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Why Some People Avoid Colonoscopies – and WHY They SHOULD NOT

Calvert County has a higher rate of colorectal cancer than both the statewide and national average, according the Centers for Disease Control and Prevention.

“The fact is, getting screened for colorectal cancer can save your life,” said board-certified gastroenterologist Dr. Renee Bright. “A colonoscopy allows your doctor to find polyps so they can be removed before they turn into cancer.”

The fear and myths associated with colonoscopies tend to shy people away from getting the very screening that could save their life. Colorectal cancer is the third most common cancer in both men and women. More than half of those cases could be prevented with proper screening.

Statistics tell us about three in 10 of eligible adults avoid or delay getting a colonoscopy for one reason or another.

Recently, we sat down with board-certified gastroenterologists Dr. Renee Bright and Dr. Dolores Rhodes-Height of Calvert Digestive Diseases Associates to set the record straight about screening for colorectal cancer.

Q. How common is colorectal cancer?

It is very common. Colorectal cancer is the third leading cause of cancer death in the U.S. More importantly, it is a cancer that is highly treatable if detected early and largely preventable, if you get screened regularly. Every year, there are about 150,000 new cases. Unfortunately, about a third of them will die because they often present late when the cancer is more advanced.

Q. Who is at risk for colorectal cancer?

The reality is everyone is at risk regardless of ethnicity or gender. Everyone needs to get screened starting at age 45. Those with a personal or family history of polyps, colorectal cancer or inflammatory bowel disease need to be screened earlier. Do not wait until you have symptoms because many people do not have any. The goal with screening is to catch it before symptoms appear.

Q. Why is it important to know your family history?

Family history is important because it determines how soon and how often you test for colorectal cancer. If you have a first-degree relative (mom, dad, brother or sister) that had colorectal cancer or polyps it puts you at a higher risk. So, you would start screening at age 40 and then every five years. Try to get a family history as best you can. It is especially helpful to find out whether they had any polyps or malignancies and at what age.

Q. How can I lower my risk?

Well certainly, tobacco increases your risk of all malignancies, particularly pancreatic, colon and lung. Fiber is your friend – it’s great for the colon and it’s great for the heart. If you are eating a diet high in fat and red meat this certainly increases your risk. Obesity and sedentary lifestyle, too. Studies suggest increasing your physical activity and keeping a healthy weight can help reduce your risk of colorectal cancer.

Q. Why is screening important?

This is a cancer where screening really matters – we can find and remove polyps before they turn cancerous in the first place. I tell people you cannot feel a polyp. Waiting until you have symptoms is not ideal. You can have a growth and it will not be obvious until it is very large or bleeds and by then it is probably malignant.

Q. Which tests are used to screen for colorectal cancer?

A colonoscopy is the gold standard for a reason. It is the only test that allows your doctor to find and remove polyps during the same exam – before they grow into cancer. A “virtual” colonoscopy is a non-invasive option that uses computed tomography or CT scans to provide an in-depth view of the colon. However, it requires the same prep as a colonoscopy. And if polyps are found that need to be removed, a traditional colonoscopy is still required.

The same holds true for stoolbased tests. There are some who prefer these alternative screening options because they are less invasive, but positive results often require a follow-up colonoscopy. Examples include FIT (fecal immunochemical test) that checks for hidden blood in the stool and FIT DNA (Cologuard®), which is intended for those who are at average risk and requires a prescription.

Q. What is the purpose of the prep?

We know this is a big issue for some people and we have modified the prep to make it more tolerable. A lot depends on the individual’s bowel habits. We try to match the right prep for the right patient. What is important to understand is that your doctor needs a clear view of your colon during the procedure in order to find and remove polyps.

Q. What are some common misconceptions about having a colonoscopy?

Some people think because they have no family history they are not at risk. About 85 percent of those who are diagnosed with colorectal cancer have no family history. Or they think screening is only for those with symptoms. The truth is most people do not have any. Some are fearful about the procedure itself because they heard it was uncomfortable. It is actually very short and you are sedated. Most people do not remember anything. Cost should not be an issue. Medicare and most insurance plans cover screening and there are grant programs for those without insurance.

Don’t Sweat the Prep

Here are some tips for making the process more bearable:

  • Adjusting your diet days before your colonoscopy by eating less and choosing low-fiber foods can make the prep go smoother and easier.
  • Refrigerate the prep at least 24 hours ahead of time. A cold prep goes down much easier. Using a straw can help with the taste.
  • On the day before your colonoscopy, you will have to stick to a liquid diet.
  • What you choose to eat and drink can make or break your prep experience. Pick up some low-sodium broth, gelatin / frozen pops (no red, orange or purple), apple or white grape juice, flavored sparking water, 7-UP® or Sprite®. Black coffee and tea (hot and iced) are okay.
  • Keep yourself hydrated. Electrolyte drinks like Gatorade® may help (no red, orange or purple).
  • Stretchy pants will be a lifesaver once the laxative begins working – you won’t have time to mess with buttons!
  • Stock up on soft toilet paper. And blot, rather than wiping too hard to reduce irritation.
  • Use skin-soothing products such as baby wipes or baby rash ointment. Medicated pads and lidocaine cream can also help reduce discomfort.
  • Whether you plan to be on your phone, laptop or tablet, find your chargers before your laxative kicks in.
  • Read the prep directions well in advance and be sure to coordinate the prep with instructions from your doctor’s office.
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