So, What’s the Deal With Colonoscopies?

Today we met with an oncologist at OSU. One of the things I’m trying to navigate is having two different healthcare systems involved in my care. I really like my surgeon up in Cleveland, the one I was originally referred to by my surgeon in San Francisco. But OSU is 10 minutes from home, so I’ve been trying to go there for things that don’t require his direct input or oversight, like the colonoscopy. I still don’t know in what order I’ll have surgery, chemo, and radiation (getting that plan next week) but I’ve been hoping the latter two can be done down here in Columbus. Cleveland is a lovely town, but there are no frequent-traveler miles awarded on I-71.

Either way, today was really helpful. I learned a lot about the variables that go into deciding on a treatment plan, and the oncologist we met with actually happens to be researching the troubling increase in colorectal cancer rates among younger people. She mentioned some interesting theories around diet, the increase in C-section births, and other factors.

One thing we didn’t really get into is why we don’t recommend colonoscopies at a younger age, especially for people with colon cancer in their family. I’ve ranted about this to enough friends and family that I’m sure it’s like, Oh boy, here goes Crazy Rectal Cancer Guy again, thinking his freak statistical event makes him qualified to critique the entire healthcare industry. I’ll be the first to admit, I’ve been a little emotional about this, acting like I’m the first person to ever believe they’ve uncovered some great flaw in the system. To all said rant recipients: I promise it’s only because I care about you.

My rants have generally just consisted of the argument that even if increased screening saves only a handful of people in their twenties, thirties, or forties, surely it must be worth it. Not from a cost perspective — a colonoscopy isn’t cheap — but just ethically. If rates are going down among older people, with increased screening often getting the credit for that trend, doesn’t that make the solution pretty painfully obvious?

Well, the last thing I want this blog to be is misleading or alarmist (or anything approaching medical advice), so I want to make sure to present both sides of the issue. As it has been explained to me by some very smart people in medicine, I’ve been overlooking to some extent the fact that performing a colonoscopy isn’t without some risk. It’s a very small risk, but a risk nonetheless, that, for example, a patient could react negatively to the sedative used during the exam, have excessive bleeding where a tissue sample is taken or where a polyp is removed, or suffer a perforation in the wall of the colon or rectum.

Should you be worried about these possibilities next time you get a colonoscopy? Definitely not. But if the world suddenly decides to start performing colonoscopies on millions and millions of 30-year-olds, it’s a statistical certainty that at least one of them, somewhere, is going to have something bad happen, and maybe even die from it. Now, is that risk worth it, when that person could have been perfectly healthy, with no symptoms and no family history of early-onset cancer? We’re getting into some tough philosophical questions there. Even if you try to argue, as I have, that every young person with hemorrhoids or an anal fistula should get a colonoscopy, you’re still in some dubious statistical territory.

My intent in writing about this stuff was never to send every healthy young person running to their doctor begging for a colonoscopy. Everyone’s situation is unique, and yes, it’s important to understand that while incredibly routine, it’s not a risk-free procedure. But it sure doesn’t hurt to ask your doctor, next time you’re there, if it might make sense for you, especially if you’ve had any of the common symptoms of colon cancer. It doesn’t hurt to make sure you understand your family history. And most importantly, it doesn’t hurt to ask questions or get a symptom checked out if there’s a nagging voice telling you to.

(It also doesn’t hurt to eat more vegetables. Lots to report about my new diet in a future post.)

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