Colon Cancer: How to Save Your Life by Finding the Right Doctor to Do Your Screening Exam (One of a series: Becoming a Smarter Consumer of Health Care in 2010)

Greetings!

Here’s another in our occasional series of newsletters on getting better medical care for yourself and your family.

Today, more about preventive care — specifically, how to get checked out for colon cancer.  But the lessons here apply more broadly.  Colon cancer is just another example of how patients can negotiate the health care system — armed with the basic knowledge I’m giving you — to get the very best chance of preventing fatal disease and living a long life.

As my article below explains, the problem is there’s a huge quality gap between doctors who do a good job inspecting the colon for precancerous growths, and doctors who do a hurried, indifferent, ineffective job.

But you can scope out the difference by asking a couple of simple, non-confrontational questions.

In our last issue, we laid out the accepted guidelines for preventive health care for adults. We talked about what works and what doesn’t work.

Colon cancer screening is on the short list of interventions that DO work to prevent fatal disease.

So it would be a shame to go to all the bother of getting a colon cancer checkup — and it is a bother, swallowing nasty fluid to clean out your colon so the doctor can see it well with his or her scope — but not get an adequate inspection.

Read the articles below for more details about how to protect yourself.

As before:  Feel free to “unsubscribe” on the button at the bottom of this email. But if you find it helpful, pass it along to people you care about.

Two Questions You Must Ask to Get a Competent Colon Cancer Screening Test

Here are the two questions you must ask before you let a doctor stick a long scope up your colon:

What is your detection rate of precancerous polyps?

What is the amount of time you typically take to inspect the entire length of the colon?

The answer to the first question needs to be: 20 percent or more.  Second question: Six minutes or more on average.

Now here’s why.  The explanation takes a bit, but by the end of this article, you’ll know a lot about this deadly cancer and how to avoid it.

Recent news reports suggest that getting only part of your colon scoped for precancerous lesions might be a good enough way to prevent colon cancer. But the real story is that whatever test you get, there is a wide variation in the quality of the colon examinations that doctors do, and out of hurry or poor training, some doctors miss a lot of lesions that should be taken out.

So if you want to have a safe, effective — and potentially life-saving —  exam, you need to do some simple doctor screening to make sure the doctor is right for you.

The good news is it’s not that hard.  Research has found that two simple questions will bring out what you need to know to assure that all the trouble you’re going through to get your colon examined will be worthwhile.

A quick anatomy lesson:

The food we eat passes through the stomach and then through nearly thirty feet of small intestine before hitting the large intestine, or colon. The place where the small intestine joins the colon is called the ileocecal valve.  It connects the ileum, the final part of the small intestine, to the cecum, the first part of the colon.  The cecum is also where your appendix dangles off the end of the colon.  In most people, the cecum and the appendix are in the right lower section of your abdomen.  Intestinal contents travel from there vertically, in the ascending colon, up your right side toward the liver. The colon then turns 90 degrees to cross your belly from the right to the left. This section is called the transverse colon.  Then the colon turns south in the descending colon, which runs down the left side of your abdomen. Finally it moves sideways one more time, in the sigmoid colon, which then reaches the rectum and the anus.

A colonoscopy uses a flexible telescope inserted through your anus to travel the entire length of the colon, to where it ends at the cecum.  Most of the visual inspection by the doctor is done while the scope is being pulled back from the cecum to the exit at the anus.

A sigmoidoscopy, by contrast, only inspects the first foot or so of your colon. In some people, that’s enough to find most precancerous growths.  But in many, it’s not.  African-Americans, for example, have a higher rate of colon cancer in the further reaches of the colon beyond where the sigmoidoscope looks.

So the smart choice is to go with the full colonoscopy, even though the bowel preparation you have to undergo is more burdensome.  That’s the recommendation of the American Gastroenterological Association, the doctors’ group that specializes in the intestines.

Now for the two questions to get the best chance of a good colon exam:

First, ask the doctor:

What is your detection rate of precancerous polyps?

(These are technically called adenomas).  The rate should be at least 20 percent — or 25 percent in men patients and 15 percent in women patients.  A lower rate means the doctor is very likely missing precancerous lesions that are waiting to turn into cancer — when the whole purpose of the colonoscopy is to find them and snip them off before they go bad.

The second question for the doctor:

What is the amount of time you typically take to inspect the entire length of the colon?

This answer should be at least six minutes. 

It takes a minimum of six minutes to adequately inspect all the nooks and crannies. (Inspection time is called “withdrawal time” in the medical research studies, because it’s the time from starting to pull the scope back from the cecum to the anus.)

Both these questions get at the same issue.  You want to minimize the chance that a hurried examination will give you a clean bill of health by mistake.

How Often Do Patients Get an Inadequate Colonoscopy?

Way too often.  In research published this year, the rate of colon cancers in people who had had a colonoscopy within the previous five years was ten times higher when the doctors who did the colonoscopy had a detection rate of ten percent or less, compared to doctors who had a detection rate of twenty percent or more.

Dr. Douglas Rex of Indiana University has written guidelines for his fellow gastrointestinal doctors about how to do an adequate colon exam. Dr. Rex is an advocate for careful comparison shopping by patients.  In an article he wrote for fellow practitioners, he estimated that the doctors with the lowest detection rates are missing 75 to 90 percent of precancerous growths in the colon.

That’s a huge number.  But patients can do their part to make sure their colon cancers aren’t missed by asking these simple questions before they undergo a colonoscopy.

 

To your continued health!

Sincerely,
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Patrick Malone
Patrick Malone & Associates