03/27/13 — Doctor recommends colonoscopies, says process is improving

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Doctor recommends colonoscopies, says process is improving

By Phyllis Moore
Published in News on March 27, 2013 1:46 PM

Mention the word colonoscopy and many grimace at the prospect.

But not just about the procedure itself. It's also the "prep."

Getting an accurate reading requires completely emptying the colon, and that means drinking hefty amounts of a liquid laxative the day before.

The process is actually getting better, says local gastroenterologist Dr. Stewart Futch, who considers education as much a part of his job as treating patients.

"It's really a shame that people are considering it an inconvenience more than about their health," he said.

Improvements are being made to the whole bowel prep component, he said.

"It's not the procedure they remember," he said. "They taste a little bit better. It used to be a gallon of salt water. Now it's a couple cups of laxative. It's much more tolerable."

Patients also are sedated during the actual procedure.

"They wake up in recovery and ask, 'Are you going to get started?' and the second thing is, 'When can I eat?'"

All told, barring any complications, the entire process takes about a half an hour.

"It's cost effective, interrupts the course of the disease. There are all sorts of reasons to do it," he said.

And yet many put it off.

Physicians recommend patients have a colonoscopy at age 50, because colon cancer, Futch said, is one of the few that's preventable and is treatable if caught early.

Breast cancer may be the most familiar form of cancer, he said, but more people -- including both men and women -- actually die from colon cancer. And while awareness of the disease is growing, he noted, it's still lagging in terms of people taking action.

"Colorectal cancer is the second cause of cancer death in the United States, and African Americans have a higher incidence, with less access to medical care and colonoscopy," he pointed out. "There's a much higher incidence at a younger age in African Americans, so it's recommended to start screening at age 45 instead of 50."

Obese patients and smokers are also at a higher risk, as well as those with a family history of colon cancer.

For the average patient, though, once the baseline test is done, another colonoscopy is not necessary again for 10 years.

Perhaps the biggest case for the procedure, he explained, is that it allows for an early diagnosis.

On average, he said, about 25 percent of patients will have pre-cancerous polyps -- or, about 25 percent of men, 15 percent of women.

"For men, that's one in four. That's a pretty high number," Futch said. "It is one of those things, it allows you to remove pre-cancerous polyps. Colon cancer is one of the few cancers where you have an opportunity to remove a pre-cancerous lesion and change the whole course of the disease."

But don't go by how you feel, he pointed out.

"Colon cancer can be symptomatic, but you can have an advanced colon cancer and have no symptoms at all," he said. "You can have symptoms and have no cancer; you can have no symptoms and have cancer."

Of late, there has been more publicity about a "virtual colonoscopy," done by a radiologist and touted as being less invasive. The down side, Futch said, is that it is not considered preventive and is not recommended for those with a family history or who have had previous polyps.

Plus, he added, the bowel prep is still required and, if anything is detected, a regular colonoscopy will still be necessary.

Futch currently does about 40 to 50 colonoscopies a week. He encourages everyone in the target demographic, or with any history or concerns, to pursue the option.

"I think I want them to be aware that colonoscopy is very important, that they get it done at the appropriate time, at recommended intervals," he said. "It's one of the few screening tests for cancer where we can actually impact the disease by removing the polyps and change the whole direction of the illness."