WHY SHOULD YOU HAVE a colonoscopy?

In 2007 there were 150,000 new cases of colon cancer and 50,000 deaths nationwide. In Rhode Island in 2007 there were 643 new cases of colon cancer and potentially 204 preventable deaths from it.

Colonoscopy is both a diagnostic and therapeutic test.

By this I mean if a polyp or growth is found during the exam it may be possible to remove it at that time. It is well established that a polyp over time can develop into cancer. That is why you should have a colonoscopy.

Who should have this test? For the correct answer it is important that you know your family history. Some need to have their first colonoscopy at age 20. Your family doctor can help you make this decision. If your mother, father, brother or sister had colon cancer, your first colonoscopy should be done at 40. If you are healthy and if there is no family history of this disease as noted, your first colonoscopy should be done at 50.

The test is done by a physician trained in this procedure in a special room in a hospital or other facility specifically designed for this test. Your family doctor or clinic doctor will refer you for this test. It is important that you provide a list of all the medications that you take, because you need to stop taking certain medicines, such as aspirin, several days before the test because they increase the risk of bleeding if a polyp is removed. You will need to clean out your colon before the exam by a combination of diet restriction and laxatives. This cleansing is extremely important because it lets the doctor performing the test see the entire colon. There are a number of preparations in the pharmacy that may be purchased to help cleanse the bowel. Ask your doctor about the best preparation for you.

What are the risks of this test? Basically there are three risks you must agree to with your signature. First, there is the risk of a reaction to medication given to you intravenously just before the exam to make you comfortable. Most often the reaction can be reversed by using other medications. Second, if a growth or polyp is found, you could have bleeding at that site. It can generally be stopped by using a small clamp over the bleeding point. The third and most serious risk is a perforation — that is, accidentally making a hole with the instrument through the intestinal wall. This would require surgical repair in the operating room. However, this risk is small and occurs in less than one in 1,000 cases in experienced hands.

During the test you are carefully monitored by one or two nurses. In general the test will take about a half hour. You will then be taken to a recovery area and observed for about one hour. A relative or friend will be necessary to drive you home since you will not be allowed to drive that day. The day of the test will be a rest day for you but you will be able to work the following day.

Be a part of the millions of Americans who have had this test and avoid being one of those unfortunate folks who failed to have this examination and suffered from colon cancer as a result.

Joseph D DiMase, M.D., is a semi-retired gastroenterologist currently supervising gastro-intestinal fellows in training at the Brown Medical School.