I had my first colonoscopy when I turned 50. It wasn’t fun, but I did what I was told and I believed the common line that it was something I needed to endure. The prep was unpleasant, but I kept good reading material with me all day for those frequent trips to the bathroom.
The results were negative.
When I turned 60, and was due for my next colonoscopy, I was looking for something different. I was starting to question the risks and benefits of what I was being sold. I chose a virtual colonoscopy, which wasn’t covered by insurance, and fortunately was negative as well. That led me to start diving deep into this specific multibillion-dollar medical industry and found some interesting facts. Remember, I’m not giving medical advice here, just information for you to help decide what is best for you.
Let’s start with the heavy stuff first. Colorectal cancer (CRC) is the third-most-common cancer (excluding all those skin cancers) in both men and women. It’s also the second-most-common cause of cancer-related deaths in both men and women, with 52,980 deaths in 2021. It’s a pretty awful disease, but don’t worry, I will give you some good news shortly.
Some of the risk factors for colon cancer are under your control, such as eating less red meat, losing weight, exercising, quitting smoking, and drinking less alcohol. There are also risk factors you can have the misfortune to be born into, the big one being a family history of this disease.
So what do we do to diagnose colorectal polyps or cancer early enough to either prevent or safely treat it?
If you follow the guidelines, we should all be getting colonoscopies starting at the age of 50, and some experts even suggest starting at 45. The problem with this is, colonoscopies aren’t without risks. As I said, it’s a multibillion-dollar industry, with some 19 million of the procedures performed in the United States in 2017. The risks for major complications (perforation, hemorrhage) are small but up to 1.6 percent and are very much dependent on the expertise of the physician.
This percentage may sound small, but indicates that in 2017, there were as many as 304,000 major complications from the procedure in and of itself. Tell one of those injured that the risk was small. In 2021, there were 149,500 new cases of colorectal cancer diagnosed. This makes you wonder what’s going on.
I am in full support for diagnosing colorectal polyps and cancers as early as possible, but I’m not in support of a perforated bowel in this pursuit for the average-risk individual. High-risk individuals are a different story and colonoscopy is still the gold standard—for now.
Don’t get me wrong, colorectal cancer screening is extremely important and can be life-saving, but there must be a better way.
Nowhere else in the world are colonoscopies used as much as here in the United States. In Canada, only 15 percent of their 970,000 colonoscopies are screening, the rest are diagnostic. That means, they get colonoscopies if they are at high risk or are in the process of being evaluated for signs of colorectal cancer such as rectal bleeding and pain. Again, I am only writing about screening testing. It’s also interesting to note that Canadian colorectal cancer survival is similar to that in the United States, despite costing half as much, due in part to the cheaper costs of medications the Canadian government negotiates with drugmakers.
I promised you some good news. There are some really promising new tests as well as additional current tests that can be done as alternatives to colonoscopies. Remember, these are screening tests for people without any signs or symptoms for colorectal disease, such as rectal bleeding, bloating, diarrhea, etc.
Fecal immunochemical testing is one such option. Basically, you poop and spread a little on a specially treated card at home. You then send it in for evaluation, and it’s examined for blood from the GI tract. If positive, you go for a full workup.
Virtual colonoscopy is another option. It’s basically a CT scan of the colon that can identify small polyps and colorectal cancer. The plus side is there is no risk of perforation or hemorrhage (rare as that may be). The negative side is, if there is a polyp, you would need a diagnostic colonoscopy. This is different from a screening colonoscopy. It’s also not covered by medical insurance.
We have all seen the commercials for Cologuard. The walking, talking box asking you to poop, scoop, and mail it back to rule out colorectal cancer. It’s actually a really good screening test. They recommend starting screening at 45 and repeating it every three years. It finds 92 percent of colon cancers. While there also is a 13 percent false-positive rate, if a patient gets a negative test result, there’s a 99.94 percent chance there is no cancer. This is an amazing screening test.
Finally, and with the most promise, there is a blood test already available that can identify colon cancer and polyps. It uses cell-free DNA blood testing and has been called a liquid biopsy test. The preliminary studies show a 91 percent early-stage colorectal cancer detection rate. Hopefully, these will become the main screening test for average-risk individuals, leaving colonoscopies as a screening test to be something soon forgotten.
Dr. Peter Weiss has been a frequent guest on local and national TV, newspapers, and radio. He was an assistant clinical professor of OB/GYN at the David Geffen School of Medicine at UCLA for 30 years, stepping down so he could provide his clinical services to those in need when the COVID pandemic hit. He was also a national health care adviser for Sen. John McCain’s 2008 presidential campaign.