Colonoscopy: Why should you just do it! Most people hear this term with dread. But again and again, colonoscopies are judged to be one of the most successful preventative and early detection tests for cancer available. There are very clear guidelines about who should get colonoscopies and when––if your doctor has indicated it’s time for you to get this test, here is why you should comply. Colon cancer is the 3rd most common cancer affecting men and women. It is estimated that over 93,000 cases are diagnosed in the United States every year. Fortunately,colonoscopy has a very high rate of success of accurately identifying early cancers and “pre-”–cancers; in fact, it is not unusual that the procedure itself (the colonoscopy) cures the problem that it found! While there is a very small risk of complication––mainly perforating (putting a hole in) the intestine at the time of the biopsy––this is quite rare, and if it does happen it is reversible by bowel rest or surgical correction. Highly regarded medical institutions such as the American Cancer Society and United States Preventative Services Task Force consider this an essential screening procedure. It is so effective at saving lives and reducing the cost of healthcare that insurance companies are now mandated to cover it. “Colon” is simply the medical term for the large intestine. It comprises the last 5 feet or so of the intestinal tract; its main function is to extract water from the fecal matter. During a colonoscopy, a long flexible fiberoptic tube is guided up through the rectum through the entire colon. The gastroenterologist who performs the procedure carefully examines all tissue during colonoscope insertion and withdrawal and identifies any abnormal growths or ulcerations which could indicate early colon cancer. If abnormalities are found, they’re typically biopsied or removed. The most common abnormality found is called a polyp. This is a small protrusion of tissue into the center of the intestinal tube. Some polyps are cancer, some are “pre”cancerous, and some are totally benign and of no concern whatsoever. When a polyp is found and removed during a colonoscopy, it is sent to the lab for pathological analysis so the treating doctor can determine the presence or risk of cancer . They then are able to recommend the appropriate follow-up. So colonoscopy is a highly accurate and very safe procedure that can detect and cure one of the the most common cancers; why would anyone balk at having it done? Firstly, there is fear of discomfort, both due to the preparation required to clean the bowel prior to the test, and of the test itself. However, both these issues can be avoided. Obviously, the large intestine needs to be quite empty in order for the gastroenterologist to be able to view the tissues. Drinking large volumes of a prescription fluid (ironically called “go-lytely”) successfully achieves this, but it is not at all enjoyable to the patient. Newer preparation strategies are much more tolerable. One commonly utilized protocol instructs the patient to eat lightly for the two days prior to the procedure and take a small amount of liquid magnesium citrate the evening beforehand. There were also “pill only” preparations to help clean the bowels. So while there is no avoiding the necessary pre-–procedural diarrhea, the discomfort associated with bringing it on has been significantly improved. As far as the procedure itself––the standard of care is now to have every patient anesthesized with IV sedation. Not only does this remove all pain from the test, it also makes it easier for the specialist to perform his or her job as it allows better relaxation of the abdominal muscles. Other reasons folks are reluctant to get a colonoscopy include embarrassment and reluctance to lose a day of work to get it done. But gastroenterologists are highly trained physicians who have chosen to spend their careers studying the intestines; there should be no shame in working with them to take care of this very important body part. And while missing work can be hard on scheduling or the pocketbook, it is eminently preferable to the extended absences that are required to treat establish intestinal cancer. There is a genetic component to colon cancer, so for individuals with a family history of this disease, colonoscopies are advised to be done regularly sometimes starting at very young ages. For most people, however, the first colonoscopy should be done at age 50. If no polyps are found, or if those found are of the absolutely benign variety, the follow-up colonoscopy would be in 10 years. If worrisome polyps are found, the repeat colonoscopy would be advised much sooner; in the case of cancer discovery, it would be necessary to see surgical and cancer specialists. The colonoscopy is a wonderful advance of medical science and one of the most validated screening procedures that we physicians have to offer. The risk and discomfort of the procedure are far, far outweighed by the benefit it provides. I urge patients to try and realize it is a privilege to be able to get this test done. It is one of the most successful strategies medicine has developed to help you avoid cancer.