La dosi20:51 How often should I have a colonoscopy?
Colorectal cancer is the fourth most common cancer in Canada, but if caught early, many people have a good chance of survival. But screening is key. Dr. Jill Tinmouth, Principal Scientist of the Colorectal Cancer Screening Program at Ontario Health and Gastroenterologist at Sunnybrook Health Sciences Center, speaks with guest host Dr. Peter Lin, on colorectal cancer screening.
For some, a colonoscopy can be scary; others just put it off as a time commitment that can wait. But doctors and advocates agree that it’s important for people not to fear the screening procedure and get it.
“What you think you’re going through with a colonoscopy is nothing compared to going through multiple surgeries, chemotherapy, all kinds of treatments and potentially dying from it and the stress not just on you. [but] to your family,” said Barry Stein, president and CEO of Colorectal Cancer Canada.
Stein also survived colorectal cancer.
“I would say that’s the biggest incentive to do it.”
Colonoscopies are part of the colorectal cancer screening process in Canada. Screening in most provinces and territories often begins with a stool test at home for the average-risk person before a colonoscopy, when needed.
Because colon cancer is the second leading cause of cancer death in Canada, doctors say it’s an important procedure to have when needed to detect cancer early.
FITs like Nova Scotia’s are a common first step in colorectal cancer screening in Canada for the average-risk person. (Nova Scotia Health)
Treatable when detected early
A recently published study and subsequent headlines have sparked discussions on the effectiveness of colonoscopies in the detection of colorectal cancer.
A randomized controlled test results published in the peer-reviewed New England Journal of Medicine found that among those invited to have a colonoscopy, there was an 18% reduction in subsequent colorectal cancers and no significant reduction in deaths.
But many of the guests never followed through.
When only people who actually had a colonoscopy were analyzed, the study authors found that the procedure reduced the number of colorectal cancers by 31% and associated deaths by 50%.
Some American experts emphasize that the results of the trial should not be misinterpreted as evidence that a colonoscopy is a poor screening test. Like any test or procedure, there are limitations.
But research shows that when colorectal cancer is caught early, it’s 90 percent treatable, according to the Canadian Cancer Society.
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Recently released cancer prevalence data of society shows that colon cancer is the fourth most diagnosed cancer in the country, but that it can be more susceptible to survival than other cancers such as lung when detected early.
“Colorectal screening has been revolutionary, as has fecal occult blood testing, in helping to diagnose colorectal cancer at an earlier stage,” said Dr. Christian Finley, a thoracic surgeon and professor at McMaster University in Hamilton and member of the Canadian Cancer Society. Cancer Statistics Advisory Committee.
“Over a long period of time, this seems to have paid off and we’re seeing a change in the number and stage of cancers that we’re seeing.”
But if you or someone you know is still hesitant to get a colon exam, here’s what experts say you should know about colonoscopies.
Who should be examined?
If you’re between the ages of 50 and 74 and have an average risk of colorectal cancer, you should get screened every two years, according to the Canadian Cancer Society.
In most provinces and territories, colon cancer screening begins with an at-home stool test, usually a fecal immunochemical test (FIT).
As part of the non-invasive FIT, a patient must collect a sample of their stool and send it to a laboratory for analysis.
The FIT looks for blood in the stool, a common sign of colorectal cancer. Other signs include anemia (low blood counts caused by low iron), unexplained weight loss, new diarrhea, new constipation and abdominal pain, gastroenterologist Dr. Jill Tinmouth told CBC’s The Dose guest host , Dr. Peter Lin.
Before having a colonoscopy, patients will need to drink a liquid solution to clean out the colon. (Jean-Paul Pelissier/Reuters)
If the FIT comes back abnormal, then a colonoscopy is often the next step, said Tinmouth, who is also the lead scientist for the colorectal cancer screening program at Ontario Health.
If the FIT results are normal, the test can be done at home every two years, he added.
People who are at high risk for colon cancer you may need to be tested at a younger age or more often, depending on the society.
If you’re 75 or older, the Canadian Cancer Society recommends that people talk to their primary care provider about whether they should continue to have stool tests.
Preparation for the test
The colon must be clean for a colonoscopy. This preparation, as it’s known, is a “major inconvenience,” according to Harvard Medical School, taking longer than the actual procedure, but necessary for the colonoscopy to work.
The preparation includes drinking a solution that will cause “diarrhea to clear the bowel.”
Patients will also need to be on a liquid diet for at least one day before the colonoscopy.
“Having a clean colon is really important because … it’s a little bit of a twisted space, and so getting all the stool out maximizes our ability to pick up polyps and find cancers,” Tinmouth said.
The procedure
A colonoscopy is a quick daily procedure that is often done by a gastroenterologist.
“The way a colonoscopy works is that it’s a long, thin tube that’s flexible. It has a light and a camera on the end and we can look right at the lining of the colon. So you get ready, clean everything up and we have a very nice look with this instrument,” said Tinmouth.
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A colonoscopy can also find polyps, which can sometimes be cancerous, which are removed during the procedure.
Often, the patient is lightly or moderately sedated for the colonoscopy so that they are not uncomfortable, Tinmouth says.
If sedated for the procedure, the patient may not be able to drive for a period of time afterwards.
Finley acknowledged that it can be difficult, especially for those with a lower socioeconomic status, who work marginal jobs or have to care for children, to find time to have the procedure.
“They don’t have the luxury of leaving work to get these tests,” he said, adding that the Canadian Cancer Society’s recent cancer prevalence study shows that for colorectal and lung cancer, the Patients with lower incomes are much more likely to be newly diagnosed, but are less likely to survive compared to wealthier patients.
“One of the big things we see in this study is that it’s not a level playing field for people.”
How effective is a colonoscopy?
There is significant research showing that screening reduces the number of colorectal cancer diagnoses and deaths by finding precancerous polyps and early-stage tumors before symptoms begin.
Tinmouth stresses that colonoscopies are only one way to detect colorectal cancer.
He adds that the recently published to study on the effectiveness of colonoscopies “it gives you an idea of what a good test looks like, but it’s not a perfect test.”
In most provinces and territories, routine colorectal cancer screening for the average-risk person begins at age 50 with a stool test at home. (Submitted by Donna Hatt)
Other doctors they have also pointed it out only 42% of the 28,220 people invited to have a colonoscopy as part of the study had the procedure done.
What if I feel uncomfortable or scared about the procedure?
Stein and Tinmouth agree that people shouldn’t be afraid of colonoscopies.
“I think people get embarrassed and ashamed of guts and poo and all that kind of stuff,” Tinmouth said.
“But really these are, as my mother would say, normal bodily functions. Everyone has them and does them.”
Stein was diagnosed with colorectal cancer that spread to his liver and lungs in 1995 and was told he had a 15 percent chance of surviving the next five years of his life.
Now that she lives without any evidence of the disease, she encourages people to keep up with their routine screening.
“From a practical point of view, [it’s] what we know will save lives and reduce the risk of going through what I went through: thirteen surgeries, all kinds of cancer treatments and being told I was going to die and have a five-year survival and so on,” she said.
“To avoid all this pain, suffering, stress for your family, doing a simple screening test is nothing.”