It’s embarrassing, it’s uncomfortable, it’s the butt of many jokes — but a colonoscopy is the easiest way to stop the second deadliest type of cancer before it has a chance to develop.
Peconic Bay Medical Center doctors Brett Ruffo and Mark Coronel spoke to a group of residents today about the dangers of colorectal cancer, more commonly known as colon cancer, and the steps everyone should be taking to prevent it.
“Colon cancer is one of the most preventable cancers,” said Ruffo, who is a colorectal surgeon. “But the biggest problem is that people don’t want to come and get screened.”
Colorectal cancer causes the most cancer-related deaths in the United States right after lung cancer. Most cases of colorectal cancer are caused by small growths, called polyps, which grow on the inside lining of the colon or the rectum.
Those polyps can be easily discovered during a colonoscopy, a medical procedure lasting only 10 to 15 minutes that can be carried out right in a doctor’s office. If polyps are discovered during a colonoscopy, the doctor removes them right then and there.
“That’s the great thing about colonoscopies,” said Coronel, who is a gastroenterologist. “They’re both diagnostic and therapeutic, meaning we can both diagnose a problem and take care of it during the same procedure.”
During a colonoscopy, a doctor uses a thin, flexible tube — “like a snake with a video camera at the end,” Coronel joked — to examine the large intestine for polyps. If any polyps are found, the doctor can simply remove them with the same tool being used to examine the colon. About five to 10 percent of polyps will eventually develop into cancer, a process that takes less than 15 years.
The patient is under anesthesia for the entire procedure. “It’s completely painless,” said Coronel. “It’s remarkable how well patients do after a colonscopy. We wheel them into the room, they turn over on their side, and the next thing they remember, it’s already finished.”
The procedure, however, is not what gives colonoscopies their dreaded reputation.
“The prep is absolutely the most difficult part,” Coronel said. “People ask me at least three times a day, ‘Why can’t you guys just figure out a better way to do it?’”
Before the actual procedure, patients need to spend a day or two “prepping,” which involves cleaning out the colon. In order to do this, a clear liquid diet combined with a laxative medicine is used to induce diarrhea. The medicine is usually taken the night before, after which patients spend a lot of time near the toilet, “cleaning” their bowels.
“Your colon is filthy,” Coronel said. “There’s stool all over the place. And if we go inside and see a lot of stool, we can’t tell if there’s any polyps.”
The preparation is at once the most dreaded and the most important part of the test. “It all comes back to the patient prep,” he said. “If the patient doesn’t prep well enough, then finding polyps becomes very difficult.”
But both Coronel and Ruffo emphasized that anxiety over preparation for colonoscopies should not prevent people from getting the procedure done.
“Colonoscopies are the gold standard for detecting colon cancer,” Coronel said.
There are other tests that detect colon cancer, but they are not as effective, and most of them do not identify polyps before they become cancerous.
“They’re not preventative,” said Ruffo. “They’re meant to diagnose cancer at an earlier stage. But a colonoscopy can actually prevent you from getting cancer, which makes it different from every other test they have.”
Average-risk patients — patients without a family history of colorectal cancer or polyps – should get their first colonoscopy at age 50, according to national guidelines. If no polyps are discovered during this first procedure, patients usually wait between five to 10 years for their next screening. If polyps are discovered, patients should go back after three to five years instead.
For high-risk patients who do have a family history of colorectal cancer, their first colonoscopy should be about 10 years before the age of the family member at the time of diagnosis.
So, for example, if a patient’s mother was diagnosed with colorectal cancer at age 45, the patient should be screened at age 35.
Peconic Bay Medical Center administers about 3,500 colonoscopies every year, but Ruffo and Coronel said that’s not enough.
“Unfortunately, only about 30 to 40 percent of the population that should be getting screened is actually getting their colonoscopies,” Ruffo said. “We have to do a better job.”
Aside from “prep” anxiety, another large factor barring people from getting the procedure is lack of or inadequate health insurance.
Peconic Bay Medical Center’s Cancer Services Program provides cancer screening for uninsured people in Suffolk County, including colorectal, breast and cervical cancer screening and treatment services.
“We do a lot of outreach at places you would not typically see health care people,” said Maureen O’Connor, director of PBMC’s Cancer Services Program. “At immigrant coalitions, at places where people are getting flu vaccines for free… And, God forbid they are diagnosed with one of these cancers, we help get them in Medicaid, help them find charity care and assistance.”
She pointed out that many people who are uninsured do not typically have jobs where they can afford to take a day off. “If they take a day off from work, they’re not getting paid,” she said. “That’s one of the biggest struggles the people we screen have.”
Ruffo and Coronel said they had been discussing offering colonoscopies on weekends to accommodate those who can’t make it during the week.
“But if you can take off from work,” O’Connor added, “you should take your day off now, so that in ten years from now, you won’t be out of work altogether.”
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