Sure glad that's behind me
Yesterday, I had my second colonoscopy in a little over three years. Looking forward to the next one--a trend, fortunately, that matches Americans' heightened attention to proactive screenings.
In June 2020, I had my first colonoscopy.
They found (and removed) three polyps, a growth of tissue that could grow into cancer. So instead of a five- or 10-year follow-up, I hit the lottery: Let’s do it again in three years!
But my appointment in July was delayed when, of all things, my doctor was summoned for jury duty. I was sort of grateful for the postponement, though it just gave me more time to dwell on the pre-procedure process and, to a degree, the procedure itself.
That dwelling turned to dread the closer my appointment loomed. Fortunately, by the time of my re-scheduled colonoscopy yesterday afternoon, the hardest part was, um, behind me.
I had just fasted for 28 hours, guzzled two liters of a bowel-eradicating drink that’s hard to pronounce—and even tougher to chug—and become re-acquainted with the bathroom throne for extended stretches of time.
And did I mention the weight-loss benefits? I was three pounds lighter than 24 hours earlier, so my weight actually matched what’s advertised on my driver’s license.
What’s not to love?1
The payoff, for me, was the great “twilight” anesthesia nap available for the procedure. (A nurse told me that some—fewer than 1%—decline this option, usually due to leeriness of going “under.”)
Before I slumbered through the half-hour procedure, I channeled my anxiety via cornball humor. As they wheeled me into the operating room, I noticed a perfectly punctuated sign reminding staff to wear their medical masks a certain way.
“No semi-colons on that sign,” I noted. “Only full colons allowed in here.”2
I kept it up for a few minutes, closing with this last quip before my lights went out:
“I was going to be a doctor…but I just didn’t have the patients.”
What Are You Waiting For?
Joking aside, if you are close to 45 years of age, you should start the process of getting screened for colorectal cancer. And if you’re over 45 and haven’t gotten one in a while (or at all), what are you waiting for?
It’s actually a serious subject, with potential life-or-death consequences.
According to the Centers for Disease Control, there are 15 million colonoscopies annually in the United States. They are on the rise, which means more people are catching cancer earlier, before it has an opportunity to spread.
The American Cancer Society reports that the average five-year survival rate for those with colon and rectal cancer, when it is localized, is around 90%. Localized means “there is no sign that the cancer has spread outside of the colon or rectum.”
But if it’s “distant” (“The cancer has spread to distant parts of the body such as the liver, lungs, or distant lymph nodes.”), then the survival rate plummets to about 15%.
You can see all the data and background, which includes the graphs above, here.
In 2012, 72.6% of U.S. adults (of screening age) had been screened. That figure climbed to 78.4%--or 4 million more adults—in 2020, when I got my first screening.
If you’re keeping tabs on all these stats, you might recall they removed three polyps at that time. Yesterday—not bragging, just reporting—five of those suckers got the heave-ho. Hopefully, they’re all benign. I’ll find out soon.
Regardless, having at least one more colonoscopy in my future is far preferable to never having this experience again at all.
For those who might not yet be aware, a colonoscopy is “a procedure in which a flexible fiber-optic instrument is inserted through the anus in order to examine the colon,” according to the Oxford Languages definition I found online.
I loved their use of it in a sentence: “a colonoscopy did not show any problem.” Well, that’s much merrier than “the 55-year-old writer who put off his colonoscopy too long just got diagnosed with cancer.”
I did provide counsel on the proper use of semi-colons; for example, I said, one test of whether a semi-colon is being properly used is if the phrase on either side of it can stand on its own as a complete sentence.
Upon further reflection, I wouldn’t have blamed them if they upped the twilight dosage a bit—those medical professionals were simply trying to wrap up their day.
Good luck with the polyps and I admire your hearty attitude.
I also reacted to the trial of a colonoscopy with punchiness, if not puns. I have found this is not appreciated, but I have no intention to quit. I can't just sit there placidly afterwards. Too boring.
The news I will link is a bit sobering, but I think the disappointing outcomes were in part due to people not availing themselves of their invitation to get a colonoscopy. I haven't reviewed the article and don't remember all of the details, so I'm not speaking as a journalist. Just providing a resource. Also, when my father was diagnised colon cancer in 2009, I heard then that 60% of people with coiled colons on one side or the other (I can't remember which) had their cancer undetected by the colonoscopy. So there is a lot of buzz that colonoscopys are not a panacea. My doctor grades people on their prep, and it was my hope that by having everything absolutely clear, she would be able to get an accurate reading.
https://www.statnews.com/2022/10/09/in-gold-standard-trial-colonoscopy-fails-to-reduce-rate-of-cancer-deaths/
By far – as you discovered – the worst part of the colonoscopy is the prep. I’ve had five – accompanied by an EGD as well - since age 45. And I was one of those “brave souls” who fell in the less than 1% who refuse sedation. But I refused not because I was fearful of going under (hell I was a practicing anesthesiologist at the time) but because I wanted to immediately go back to work after the procedure and also I wanted to drive home. I did not want a designated driver. Anyway, five years ago my GI doc told me “hey Bruce, I know you don’t want sedation and all, but it really does make my job easier, and will make you much more comfortable.” OK. I gave it a try: into the procedure room … name rank and serial number … “a little propofol” … “hey when are you guys going to start the procedure?” … “well we already did and it’s over.” Wow. That propofol stuff is great. Michael Jackson was right. No more going “bare” for me.
So I’m a believer. But as a man of science belief is not good enough. Belief is great for religion but not necessarily for science. So is colonoscopy the miracle screening that saves lives that it’s all crapped up to be? I’m not sure anymore. David Harris provides the STAT report. Here is the primary source:
https://www.nejm.org/doi/pdf/10.1056/NEJMoa2208375?articleTools=true
The actual reason why this study did not show a mortality benefit is complicated. It may in fact be that - contrary to the conventional wisdom - there is NO mortality benefit from colonoscopy. It may be that the design of the study was biased to show no mortality benefit. This has to do with comparing results from an “intention to treat” design (the design of this study) to a “per protocol” to a “per treatment” design. They often will result in different and divergent outcomes. Comparing the differences in outcomes (how robust the study results are) due to differences in trial design is known as sensitivity analysis. A supremely robust study will yield the same results regardless of design. That is not the case here. In fact if one were to analyze the results “per treatment” (rather than “intention to treat”) the results are then reassuring and drastically in favor of colonoscopy:
The risk of developing colon cancer decreased by about 31% and deaths were decreased by approx. 50%. (according to a post hoc analysis by the President of the American Society for GI Endoscopy via "per treatment" analysis).
Of course, colonoscopy and related procedures are extremely lucrative to both hospital and physician. In fact the open secret in medicine is we refer to colonoscopy as “scoping for dollars”. So if one was a cynic (I am a skeptic; not a cynic) one might be doubtful about the endorsement of colonoscopy by a President of a GI endoscopy society.