One of the most common questions I am asked during a wellness visit (routine physical) is "when should I get a colonoscopy?" . I was not asked this question as often 10 years ago or even 5 years ago, but there has finally been an increased awareness among the general population with colorectal cancer.
As a former med/surg nurse, I took care of countless patients after their colonoscopy or even their colon resection for colon cancer. I helped care for their fresh colostomy site and stumbled to find the "right" words to give them comfort.
I have one patient etched in my heart who lost his battle to CRC (colorectal cancer) at age 27. I was only 23 or 24 myself at that time. His young wife and 2 year old son stayed with him as much as they could. He had a suprapubic catheter (one that came out of his abdomen directly from his bladder to drain his urine) because the cancer had eaten through his entire pelvic cavity. I cried on my way home every time I took care of him. But I wanted to take care of him. I wanted him to see someone close to his age. Someone that didn't pity him like a child "poor dear" and all the other patronizing words I heard some of our senior nurses mumble. He and I would talk about TV shows and popular songs, whatever we could that would help him feel a little more "normal."
This post isn't about him, it's about all of my patients.
That said, I couldn't write this post without mentioning him because his life mattered and my time with him touched me forever.
I could not write this post without telling you about another dear friend who lost his 6-year battle with CRC in 2020 at the age of 44. Out of love for his family, I will leave his story at that but HE MATTERED and MATTERS and cancer statistics are NOT just numbers my friends! They are mothers, fathers, sisters, brothers, sons, daughters, friends, employees, bosses, lovers, neighbors, coworkers, and beyond.
The next time you see a cancer statistic on the news, I hope you pause
and remember reading this post.
So the question remains: When should I get a colonoscopy?
In the words of my beloved GI colleague, "45 is the new 50!".
The earlier CRC is found, the better the 5-year survival rate. We can easily remove a 5mm or smaller polyp in the colon and prevent it from ever becoming a malignant tumor. Yes there are some other screening tests on the market that have their place and time, BUT nothing beats a visual inspection by a well-trained eye looking for colon cancer. Direct visualization - there is nothing better!
The prep is not always "a gallon of nasty stuff" anymore either. There are a variety of prep techniques, so please don't let a colonoscopy prep prevent you from possibly saving your own life. You are NOT awake during the procedure. I have had one and I can tell you with certainty that I do not remember any of it AND I had zero soreness after the procedure. It was honestly a much-needed fantastic nap and a day off work.
I urge you to see your PCP for a colonoscopy referral from a GI specialist if you are 45 years old or older and have never had one. If you have certain risk factors or family history, you should have a colonoscopy before age 45. Your PCP should be able to guide you. Any bright red rectal bleeding or alternating constipation and diarrhea needs to be worked up by your medical team. Please do not hesitate to seek care for those issues!
I hope this answers your questions about colonoscopy screening. If polyps are found on your colonoscopy, your GI provider may want to repeat your scope in 2 years, 3 years, or 5 years depending on they type of polyp (per pathology diagnosis). If your colonoscopy is clear and there is no family history of CRC (or other extenuating risk factors), you will probably receive a 10-year pass.
Most insurance companies pay very well for colonoscopy screening, BUT most insurances have a certain deductible each year that enrollees must meet, so do not be surprised when the procedure is not 100% free like your mammogram or pap smear was. Do not let cost stop you, though! It is well worth your insurance deductible. You can always call ahead to find out what your out-of-pocket expense will be, and most healthcare facilities offer payment arrangements.
Please comment below if you have any other specific questions.