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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