Dreading the colonoscopy

For most people, having a colonoscopy holds only slightly more appeal than, say, having their teeth gouged out one at a time with a rusty chisel.

So I was rather bemused when AmSurg, a for-profit ambulatory surgery company, emailed me a link last week to a new YouTube video, praising the colonoscopy experience as “not that bad.”

Cheesy soul singer and a trio of women in silver miniskirts – what’s not to like? Oh, wait. Colonoscopy.

Few people would argue that the colonoscopy isn’t a valuable screening and diagnostic tool. Indeed, a brand-new study published a couple of weeks ago in the New England Journal of Medicine confirmed this: It concluded that when colonoscopies are performed and precancerous polyps in the colon are detected and removed, the death rate from colorectal cancer is reduced significantly.

In view of this compelling evidence, it’s unfortunate that colonoscopy is lumbered with so much negative baggage.

Many of the people who posted at Medicine.net about their colonoscopy were ambivalent or found the experience downright miserable. “The most painful experience I have ever had and would not go back,” wrote one person. “Painful” and “degrading” was someone else’s assessment. Another commenter found it assaultive and reported waking up from the anesthesia several times during the procedure. “I hate that I will have to get this again eventually, and I will only consent because I want to keep myself as healthy as possible to be around for my kids, but I dread it and wish I didn’t have to,” she concluded.

The medical community acknowledges there are plenty of barriers to discourage people from undergoing a colonoscopy, especially routine screening colonoscopies in those who are otherwise healthy. When a group of Australian researchers reviewed a collection of more than 50 previous studies on patient attitudes toward colonoscopy, they found the laxative bowel preparation was “the most burdensome part” for most people. Anxiety, embarrassment, worries about pain, and fear of finding cancer also were reported as significant issues. The findings were published last month in the Patient Education and Counseling Journal.

Other studies have noted practical concerns as well. One of them is lack of health insurance. Scheduling and logistics also can be a problem; the anesthesia requires not only taking a day off work for the working-age population but also someone to accompany them and drive them home after the procedure.

Add it all up and it’s not particularly surprising that adherence to colonoscopy screening guidelines in the U.S. – recommended for adults between the ages of 50 and 75 – is less than ideal. According to recent figures from the Minnesota division of the American Cancer Society, one in three Minnesotans who are 50 and older have never been screened. Nationally, about four out of 10 adults aren’t up to date on the screening.

Is there a way to improve this? Maybe getting rid of some of the myths surrounding the procedure would help, suggest the folks at Providence Cancer Center of Oregon and Washington. The prep is short-lived, the procedure is done under anesthesia and most people only need to take a couple of days off work, they explain. Their advice: “Get over it, please – and get screened.”

It should be pointed out that colonoscopy does carry some risk of complications. Bleeding and perforation can occur, and some people may become ill from the prep. Serious complications don’t appear to be common, however; one study put the incidence at about 5 per 1,000 procedures.

For what it’s worth, many people who undergo the procedure discover it wasn’t as bad as they thought it would be. Still, it’s not hard to see why the colonoscopy is heartily disliked or why patients would balk at having one. There’s ongoing research on alternative, less invasive screening methods such as virtual colonoscopy, but to date none of them have been shown to be as reliable or effective as the standard colonoscopy. Until we can come up with something better, the dreaded colonoscopy is the best we have.