Colonoscopy is highly effective at preventing colorectal cancer, the second-deadliest type of cancer, because it allows a doctor to detect precancerous growths in the colon and remove them on the spot.
Yet only about half of Americans age 50 and older get any kind of screening for colorectal cancer, colonoscopy or otherwise, according to Otis Brawley, chief medical officer of the American Cancer Society. He estimates that an additional 15,000 to 20,000 lives could be saved each year if that rate rose to 90 or 95 percent.
Here are five common barriers to this important test and how to overcome them.
The concern: You’ll get bad news.
The fix: Colorectal cancer grows slowly, typically taking 10 to 15 years to develop. Getting screened at recommended intervals increases the likelihood of catching it early, when you have the best chance of being successfully treated. A study of 1,071 colon-cancer patients published in June in JAMA Surgery found that those whose disease was detected by a screening colonoscopy tended to have it diagnosed earlier and to have longer survival rates than people whose tumors were detected in other ways.
The concern: Preparation for the test is a nightmare.
The fix: You’re limited to a clear-liquid diet for about 24 hours before the procedure, and you may also have to drink up to a gallon of a laxative solution. To improve the solution’s taste, chill it first or ask your doctor whether it’s okay to add lemon, lime, ginger or a flavor enhancer such as Crystal Light. Other steps that might help include eating lighter than usual a day or two before your prep, using a straw to drink the solution, staying near a bathroom and using flushable wipes and diaper ointment to prevent irritation.
The concern: Complications.
The fix: It’s true that both colonoscopy and the less invasive flexible sigmoidoscopy (in which only the lower colon is checked) pose a small risk of bowel perforation or infection. And the sedating drugs under which colonoscopy is typically performed — such as propofol (Diprivan and generic) or midazolam (Versed and generic) — have rare but potentially serious risks, such as difficulty breathing. But the benefits of the procedure far outweigh the dangers for people age 50 to 75, says Carla H. Ginsburg, a gastroenterologist in Newton, Mass.
If even the small risk of complications is intolerable, you can do an annual stool test instead, though you’ll need to follow up with a colonoscopy if the result is positive.
The concern: You can’t afford it.
The fix: Under the health-care law passed in 2010, Medicare and private insurers are required to cover most types of colorectal-cancer screening, including colonoscopy. (They might not fully cover removal of polyps during the procedure.) The requirement is already in effect for Medicare; group and individual plans must comply by 2014. But you’ll probably be billed separately for the procedure and the anesthesia, so find out ahead of time whether the anesthesiologist is in your insurance plan’s network.
The concern: You feel generally squeamish about the whole thing.
The fix: Meet with the gastroenterologist who will do the procedure ahead of time to talk about the test. (For example, you can ask who else will be in the room.) Also keep in mind that the average procedure takes only 10 to 15 minutes, and you won’t be cognizant enough to feel bashful. By the time you’re lucid, it will all be over.
For further guidance, go to www.ConsumerReports.org/Health, where more detailed information, including CR’s ratings of prescription drugs, treatments, hospitals and healthy-living products, is available to subscribers.