How Katie Couric continues to influence the colonoscopy debate

How Katie Couric continues to influence the colonoscopy debate

In 2003, the Archives of Internal Medicine published an observational study assessing the impact of Katie Couric’s March 2000 Today Show colorectal cancer awareness campaign, including the well-known colonoscopy she underwent live on air. The data was compelling, showing a sizeable spike in colonoscopy rates across the U.S. of more than 20%, thanks to this very likeable, personable, and brave public figure who shared her personal story of losing her husband, Jay Monahan, to colorectal cancer.

Coined as the “Katie Couric effect,” data such as this highlighted the power that a celebrity spokesperson can have on raising awareness about preventative health measures like screening colonoscopies. And many other celebrity personalities like Steve Harvey and Dr. Mehmet Oz have followed suit in having the goings on, sometimes from start to finish, of their colonoscopic procedures televised in hopes of producing even a fraction of Couric’s level of impact.

The flip side of these television personalities’ good deeds are provocative articles in well-read newspapers. Highly-publicized pieces can sometimes help to inform the public about health-related topics, but can also work to set back the positive influence of the Katie Couric effect.

Case and point is a recent piece from the New York Times published in June 2013 that has gained much attention as part of a series entitled “Paying Till It Hurts,” that focuses on the high cost of healthcare in America. Elisabeth Rosenthal’s front-page article, “The $2.7 Trillion Medical Bill – Colonoscopies Explain Why U.S. Leads the World in Health Expenditures,” highlights colonoscopies, and by extension the endoscopists who perform them (be they gastroenterologists, internists, or surgeons), as one of the primary reasons for the high cost of medical care in the country today.

The article sparked much debate, which is arguably a good thing, because it gets people thinking and talking. No one can argue that our current healthcare system is flawed, that defensive medicine drives up healthcare costs, and huge medical bills are a legitimate fear for families, for astronomical medical bills can drive some families deep into debt. Clearly this is a problem that deserves significant attention. And as Rosenthal highlights in her article, more data is needed showing a head-to-head comparison between the noninvasive methods of screening versus procedural screening methods like colonoscopies and flexible sigmoidoscopies.

What many take issue with, though, and as letters to the editor in response to the article emphasize, is that “the [New York Times] article focuses attention on the one and only preventative cancer test that has been demonstrated to significantly reduce the incidence of colon cancer and death.”  Data as recent as 2012 show that colonoscopies result in an estimated 53% reduction in colorectal cancer, which is quite impressive. If only we had such successful preventative exams for other cancers! And not only does the test work to catch cancers early, but it also functions to prevent colorectal cancers by finding and removing precancerous growths, or polyps.

It is important to inform those patients due for screening that there are other options for screening aside from colonoscopies, and that there is certainly good data behind these noninvasive alternatives. But we must also be mindful of the reality that preventative tests are preferred over detection tests. Colonoscopies fall under the category of preventative tests, because as mentioned above, they catch polyps, the precursors of colorectal cancer. Colorectal cancer claims over 50,000 lives yearly. It is the second most common cancer killer amongst men and women in the U.S. These are unacceptable numbers for a preventable cancer.

So, let me offer a big thank you to Katie Couric, for specifically addressing and responding to the Times article in a blog featured in the Huffington Post, with hopes that her star power can grab people’s attention once again, and help raise rates of colonoscopy screening as it had so fiercely done in 2000. In her opinion piece entitled “Colorectal Cancer Screening Saves Lives,” she writes: “Watching a loved one die of cancer is devastating, particularly if the death – indeed the cancer itself – could have been prevented.” Over 90% of colorectal cancers are preventable. Her piece is heartfelt, honest, poignant, and quite informative, not only about the different methods of screening available, but also because she explains why a colonoscopy was the right screening test for her.

The Katie Couric effect is powerful. She worked to raise awareness about the importance of colorectal cancer screening and prevention. She demystified the procedure so that others could understand the ins and outs not only of her insides, but also about the importance of the screening procedure itself. And it worked – beautifully. Hopefully, her continued dedication from that 2000 campaign until now not only honors her husband’s legacy, but can soften the blow of arguably one-sided reporting about colonoscopies and the physicians who perform them. Her efforts urged others to get screened, and undoubtedly saved lives in the process. In her article, she writes plainly, “Colonoscopies save lives.”

And she’s right – they do.

Sophie M. Balzora is a gastroenterologist and can be reached on Twitter @SophieBalzoraMD.

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  • ninguem

    She looks perky.

    • buzzkillerjsmith

      A little too perky, if you ask me. Bipolar II, hypomanic phase?

      • Guest

        So now we’re using this as an opportunity to mock the mentally ill? Brilliant.

        • buzzkillerjsmith

          You’re right. My comment was inappropriate. I’ll try to do better.

          • penguin50

            I wouldn’t be too hard on yourself. The photograph is quite startling; it’s just not a facial expression that one expects to see in the normal course of human interaction. I pondered the image at length myself, thinking, “Wow. This must be what happens when someone is paid a great deal of money to be constantly perky.”

  • JeanArt

    I must say that I agree with the NY Times article on the expense of colonoscopies and how they contribute to our expanding health care costs. Other countries do not use colonoscopy as the first line of screening and their death rates from colon cancer are not any higher than those in the US. It seems that I have also read that colonoscopy has not been evaluated by the gold standard: the random, controlled trial, whereas FOBT has been. Besides, the other problem I see with colonoscopies is that while they do have the ability to “prevent” cancer by removing polyps, the vast majority of polyps will not progress to cancer so in effect you have a case of “overtreatment” (and expense) by polypectomy of non threatening lesions and also those patients are then referred for more frequent colonoscopies. It seems to me that the more cost effective and evidence based way to screen for colon cancer would be to begin with FOBT/FIT and then only proceed to colonoscopy for those with a positive result.
    As far as the Katie Couric effect: her husband died of colon cancer when he was still in his 40s, so even if colonoscopy was in wide use then he would have missed the 50 year old guideline. I am surprised that she, as well as the medical profession, did not recommend screening start at 40! While I can understand her zeal on the issue I personally think celebrities should steer clear of trying to influence medical decisions. I think it contributes to disease/fear mongering and adds to the ranks of the worried well. With our limited resources we cannot continue to spend on medical care like there is no tomorrow. Screening of healthy individuals should be carefully considered without the added input of non medical celebrities.

  • SBornfeld

    Two minor quibbles: The bulk of my sources (incl. the CDC) list colorectal cancer as the no. 3 cancer killer in men–behind lung and prostate ca.
    Second–(and here I’m being petty)–I really dislike the word “preventative”–I know it’s used, but…

  • SBornfeld

    ah, as Norm Crosby might have said, “I misconscrewed”.

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