Getting Over the 'Ick' Factor: Colonoscopies Save Lives

More lives could be saved from colon cancer -- "a preventable, treatable, beatable disease" -- if people could overcome their squeamishness and get a colonoscopy. That's the findings of new research and the message from New Jersey doctors speaking out for colon cancer screening.

But despite the evidence affirming the colonoscopy as a lifesaver, the screening endures an unpleasant and inconvenient reputation, or as one NJ doctor described it, the "ick" factor.

"It is all due to fear of the test, embarrassment, and stories they have heard about how difficult the prep is -- it is really overstated hype," said gastroenterologist Dr. Paul De Martino, who will be in Toms River on Tuesday at the Community Medical Center's Annual Colorectal Cancer Awareness Fair.

De Martino founded the event eight years ago. "My mission is to raise the awareness of the general public about colorectal cancer," he said.

Recommended every 10 years from age 50, a colonoscopy requires patients to prep by taking laxatives to thoroughly clean out the colon, or large intestine. Most patients choose sedation for the procedure, which lasts about a half hour, while a physician inserts a flexible tube with a camera on the tip, and examines the interior of the colon. If polyps are found, the physician usually removes them immediately. If cancer is suspected, tissue is removed for biopsy.

Unlike most diagnostic tests, the colonoscopy delivers both screening and treatment: Removing polyps removes the risk that they might develop into colon cancer.

"This is one of the few cancers we can detect early by finding polyps, which are the forerunners of colon cancer," said Dr. Richard Chessler of Advanced Gastroenterology in Englewood Cliffs.

The life-saving value of the colonoscopy was affirmed by a newly reported study that followed patients for 20 years, and found the death rate cut by 53 percent for patients who had colonoscopies in which doctors removed pre-cancerous polyps. The research, led by a team from Memorial Sloan-Kettering Cancer Center in New York, was published Feb. 23 in the New England Journal of Medicine.

New Jersey requires insurance plans to cover colon cancer screenings, which are also covered by Medicare and Medicaid. In addition to the colonoscopy, other screenings for colorectal cancer include the virtual colonoscopy, in which a radiologist views a CT scan of the interior of the colon; flexible sigmoidoscopy, where a scope is inserted to examine the lower one-third of the colon, and a barium enema. An annual fecal screening is recommended each year to check for blood in the stool.

Thomas Vincz, spokesman for Horizon Blue Cross Blue Shield of New Jersey, said a colonoscopy once every 10 years is a covered benefit for Horizon members. "As with many other forms of cancer and disease, we believe that prevention and early detection are extremely important," Vincz said. "Colorectal cancer is curable if caught in the early stages. We encourage members to talk with their healthcare provider about when to begin screening for colorectal cancer, what tests to have, the benefits and risks of each test."

Low-income New Jerseyans can get free colon cancer screenings through a program of the state Health Department, called New Jersey Cancer Education and Early Detection (NJCEED). The program provides education and screening for breast, cervical, colorectal and prostate cancers. For colon cancer screening, NJCEED offers the fecal blood test and the colonoscopy.

In fiscal year 2011, NJCEED provided 3,858 fecal blood screenings and 367 colonoscopies, which led to five colon cancer diagnoses. Individuals eligible for NJCEED services must be at or below 250 percent of the federal poverty level and be either uninsured or under-insured. NJCEED services are delivered statewide by 22 agencies, with at least one in each county, and information is available at 1-800-328-3838.

According to a 2010 estimate from the federal Centers for Disease Control and Prevention, 65.6 percent of New Jerseyans over age 50 have had at least one colonoscopy or sigmoidoscopy. And according to estimates from the state's health department, from 2004 to 2008, colon cancer deaths per 100,000 were 22.6 for New Jersey men, compared to 20.7 for the U.S.; and 16 for New Jersey women compared to 14.5 for the U.S.

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