By DR. THOMAS RUFFOLO

Gastroenterologist with Vidant Beaufort Hospital

A grimace, a frown, a snicker or growl. Which will your response be when advised that it is time for your colonoscopy? I can assure you that a smile is not usually the expression I see when discussing the need for colon screening with my patients. Fortunately, I’ve learned not to take that initial response personally.
March is recognized as colon cancer awareness month. This is a time when health professionals and the cancer society go all out promoting the message and importance of having regular colon screenings performed.
This is a tough message to promote, mostly because our audience is less than receptive to the thought of what is to come.  So each year I write an article like this extolling the benefits of colon cancer screening and hope that someone is listening. Sometimes it’s hard to tell if the message is being heard. Yet every once in awhile a patient comes in requesting the appropriate colon testing as a result of what they’ve read. This is rewarding to me as a physician, particularly if I can tell them their results were normal, or that I was able to remove a pre-cancerous lesion before it caused them harm.
Awareness of the need for colon screening is probably at an all time high. Just to be sure I am going to review the basic guidelines for colon cancer screening further down in this article. So if most everyone has heard the message but many continue to ignore it, then I feel we need to change the message to one of a “Call To Action.” The guidelines are clear. It is time to ACT. Excuses are no longer acceptable.
Colon cancer remains the second most common cause of cancer death inAmerica. Over 50,000 lives are lost each year to this disease, a large percentage of which were potentially preventable. When detected early (Stage I) colon cancer is curable in 90 percent of the patients. At advanced stages (Stage IV) where the disease has spread beyond the local region of the colon 5 year survival rates fall to around 20 percent. Regular screening and removal of polyps before they become cancerous results in a near 99 percent survival rate.
Risk factors for colon cancer development include a personal or family history of colon polyps or colon cancer, a history of inflammatory bowel disease, older age, or the presence of a hereditary cancer syndrome. Additional predisposing factors that likely play a role include being obese, a sedentary lifestyle, smoking, a high fat diet and decreased fiber intake. Colon cancer also tends to occur at an early age in certain racial groups (African Americans). The benefits of products like aspirin, anti-inflammatory products or calcium are less clear.
For low risk individuals the recommendations for screening include a yearly rectal exam and stool test for blood starting at age 40. At age 50 a more complete colon study is advised. Typically this is the colonoscopy exam. Other alternative studies such as a flexible sigmoidoscopy, barium enema or CT colonography are suitable alternatives but are less complete and tend to overlook some smaller polyps or lesions. The gold standard remains the colonoscopy as it views the entire colon and allows removal of potentially pre-cancerous polyps at the same setting, something the other alternative exams do not allow. Individuals considered “high risk” for colon cancer may require earlier screening studies.
The biggest drawback and “fear” for individuals in having a colonoscopy is the need for a bowel prep. Yes, there is a preparation that is consumed before the exam that cleanses the colon of fecal matter. This is critical in order for the physician performing the exam to be able to visualize all portions of the colon. Yes, it is not the most pleasant solution to drink but certainly is tolerable. (I am sure in our diets we consume things a lot worse.) Unfortunately, this is the major reason why patients refuse to have a colonoscopy. Seems kind of foolish particularly when the benefit can be life-saving.
The actual colonoscopy exam is generally comfortable and uneventful for the patient. It usually lasts only 20-30 minutes. With sedation provided to relax the individual most patients have minimal recollection of the exam. During the exam any polyps or growths that are identified are removed if possible. Recovery time is minimal and patients can resume their normal activities by the next morning.
Most all insurance companies will provide benefits for colon screening studies. If in doubt contact your insurer for specific details. Also review your specific risk factors with your healthcare provider to ensure that you get screened at the appropriate age.
And if you see me, it’s okay not to smile. Just ACT.