colorectal cancer

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Colonoscopy Culture Clash: Why Am I Getting One When Canada Says Not So Fast?

Various colonoscopy prep options, none of them yummy (Courtesy of Dr. Ram Chuttani)

Various colonoscopy prep options, none of them yummy (Courtesy of Dr. Ram Chuttani)

My last thought before drifting off was: What am I doing here?

As the nurse hooked up the IV for my “conscious sedation” — a pain-killing, amnesia-inducing, anxiety-easing cocktail of fentanyl and Versed — I had checked my phone one last time and up popped this headline: “New Canadian recommendation against colonoscopy for routine screening of colorectal cancer.”

So why was I in the endoscopy suite on a recent Monday morning, my backside exposed in a hospital johnny?

Some background: I was supposed to get this routine colonoscopy when I turned 50 in 2014 but, like many people, I delayed — no family history and an emotionally tough year offered good excuses. When the year passed, I tried to procrastinate further, and asked my doctor about alternatives. “There are no real alternatives,” she told me. “If there were another good option, I would choose that for myself but I will be having my colonoscopy this year as well.”

As Dr. Ram Chuttani, chief of endoscopy at Beth Israel Deaconess Medical Center in Boston, put it: “Colonoscopy is still the gold standard.”

So, of course, I made the appointment, ate the low-fiber diet, complied with the clear liquid fast the day before and suffered through the prep. (Except I was unable, at 4:30 in the morning, gagging, to finish the full 16 ounces of prep mixture.) Like countless other middle-aged Americans, sitting on the toilet en route to a pristine colon, I thought: There’s got to be a better way.

Better In Canada?

Late last month, for the first time, Canadian medical professionals came out against colonoscopies for routine screening, saying that the evidence is lacking that this method is effective enough at preventing deaths from colon cancer.

“We recommend not using colonoscopy as a screening test for colorectal cancer,” the new guidelines, published in the Canadian Medical Association Journal, say, in a summary.

So, if colonoscopy is the gold standard here but not recommended there, what’s a patient to do? Maybe just acknowledge that different health systems, with different priorities and cost structures, end up promoting different flavors of medical care. What you should not do is nothing. If there’s one thing pretty much everyone agrees on: colon cancer kills, but it’s also largely preventable, so the best screening method is one that actually gets done.

The Canadian Task Force on Preventive Health Care, the group that wrote the new guidelines, cited two preferred colon cancer screening methods for low-risk, asymptomatic adults ages 50 to 74:

  • Fecal occult blood testing (FOBT), in which stool samples are analyzed for hidden traces of blood, every two years
  • Flexible sigmoidoscopy, which uses a scope to examine the lower part of the colon and rectum only, every 10 years (This procedure involves less prep than colonoscopy, no sedation, and in Canada it’s done by either a nurse practitioner or primary care doc, with no specialist needed)

In America, the U.S. Preventive Services Task Force, an independent panel of medical experts that issues guidelines, recommends a range of colon cancer screening methods for low-risk adults 50 to 74.

Dr. Albert Siu, chair of the U.S. Preventive Services Task Force, told me in an email that the main point of the guidelines is simply to encourage screening. Continue reading

Why To Exercise Today: Fear Of Colorectal Cancer

Yes, exercise has all kinds of positive effects, but perhaps the most compelling reason to work out is to avoid the negative. To exercise because you just don’t dare not to. The myriad illnesses that exercise helps stave off are just too frightening.

Case in point: Colon cancer. I know two people who died of it in middle age, deaths that included much physical pain and left behind young children. The National Cancer Institute has a colon-cancer risk assessment tool that lets you calculate your personal risk (That’s mine to the left. Not nearly as low as I’d hoped.) But before you even get there, the introductory page reminds you:

Factors that can lower your risk of colorectal cancer include:
•colorectal cancer screening
•regular use of aspirin and NSAID’s (which stands for non-steroidal anti-inflammatory drug)
•maintaining a healthy weight
regular, vigorous exercise (all activities that cause sweating and heavy breathing)
•a diet high in vegetables
•hormone replacement therapy use in women

It also includes “inactive lifestyle” among the factors that heighten your risk: Continue reading

A Mother Savors Life While Battling Cancer

My friend Marie Pechet recently learned that the colorectal cancer she’d thought was gone has re-emerged. Doctors tell her the surgery and chemotherapy regimen she is now undergoing must be 100% effective for a chance at long-term survival. At the same time, she has two young sons, a husband, and a full, active life to lead.

I know Marie because our children are the same age, and at the same schools, but I learned about the details of her cancer because rather than hunker down and suffer privately, Marie decided very early on in her treatment to share her sometimes excruciating journey with the community. She sends out regular email updates on life and chemotherapy to hundreds of family members and friends, and she was recently interviewed by Dr. Annie Brewster, a Boston internist who is working on a project documenting the lives of patients and their families.

Marie’s essay, about how to create moments of joy for her family while navigating harsh, life-threatening realities, offers lessons to anyone who has ever lost it with their kids, yelled at another driver or simply forgotten — momentarily — what is truly important in life. Marie is 47 years old:

As a mother to two young boys who love to watch movies, certain lyrics tend to run through my head, like Chitty Chitty Bang Bang we love you! or You’ve got a friend in me…. from Toy Story.
Since my most recent cancer diagnosis, the lyrics that stick in my mind are from Frosty the Snowman:

Frosty the Snowman
Knew the sun was hot that day
But he said let’s run and we’ll have some fun
Now, before I melt away….

I was initially diagnosed with colorectal cancer when my sons were 1 and 4 years old. At that time, we put our lives on hold for an entire school year while I had surgery to remove part of my colon followed by chemotherapy to kill any remaining cancer cells. Our lives revolved around my healing, and any treatment that might make me well again — like acupuncture or sleep — took priority. While I missed doing many activities with the kids, my husband and I decided that the trade-off would be worth it in the long run.

After nine months, I completed chemotherapy. There was no sign of cancer, and I returned to living my life.

Like many people, being diagnosed with cancer shifted my view on what was important, and I swore that I would never again take life for granted. But one of the beautiful things about living life as a healthy person is that you do get to take it for granted. So, as I returned to health, I also returned to doing all the things that I swore I would never do again. I became easily annoyed with other drivers, got impatient with the kids, juggled too many commitments, and spent time doing things out of obligation rather than joy. Still, this made life feel comfortable and normal, and there seemed to be security in that.

Of course, security is an illusion, and almost a year later, we saw the first signs that the cancer had returned.

Continue reading