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opinion | Joan Wickersham

A needed test that no one wants to get

‘IF EVERYONE got regular colonoscopies, then no one would die of colon cancer.” That’s what the surgeon told me, after spending a full day operating on my mother. She was 65 at the time, and had never had a colonoscopy. By the time her cancer was detected — after a high fever had sent her to the doctor — it had spread. The surgeon had removed it from her large and small intestines, and her stomach lining, and he also removed her uterus and an ovary.

Twenty years later, as I get ready for my next colonoscopy in just a few days, I still remember the quiet certainty of my mother’s doctor. We’re always talking about finding a cure for cancer. Colonoscopy offers the potential for cure, through early detection. Equally important, the procedure actually reduces the need for cure, because it can help stop cancer before it ever gets started. Different technologies are being developed, but meanwhile, colonoscopy is a great one that is sadly underutilized.

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Each year over 140,000 new cases of colorectal cancer are diagnosed, and around 50,000 people will die of the disease. The American Cancer Society estimates that 65 percent of these deaths could be prevented by regular colonoscopies. Once you turn 50, most experts recommend, you should have the procedure at least every 10 years (getting checked earlier and more frequently if you or a family member has a history of cancer or polyps).

Colon cancer generally develops when a benign intestinal growth, or polyp, turns malignant. During a colonoscopy, a lighted camera at the end of a thin rubber tube allows a close visual inspection of the entire length of the colon. If there is cancer, the test will detect it. And here is the important prevention piece: the gastroenterologist can spot polyps (which show up roughly 20 percent of the time) and remove them during the procedure — before they have a chance to develop into cancer.

Yet as effective as colonoscopies are at heading potential cancers off at the pass, a lot of people still aren’t getting them. According to the American Cancer Society, only about half of all Americans over 50 have had either a colonoscopy or a sigmoidoscopy (which is less invasive but also arguably less effective, since it only examines the lower part of the colon. Many cancers, like my mother’s, develop higher up in areas visible only through colonoscopy).

So why aren’t more people getting screened? The biggest reasons nationwide are cost, and lack of health insurance. A colonoscopy isn’t cheap; if you’re uninsured, it can cost $2,000 or more. Not surprisingly, the rate of testing is dramatically lower for the uninsured — only 19 percent, compared with 55 percent for people with insurance.

But the statistics also show that a lot of people who have insurance aren’t getting the tests either. Embarrassment and fear are the biggest reasons. Nobody enjoys the prep (spending the evening before the test drinking salty laxatives that do an emphatically thorough job of emptying the colon). And some avoid the test because, as several people said to me, “I’m afraid of what they might find.”

We’re always talking about finding a cure for cancer. Colonoscopy offers the potential for cure, through early detection. And the procedure actually reduces the need for cure, because it can help stop cancer before it ever gets started.

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But we need to get over it, individually and collectively. Individually, all of us over 50 should be getting regular colonoscopies — even if the prep and the test are no fun, and even if we’re scared of the results. As a society, we need to find a way to make colonoscopies available and affordable for everyone who needs them. And we need to do a better job of explaining that colonoscopies are not just used to find cancer — but also to stop cancer before it can start.

My mother was lucky. Though her cancer was advanced, it was treated successfully, and she lived the rest of her life without a recurrence. But having seen what she went through — the diagnosis, the surgery and prolonged recovery, a year of chemo, two subsequent surgeries to remove painful scar tissue, and always the fear of dying — I am determined to do everything I can to avoid it. A colonoscopy is a minor inconvenience and an enormous gift. I will always be grateful to that surgeon. His skill saved my mother’s life. And his advice may one day save mine.

Joan Wickersham’s column appears regularly in the Globe. Her website is joanwickersham.com.
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