Warning Signs of Colon Cancer. There aren’t any!
As a gastroenterologist practicing for over 4 decades and having performed over 40,000 colonoscopies, I have certainly seen the ‘good, bad and the ugly” when it comes to colon cancer. During those 40+ years, there have been patients who, lucky for them, came on time for their screening procedure, and then there were the unfortunate ones who procrastinated a little too long and wound up with a much more serious outcome. From my point of view there are several things to keep in mind when speaking to a patient about having a colonoscopy. The first is that that colon cancer is the second leading cause of cancer death in the United States (approximately 53,000 people died from it in 2021) so it’s chances of affecting you are in fact significant. Secondly, colon cancer is also THE MOST PREVENTABLE cancer of all common cancers, a fact which is surprisingly little known. Third, although we have a very effective intervention (screening colonoscopy) that can prevent colon cancer, more than 30% of our patients still have not undergone colonoscopy despite its proven safety and effectiveness. Said another way, our patients are experiencing excess, unnecessary cancer morbidity and death due to noncompliance. So, what can we do about that? Based on my experience, I believe the problem is the result of certain persistent ‘Mindsets’ or misconceptions about colon cancer which, if addressed, could result in significantly improved compliance. I have written them below in the form of false ‘Beliefs’ about colon cancer and screening. By addressing these with your patients, you may allay their concerns enough to have them schedule their colonoscopy instead of taking their chances with colon cancer. Here they are:
Belief “I am not likely to get colon cancer.”
Fact: colon cancer effects 1 in 25 women and 1 in 21 men. Put another way if you are in a room with 100 people, 5 of them either have come down with colon cancer or will get it without an intervention. You are not exempt!
Belief “I feel fine, I do not have any symptoms, so I am ok.
Fact: The most common symptom of colon cancer is NO SYMPTOMS. To be effective, you have to get screened before you have symptoms otherwise there is a much greater chance of developing an advanced cancer. Said another way, it would be a very bad idea if you waited to change the oil in your car until you heard a noise coming from the engine. You would not risk your car engine for a $30 ‘preventative’ service stop, so why would you risk your life for a 10-minute colonoscopy?
Belief “I am not at risk for colon cancer because no one in my family had it.”
Fact: 85-90% of colon cancer is nonfamilial, so NOT having a family history is not a hedge against colon cancer.
Belief “let me just do the stool test, I do not want a colonoscopy.”
Fact: Unfortunately, Cologuard and other stool tests are not nearly as effective and/or accurate as colonoscopy. In fact, Cologuard misses 75% of advanced precancerous polyps. There is a false sense of security because these tests simply are not sensitive and accurate.
Belief “I eat a good diet and take care of myself, so I am good.”
Truth/fact: While I am not a proponent of eating poorly, a good or bad diet will not eliminate your risk of colon cancer although it is obviously a good idea for your health.
Belief “if I have a colonoscopy, they are going to find something bad (like cancer).”
Fact: Actually, finding cancers on a screening colonoscopy is fairly unusual, only about 1 in every 200-300 colonoscopies in my practice. I almost always reassure patients that actually finding the cancer is rare. On the other hand, we do find polyps in about 20-25% of patients, which are ordinarily completely benign. Because we can remove these polyps during the colonoscopy, therefore averting their development into cancer, we literally ‘nip the cancer in the bud.’ This is the whole point of colonoscopy.
Belief “colonoscopy is painful, is risky and is embarrassing.”
Fact: Virtually all colonoscopy procedures performed by specialists are now done with rapid, safe anesthesia in the office so people have no experience of pain or even embarrassment given the level of sedation. With the newer video technology and improved anesthesia, the risk of a complication with colonoscopy is far less than 1/1000. One caveat, however, is that I think you still have to be very sensitive to patients and just give room to their trepidation, which is understandable. Oftentimes, just having the opportunity to express their worries, those worries often diminish or disappear.
I think it is critical when you talking to patients about having them have a diagnostic or screening procedure, that you are very alert and attuned to any concerns they may have that they have not expressed. Truth is, you never know what is really on their mind. Unfortunately, whatever it is will likely wind up influencing their decision making and in fact often does. Sometimes I just ask people outright “So what do you think of all this? What are your concerns, what do you see as the upside and downside?” If you allow them to speak without intervention, oftentimes they will express whatever is on their mind. Just being heard or ‘re-created,’ diminishes or disappears whatever it is as a concern. The important thing is not to use what they tell you to argue or strategize them into something you think they should do. Just being willing to ‘get into their world’ with no agenda is greatly appreciated by them and often engenders a genuine trust.
I also remind people that while they already know that colon cancer screening is important, they intend on ‘putting it off’ for whatever reason, convenience etc. As you have seen from the above, the colonoscopy itself is not at all difficult (although the 24-hour prep definitely is not the patient’s favorite part). The truth of it is that the longer you put something off that you know you need to do anyway, you wind up suffering more over time by delaying than by just getting it done.