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Health and Wellness

Colonoscopy Save Lives

By Andy Tan
Northeastern University
ENGW 3306

“Have you gotten a colonoscopy

done recently,” I asked the patient.

Working as a medical assistant at Beth

Importance of colorectal screening
to ultimately predict the start of a disease and stall its progression.
Israel Deaconess Medical Center’s
primary care department, Healthcare
Associates, this is one of the screening
questions I am required to ask. It is
important to ask screening questions are
at a primary care environment, because
this is where the first signs of symptoms,
such as colorectal cancer, can be spotted;
it helps ensure that each patient gets the
right care in the right setting in an effort

Colorectal cancer begins as polyps, which are abnormal tissues that grow on the inner linings of
the colon or rectum. These polyps project away from the colon or rectum, enabling it to penetrate
the bowel wall and effect adjacent organs. Most abnormal tissues, such as hyperplastic polyps,
do not become cancerous. However, adenomatous polyps are precancerous. If let undetected and
untreated, colorectal cancer is the third most deadly cancer with approximately 150,000 new
colorectal cancer diagnoses and 50,000 deaths from colorectal cancer each year.

Occasionally, patients will tell me that they already got a colonoscopy done or they have one
scheduled. However, the responses I get most of the time goes somewhat like this:

“What is that?” the patient replied.

One in every 19 people will be diagnosed with colorectal cancer in their lifetime with one person
dying from the disease every nine minute. These values are alarming and it’s unfortunate that
many are unaware and lack the understanding of what can be done to prevent it. A colonoscopy
is a screening measure used to detect polyps and colorectal cancer when symptoms such as
bleeding from anus, changes in bowel activity, pain in abdomen, and/or unexplained weight loss
arises.

For the procedure, the individual gets sedated. It involves a physician inserting a flexible tube
containing a light and endoscope into the rectum. The physician moves the tube through the
entire colon to look for polyps and other signs of colorectal cancer. In cases when abnormal
polyps are found, physicians can perform a biopsy to remove it.

“I’m not putting myself through that” another patient said.

Before the colonoscopy, there are prior preparation that needs to be done. An orally bowel
preparation is administered to clean out the contents of the colon so that the linings would be
more visible during the procedure. A clear liquid diet for 1 to 3 days before the procedure is also
required. Fat-free broth, clear gelatin, plain coffee or tea, and water are acceptable but any red
and purple colored drinks or gelatin should be avoided. The preparation for the colonoscopy can
be very unpleasant and most people don’t end up getting one because of it. This is
understandable to some extent. The prep won’t be easy, but then again, neither is cancer.

As with any procedure, there are some risks of a colonoscopy. These include internal bleeding,
perforation of the colon, a reaction to the sedative, and severe pain in the abdomen. However, a
study screening colonoscopies found roughly 4 to 9 serious complications for every 10,0000
colonoscopy procedures performed.

Many people often opt for other options, such as the Faecal Occult Blood Test (FOBT), because
of the unappealing nature and risk of a colonoscopy. The FOBT is simple to perform,
noninvasive, and cheap. It detects the presence of hidden blood in the stool. The test is done by
placing a small sample of stool on a chemically treated card. The card is then submitted to a
laboratory where a chemical developer solution is put on top of the stool. If the card turns blue,
then there is blood in the stool in which the individual must be followed up with a full
colonoscopy procedure anyways.

There’s a huge misconception that FOBT can be done instead of a colonoscopy to screen for
colorectal cancer. In actuality, the FOBT can be inaccurate. The FOBT can result to false
positives in individuals with gastrointestinal bleeding due to causes other than colorectal cancer,
such as erosions, ulcers, inflammatory bowel disease, or medication with antiplatelet agents and
anticoagulants. Furthermore, FOBT also has a limited benefit for cancer prevention because it
cannot detect abnormal polyps that can lead to colorectal cancer.

“No and I don’t plan on ever getting one” one other patient responded.

New guideline from the American Cancer Society recommended Americans to start getting
colorectal screening at age 45 instead of waiting until age 50. However, according to the
American Society for Gastrointestinal Endoscopy, only about 40 percent of the adults who
should have a colonoscopy comply with this recommended guideline and more than 60 percent
of Americans, approximately 23 million people, have not utilized this screening method. This is
an extremely high number given the fact that many deaths caused by colorectal cancer occurs in
individuals who were not tested.

The fact remains that colonoscopies can save lives. Several large cohort studies have been done
showing that among the individuals at average risk who undergone a screening colonoscopy, 0.5
– 1.0% have colon cancer and 5 to 10% have abnormal polyps that can be removed.
Additionally, evidence form the National Polyp Study showed that individuals with polyps
removed during a colonoscopy had a 53% reduction in mortality from colorectal cancer.

“Alright, let me bring you back to an exam room to see your doctor ” as I complete
their vitals.

It is important that physicians continue to discuss with their patients whether a colonoscopy is
right for them. Individuals often lack an understanding of what a colonoscopy is, have
misconceptions of other screening methods, and undermine the actual importance of getting a
colonoscopy done. Getting a colonoscopy once you reach 45 years old, and repeating it every 10
years, is worthwhile. Colorectal cancer is one of the few types of cancer, other than cervical and
skin cancer, in which abnormal growth can be identified and the disease can be prevented if
those growths are detected and removed.
 References:

American Cancer Society. (2018). American cancer society guideline for colorectal cancer
screening. Retrieved from https://www.cancer.org/cancer/colon-rectal-cancer/detection-
diagnosis-staging/acs-recommendations.html

Bretthauer, M. (2011). Colorectal cancer screening. Journal of internal Medicine, 270 (2), 87-98.
https://onlinelibrary-wiley-com.ezproxy.neu.edu/doi/10.1111/j.1365-2796.2011.02399.x

Crico. (2014). Advantages and disadvantages of colorectal cancer screening options. Retrieved
from https://www.rmf.harvard.edu/Clinician-Resources/Guidelines-
Algorithms/2014/CRC-pros-cons-screening-options

Holeden, D.J., Harris, R., Porterfield, D.S., Jonas, D.E., Morgan, L.C., Reuland, D., Gilchrist, M.
Viswanathan, M., Lohr, K.N., Lyda-McDonald, B. (2010). Enhancing the use and quality
of colorectal cancer screening. Agency for Healthcare Research and Quality.
https://permanent.access.gpo.gov/gpo49125/crcpro-evidence-report.pdf

Lieberman, D.A. (2009). Screening for colorectal cancer. The New England Journal of Medicine,
361, 1179-1187. https://www.nejm.org/doi/full/10.1056/NEJMcp0902176

Lin, JS. (2016). Screening for colorectal cancer: updated evidence report and systematic review
for the US preventive services task force. JAMA, 315 (23), 2576–2594

National Cancer Institute. (2017). Colon cancer treatment. Retrieved from

https://www.cancer.gov/types/colorectal/patient/colon-treatment-pdq#link/_93

National Institute of Diabetes and Digestive and Kidney Diseases. (2017). Colonoscopy.
Retrieved from https://www.niddk.nih.gov/health-information/diagnostic-
tests/colonoscopy

Taylor, B. (2018). Importance of colorectal screening [Online Image]. Retrieved from

https://patch.com/michigan/grossepointe/importance-colorectal-screenings