5 fixes for colonoscopy concerns

Here are solutions that can put your mind at ease

Published: October 2013

Colonoscopy is highly effective at preventing colorectal cancer, the second deadliest type of cancer, because it allows a doctor to detect precancerous growths in the colon and remove them on the spot.

Yet only about half of Americans age 50 and older get any kind of screening for colorectal cancer, colonoscopy or otherwise, according to Otis Brawley, M.D., chief medical officer of the American Cancer Society. He estimates that an additional 15,000 to 20,000 lives could be saved each year if that rate rose to 90 or 95 percent. Here’s how to overcome five common barriers to this important test.

1. The concern: You’ll get bad news.

The fix: Colorectal cancer grows slowly, typically taking 10 to 15 years to develop. Getting screened at recommended intervals increases the likelihood of catching it early, when you have the best chance of being successfully treated. A study of 1,071 colon-cancer patients published in June 2013 in JAMA Surgery found that those whose disease was detected by a screening colon­oscopy tended to be diagnosed earlier and have longer survival rates than people whose tumors were detected in other ways.

2. The concern: Preparation for the test is a nightmare.

The fix: You’re limited to a clear-liquid diet for about 24 hours before the procedure, and may also have to drink up to a gallon of a laxative solution. To improve the solution’s taste, chill it first, or ask your doctor whether it’s OK to add lemon, lime, ginger, or a flavor enhancer like Crystal Light. Other steps that might help (bravely shared by readers who responded to a query on the Consumer Reports’ Facebook page) include eating lighter than usual a day or two before your prep, using a straw to drink the solution, staying near a bathroom, and using flushable wipes and diaper ointment to prevent irritation.

3. The concern: Complications.

The fix: It’s true that colonoscopy and the less invasive flexible sigmoidoscopy (in which only the lower colon is checked), pose a small risk of bowel perforation or infection. And the sedating drugs under which colonoscopy is typically performed—such as propofol (Diprivan and generic) or midazolam (Versed and generic)—have rare but potentially serious risks, such as difficulty breathing. But the benefits of the procedure far outweigh the dangers for people age 50 to 75, says Carla H. Ginsburg, M.D., M.P.H., a gastroenterologist in Newton, Mass.

If even the small risk of complications is intolerable, you can do an annual stool test instead (see box below), though you’ll need to follow up with a colonoscopy if the result is positive.

4. The concern: You can’t afford it.

The fix: Under the health reform law passed in 2010, Medicare and private insurers are required to cover most types of colorectal-cancer screening, including colonoscopy. (They might not fully cover removal of polyps during the procedure.) The requirement is already in effect for Medicare; group and individual plans must comply by 2014. But you’ll probably be billed separately for the procedure and the anesthesia, so find out ahead of time whether the anesthesiologist is in your insurance plan’s network.

5. The concern: You feel generally squeamish about the whole thing.

The fix: Meet with the gastroenterologist who will do the procedure ahead of time to talk about the test. (For example, you can ask who else will be in the room.) Also keep in mind that the average procedure takes only 10 to 15 minutes, and you won’t be cognizant enough to feel bashful. By the time you’re lucid, it will all be over. ■

Options for colon-cancer screening

Our medical consultants recommend that healthy adults age 50 to 75 get screened regularly for colorectal cancer using one of these three options.

• An annual test for blood in the stool (known as a fecal occult blood test).

• Sigmoidoscopy every five years beginning at age 50, plus a stool test every three years.

• Colonoscopy every 10 years beginning at age 50.

People at increased risk for colorectal cancer due to family history or other reasons often need more frequent screening and to start screening at a younger age. Otherwise, there’s no benefit to getting screened more often than recommended, and it can actually expose you to unnecessary risks. And screening isn’t advised for people older than 75 because the benefits diminish after that age and the risks increase.

See our Ratings of cancer screening tests.

Editor's Note: This article appeared in the October 2013 issue of Consumer Reports on Health.

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