Margaret Krome: Time for a colonoscopy? Just do it

Margaret Krome  —  8/05/2008 5:56 am

I write this week in celebration of colonoscopies. When the editors of this paper asked me 13 years ago to write a personal editorial column, maybe they didn't mean quite this personal. But my friend Celeste taught me that colonoscopies should be excused from the realm of squeamish topics and discussed openly as a matter of public health.

Once I crossed the 50-year mark, colonoscopies have come to signify a middle age ritual as predictable as all the weddings, baby showers, children's birthday parties and bar mitzvahs I attended in my 20s, 30s and 40s. So I wasn't surprised when, last fall, my doctor asked me to undergo a colonoscopy, but it was months before the clinic could schedule it, and I didn't press them very hard. I finally had my coming-of-age colonoscopy last week.

Ten years ago last March, several women and I gathered at the home of our friend Celeste, who was dying of colon cancer. She was in her late 40s, so not yet of the age for a routine colonoscopy. However, she had asked her doctor for one when she felt abdominal pain, and had been refused. Normally a sunny, blithe spirit, on this last visit she was angry and bitter. She didn't want to die. She felt cheated of life by her doctor's refusal to prescribe the diagnostic procedure that could have saved her life. And she made all of her friends promise to get colonoscopies the first time our doctors prescribed them.

Ten years later, I stood in my kitchen drinking my prescribed cupfuls of gunk designed to clear out my digestive tract. The clear liquid diet hadn't disturbed me, and I managed the first half gallon of gunk holding my nose tight, but that last seven or eight cups began to seem endless. I thought of my friend and raised my glass. "To Celeste," I said aloud and downed them, each at the prescribed time.

Not counting skin cancers, the American Cancer Society reports that colorectal cancer is the third most common cancer found in men and women in this country, and predicts about 108,070 new cases of colon cancer and 40,740 new cases of rectal cancer in 2008. The two cancers together will cause about 49,960 deaths.

The death rate from colorectal cancer has been going down over the past 15 years, a decline largely due to the greater prevalence of early testing. When colorectal cancer is found early and treated, the five-year survival rate is 90 percent. As many as 60 percent of deaths from colorectal cancer could be prevented if everyone age 50 and older were screened regularly.

However, screening rates are low, so less than 40 percent of colorectal cancers are found early. A 2000 survey by the Centers for Disease Control found that only 42.5 percent of U.S. adults age 50 or older had undergone a sigmoidoscopy or colonoscopy within the previous 10 years or had used a fecal blood test kit at home within the preceding year.

The various tests range from a colonoscopy, which can remove any precancerous polyps or growths found during screening, to a "virtual colonoscopy," which is less invasive and expensive but can't remove such growths, to inexpensive at-home stool tests. Such home stool tests can't diagnose as accurately as other tests, but recent research showed a third fewer deaths from colorectal cancer among those who use them.

Reasons for not being tested range from squeamishness to expense and lack of health insurance. Expense is one thing. But squeamishness is goofy, and the colonoscopy's bad rap is no good reason. The misery factor is overrated. Not only was the preparation entirely manageable, but once I was at the surgery center, nurses covered me with warm blankets and later brought me apple juice as I recovered from anesthesia. Most important, the test brought me really great news. No problems!

OK, so that's too much information. I'll stop. Just take Celeste's advice: Get your colonoscopy.

Margaret Krome of Madison writes a semimonthly column for The Capital Times.

Margaret Krome  —  8/05/2008 5:56 am