develop into cancer. Unless you have previous symptoms, schedule your first colonoscopy at age 50 and then follow your doctor's recommendation for repeat procedures. The risks of not having a colonoscopy far outweigh these concerns. Review the screening guidelines and contact your primary care provider and request a referral for a colonoscopy. (credit:Getty Images)