The Must-Have Test for Age 50 and Over

by Edward Paredez, M.D.

If you knew there was a health screening exam that is virtually painless, covered by most insurance plans and could potentially save your life, wouldn’t you be sure to have it?

The answer is probably “yes.” Yet more than 50 percent of people who should have a colonoscopy—a screening exam that can detect, treat and even prevent colon cancer—haven’t done it. Many don’t know they should. Others put it off because they worry that it will be painful. Still others think that colon cancer only affects men, or that once you have it, there is no treatment.

However, these are all misconceptions. The fact is, colon cancer affects both men and women equally. It is the third most common cancer in the United States, and the American Cancer Society estimates that there will be over 108,000 new cases of colon cancer in the country this year. But thanks to screening techniques like colonoscopy that find the disease in its most treatable stages, the death rate from colon cancer has been decreasing; the five-year survival rate for patients whose cancer is detected in the early stages is 90 percent. Moreover, colonoscopy can detect polyps, which are small growths in the lining of the colon, before they become cancerous, thereby preventing cancer from even developing.

Because colon cancer usually has no early warning signs, colonoscopy is the best way to diagnose it.

Who Should Be Tested?

In general, everyone should have a colonoscopy at age 50, with repeated screenings every 10 years. Your physician may recommend that you start screening at an earlier age if you have other risk factors, including:

  • Personal history of polyps or chronic inflammatory bowel disease (such as ulcerative colitis or Crohn’s colitis)
  • Family history of colon cancer
  • African-American heritage
  • An inherited condition that may increase risk
  • Smoking or use of other tobacco products
  • A diet high in fat, especially animal fat, and low in fiber

Colonoscopy: Get the Facts

There are several types of colon cancer screening techniques, but colonoscopy remains the “gold standard” to evaluate and diagnose both cancerous and precancerous growths. Colonoscopy allows the physician to inspect and sample the tissue in the rectum and colon via a long, flexible tube with an attached camera. The tube is inserted through the rectum, and images from the camera are displayed on a video monitor, which enables the physician to see polyps, inflamed tissue or other irregularities. Should any abnormalities be found, they can be biopsied or removed during the procedure.

Some people avoid having a colonoscopy because they are afraid of the procedure, but it sounds far worse than it actually is. Patients are sedated and often fall asleep during the test, which takes only 15-30 minutes. The two comments I hear most often from patients who have had the procedure are that it was much easier than they expected, or that they don’t even remember it at all.

An alternative type of colonoscopy, called virtual colonoscopy (VC), is available for patients who cannot take sedation drugs or have scar tissue or other obstructions that prevent the scope from getting through the bowel. Also known as CT colonography or CT colonoscopy, VC uses a very thin tube inserted only into the rectum to inflate the colon with air, and specialized scanning equipment to take an image. The image is transferred to a video monitor, which creates a detailed picture of the inside of the colon. The physician can then look for the same abnormalities that would be seen with conventional colonoscopy.

Both procedures require the same preparation, in which the patient follows a liquid diet and uses laxatives to completely clear the colon prior to the exam. However, patients are not sedated during VC, and should a polyp or other abnormality be found, it cannot be removed or biopsied; a conventional colonoscopy would still be required. Also, insurance plans do not cover VC.

If you are age 50 or older, be sure to have this potentially life-saving test. Talk to your physician about the best choice for you.

Edward Paredez, M.D., is a gastroenterologist with Scripps Memorial Hospital La Jolla. For more information on cancer screenings, call 1-800-SCRIPPS (1-800-727-4777).