How should people decide whether or not to have a colonoscopy? New guidelines for this procedure have recently been published in The Canadian Medical Association Journal. It reports that some people have a choice. Others have no choice. But what will Justin Trudeau and Barack Obama do?
Large bowel malignancies are the third most commonly diagnosed cancers today and a leading cause of death. So it’s prudent to give colon cancer the sufficient thought that it deserves. The CMA committee ruled that not all people need colonoscopy. This will bring a sigh of relief to many between 50 and 74 years of age who have no prior or family history of this disease, bleeding or polyps. It’s suggested that this group should only have a fecal occult blood test (FOBT) done every two years to detect blood in the stool, and a flexible sigmoidoscopy every 10 years. This procedure examines the lower large bowel, not its entirety.
Does this age guideline make sense? Possibly so, if you don’t consider the exceptions and want a speedy answer. After all, it makes no sense to make colonoscopy mandatory for those in their 20s or others in their 90s. But strictly following guidelines can occasionally result in death.
Cancer does not give a tinker’s damn for your age. For instance, you might say no to colonoscopy at age 35. But a precancerous polyp may be present and could be removed. Death at 49 years of age could result from metastatic disease.
What about the accuracy of the fecal occult blood test compared to colonoscopy? The medical committee indicated that further studies must be carried out before this question can be answered. I personally would want that question answered before making a sweeping decision on this matter.
Good sense tells me research will find the FOBT does not detect early malignancy as accurately as colonoscopy. Why? Because bowel polyps can be present for years without bleeding. Moreover, by the time they do bleed, the cancer may have spread to other organs…
Another problem with stool blood tests is that they may give a false report that blood is present in the stool, or a negative one when blood is confirmed in the stool.
So what would physicians caring for the health of Justin Trudeau and Barack Obama do? I’d bet my life on it that both would be advised to have a colonoscopy. You don’t take risks when dealing with high profile or rich patients.
As with any procedure, there is a risk to colonoscopy. Removal of a polyp may trigger bleeding. Or, the colon may be perforated requiring surgery. This is a serious complication and happens about once in every 4,000 colonoscopies. But practice makes perfect, and you can be certain Trudeau and Obama will not be referred to a doctor performing her or his first colonoscopy.
So why do some never agree to this procedure? It’s a combination of cost and availability. There are not enough doctors trained in this procedure to do a colonoscopy on everyone in this country. Secondly, doing so would be very expensive.
But here is something that is unconscionable. Readers with rectal bleeding have complained to me that it can take weeks to see their family doctor. Then, more weeks to see a specialist. There is no way that Trudeau and Obama would have to wait until the malignancy had spread. Doctors trained in colonoscopy should put patients with rectal bleeding at the top of their list. Routine screening can wait at the bottom.
What about patients that have no choice? It does not surprise me that every province has screening programs available or are implementing one. But it does surprise me that, at the moment, territories in the north such as Nunavut have no screening programs.
My advice is that if you live in North America where colonoscopy is available, it’s prudent to have it done. What is good for the rich and famous is also good for you. Moreover, never make the error of ignoring rectal bleeding. See your doctor promptly but remember, I am not your doctor and this column is not meant to diagnose and treat disease, only for informational purposes.
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